Department of Radiology, Hallym University Dongtan Sacred Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, South Korea.
Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 445-907, South Korea.
Skeletal Radiol. 2021 Aug;50(8):1647-1655. doi: 10.1007/s00256-020-03697-1. Epub 2021 Jan 23.
To evaluate the diagnostic performance and reliability of magnetic resonance of arthrography (MRA) in diagnosis of subscapularis (SSC) tendon tears between two reviewers with varying levels of experience, and compare the results with clinical tests.
SSC tendons were retrospectively evaluated in a total of 272 patients with arthroscopic confirmations. A total of 548 shoulder MRAs were evaluated by two musculoskeletal radiologists, and SSC tendon pathologies were classified into three groups: intact tendon (n = 149), partial-thickness tear (n = 92), or full-thickness tear (n = 31). Diagnostic performance was determined using arthroscopy as gold standard and compared with results of four clinical tests. Intra- and inter-observer reliabilities of two reviewers were evaluated using kappa statistics.
For full-thickness tears, mean values of sensitivity, specificity, and accuracy of reviewer 1/reviewer 2 were 71.0%/87.1%, 97.3%/98.3%, and 94.4%/95.5%, respectively. For partial-thickness tears, mean values of sensitivity, specificity, and accuracy were 72.8%/73.4%, 78.3%/81.2%, and 76.5%/78.5%, respectively. Intra- and inter-observer reliabilities for both reviewers were good to very good (k = 0.85/0.93, p < 0.001; k = 0.74-0.89, p < 0.001). For all clinical tests, while specificity was very high, sensitivity was very low and the overall accuracy was also low.
MRA showed high diagnostic performance for the diagnosis of SSC tendon tears, especially full-thickness tears, with good inter- and intra-observer reliabilities, regardless of the level of experience of the reviewer.
评估两位不同经验水平的阅片者对磁共振关节造影术（MRA）诊断肩胛下肌腱撕裂的诊断性能和可靠性，并与临床检查结果进行比较。
回顾性评估了 272 例经关节镜证实的肩胛下肌腱病变患者。由 2 名肌肉骨骼放射科医生评估了总共 548 例肩关节 MRA，将肩胛下肌腱病变分为 3 组：完整肌腱（n=149）、部分厚度撕裂（n=92）或全层撕裂（n=31）。以关节镜检查为金标准，评估诊断性能，并与四项临床检查结果进行比较。采用κ 统计评估两位阅片者的组内和组间可靠性。
对于全层撕裂，阅片者 1/2 的敏感性、特异性和准确性的平均值分别为 71.0%/87.1%、97.3%/98.3%和 94.4%/95.5%。对于部分厚度撕裂，敏感性、特异性和准确性的平均值分别为 72.8%/73.4%、78.3%/81.2%和 76.5%/78.5%。两位阅片者的组内和组间可靠性均为良好至极好（k=0.85/0.93，p<0.001；k=0.74-0.89，p<0.001）。对于所有临床检查，特异性均非常高，但敏感性非常低，整体准确性也较低。
MRA 对肩胛下肌腱撕裂的诊断具有较高的诊断性能，尤其是全层撕裂，具有良好的组内和组间可靠性，而与阅片者的经验水平无关。
