Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury.
BACKGROUND
Advances in shoulder magnetic resonance imaging (MRI) and arthrography (MRA) have revolutionised musculoskeletal diagnosis and surgical planning. Despite this, the overall accuracy of MRI, with or without intra-articular contrast, can be variable.


METHODS
In this prospective non-randomised analysis, 200 participants (74.5% males) with suspected shoulder injuries underwent MRI (41.0%) or MRA followed by arthroscopy. A study specific proforma was developed to ensure consistency of reporting by radiologists and surgeons. The reports were compared to assess the predictive power of MRI/MRA. Specific assessment of rotator cuff tendon appearance, long head of biceps (LHB) tendon appearance, position and anchor, subacromial space, glenoid labrum and humeral cartilage grade were included.


RESULTS
Shoulder MRA demonstrated a higher agreement with arthroscopy than MRI for supraspinatus, infraspinatus and subscapularis tendon appearance (κ = 0.77 vs. κ = 0.61, κ = 0.55 vs. κ = 0.53 and κ = 0.58 vs. κ = 0.46 respectively). There were also superior agreement rates with MRA compared to MRI for LHB tendon appearance (κ = 0.70 vs. κ =0.54) and position (κ = 0.89 vs. κ = 0.72). As an overall assessor of shoulder pathology we found significantly higher total agreement scores when MRA was used (p = 0.002).


DISCUSSION
Whilst magnetic resonance imaging with arthrography is an extremely useful tool to assess underlying pathological shoulder states it does not confer 100% accuracy. In cases whereby this modality is inconclusive, an examination under anaesthesia and diagnostic arthroscopic assessment for the detection of intra-articular shoulder pathology may be considered.
['Groarke|Patrick|P|', 'Jagernauth|Simond|S|', 'Peters|Susan E|SE|0000-0002-2705-643X', 'Manzanero|Silvia|S|0000-0002-5294-7082', "O'Connell|Paul|P|", 'Cowderoy|Greg|G|', 'Gilpin|David|D|', 'Hope|Benjamin|B|', 'Marchant|Darren|D|', 'Cutbush|Kenneth|K|', 'Andrews|Steve|S|', 'Duke|Phillip Fr|PF|', 'Ross|Mark|M|0000-0003-4624-787X']
D001182:Arthroscopy D005260:Female D006801:Humans D008279:Magnetic Resonance Imaging D009682:Magnetic Resonance Spectroscopy D008297:Male D011446:Prospective Studies D000070636:Rotator Cuff Injuries D012680:Sensitivity and Specificity D000070599:Shoulder Injuries D012785:Shoulder Joint
magnetic resonance arthroscopy shoulder specificity sensitivity