title: Quantitative assessment of fatty degeneration in rotator cuff muscles determined with computed tomography.
abstract: OBJECTIVE
  Reliable assessment of fatty degeneration of rotator cuff muscles is desirable to predict the outcome of shoulder surgery. Currently used qualitative assessments are limited by relatively high inter- and intraobserver variability. It was hypothesized that a quantitative measurement of muscle density using computed tomography (CT) was more reliable and reproducible.
  
  
  METHODS
  Thirty shoulders from patients with rheumatoid arthritis were analyzed using parasagittal multiplanar reconstructions acquired from a 16-slice CT scanner. Three observers visually rated the severity of fatty degeneration and independently outlined the rotator cuff muscles, after which the mean density was calculated. Inter- and intraobserver agreement on both measurements was expressed by the interclass correlation coefficient (ICC) and the standard deviation of the differences (SDD) between the measurements.
  
  
  RESULTS
  A strong correlation was found between the quantitative measure and the visual rating (R2 = 0.94; P < 0.0001). The SDD in muscle density did not exceed 2.3 Hounsfield units, and the mean rotator cuff ICC (0.98) was substantially greater than that of the visual rating (0.63).
  
  
  CONCLUSIONS
  This study describes a reproducible method to quantify fatty degeneration of the rotator cuff muscles in CT images, with a higher interobserver agreement than the visual score, and may prove a reliable tool to evaluate the quality of the rotator cuff muscles.
authors.affiliation: Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands. M.A.J. van_de_Sande@LUMC.nl
authors.forename: Michiel A J
authors.initials: MA
authors.lastname: van de Sande
authors.forename: Berend C
authors.initials: BC
authors.lastname: Stoel
authors.forename: Wim R
authors.initials: WR
authors.lastname: Obermann
authors.forename: John G S
authors.initials: JG
authors.lastname: Tjong a Lieng
authors.forename: Piet M
authors.initials: PM
authors.lastname: Rozing
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000000981:diagnostic imaging; D009135:Muscular Diseases / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D000070636:Rotator Cuff Injuries; D014057:Tomography, X-Ray Computed / Q000379:methods