Malavolta Eduardo Angeli, Assunção Jorge Henrique, Gracitelli Mauro Emilio Conforto, Yen Talitha Koo, Bordalo-Rodrigues Marcelo, Ferreira Neto Arnaldo Amado
Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos 333, 3rd Floor, São Paulo, SP, 05403-010, Brazil.
Arch Orthop Trauma Surg. 2019 May;139(5):659-667. doi: 10.1007/s00402-018-3095-6. Epub 2018 Dec 11.
The accuracy of MRI for subscapularis tear is lower than that of overall rotator cuff tears. Until now, no systematic reviews and meta-analysis have been conducted to compile these data. The purpose of this study was to determine, through a systematic review and meta-analysis, the diagnostic accuracy of MRI in the detection of subscapularis tendon tears.
A systematic review of PubMed, EMBASE, and MEDLINE databases up to April 2017 was performed. All studies assessing the sensitivity and specificity of the MRI (index test) compared to arthroscopic surgical findings (reference test) for subscapularis tendon tear were included. A meta-analysis was performed to calculate pooled sensitivity, specificity, sROC curve, and diagnostic odds ratio values.
A total of 497 citations were identified. After applying the eligibility criteria, 14 articles were included, including 1858 shoulders with 613 subscapularis tears. For overall subscapularis tears, sensitivity was 0.68 (95% CI 0.64-0.72) and specificity was 0.90 (95% CI 0.89-0.92). Sensitivity was 0.93 (95% CI 0.83-0.98) for full-thickness tears and 0.74 (95% CI 0.66-0.82) for partial tears. Specificity was 0.97 (95% CI 0.94-0.98) for full-thickness tears and 0.88 (95% CI 0.85-0.91) for partial tears. Analyzing only studies with field of strength ≥ 1.5 T, sensitivity was 0.80 (95% CI 0.76-0.84) and specificity 0.84 (95% CI 0.81-0.87).
MRI is an accurate method for diagnosing subscapularis tendon tears; however, its accuracy is lower than that of overall rotator cuff tears, due to its lower sensitivity.
III, systematic review of Level II and III studies.
MRI诊断肩胛下肌撕裂的准确性低于诊断肩袖全层撕裂的准确性。到目前为止，尚未进行系统评价和荟萃分析来汇总这些数据。本研究的目的是通过系统评价和荟萃分析，确定MRI检测肩胛下肌腱撕裂的诊断准确性。
对截至2017年4月的PubMed、EMBASE和MEDLINE数据库进行系统评价。纳入所有评估MRI（索引测试）与关节镜手术结果（参考测试）相比诊断肩胛下肌腱撕裂的敏感性和特异性的研究。进行荟萃分析以计算合并敏感性、特异性、sROC曲线和诊断比值比。
共识别出497篇文献。应用纳入标准后，纳入14篇文章，包括1858个肩部，其中613个存在肩胛下肌撕裂。对于总体肩胛下肌撕裂，敏感性为0.68（95%CI 0.64-0.72），特异性为0.90（95%CI 0.89-0.92）。全层撕裂的敏感性为0.93（95%CI 0.83-0.98），部分撕裂的敏感性为0.74（95%CI 0.66-0.82）。全层撕裂的特异性为0.97（95%CI 0.94-0.98），部分撕裂的特异性为0.88（95%CI 0.85-0.91）。仅分析磁场强度≥1.5T的研究，敏感性为0.80（95%CI 0.76-0.84），特异性为0.84（95%CI 0.81-0.87）。
MRI是诊断肩胛下肌腱撕裂的准确方法；然而，由于其敏感性较低，其准确性低于肩袖全层撕裂。
III，对II级和III级研究的系统评价。
