title: Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon.
abstract: OBJECTIVE
  To evaluate prospectively the accuracy of indirect magnetic resonance (MR) arthrography for supraspinatus tendon tears during neutral positioning or abduction and external rotation (ABER) and neutral positioning.
  
  
  METHODS
  Informed consent was obtained in all patients, and the study was approved by the institutional review board. Indirect MR arthrography of the shoulder was performed in 51 symptomatic patients (14 female, 37 male; mean age, 47 years) in the neutral position (set 1) and in the neutral and ABER positions (set 2). Two readers independently interpreted both sets, and diagnoses were compared with arthroscopic findings. Diagnostic accuracy was calculated, and 95% confidence intervals were used to detect significant differences between sets. Diagnostic confidence was recorded by using a three-level confidence score. Differences between sets were evaluated by using the Wilcoxon signed rank test. Interobserver agreement was determined separately for each set and for all diagnoses, full-thickness tears, and partial-thickness tears.
  
  
  RESULTS
  For full-thickness tears, there was no benefit to reading set 2. For reader 1, sensitivity and specificity were 95% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 80% and 100%, respectively, for set 1 and 100% and 100%, respectively, for set 2. For partial-thickness tears, sensitivity was significantly higher after reading set 2. For reader 1, sensitivity and specificity were 71% and 88%, respectively, for set 1 and 93% and 100%, respectively, for set 2. For reader 2, sensitivity and specificity were 50% and 88%, respectively, for set 1 and 86% and 94%, respectively, for set 2. For both readers, diagnostic confidence for partial-thickness tears was significantly higher after reading set 2. After the interpretation of set 2, kappa values increased from 0.35 to 1.00 for full-thickness tears and from 0.12 to 0.63 for partial-thickness tears.
  
  
  CONCLUSIONS
  Indirect MR arthrography with supplementary images obtained with patients in the ABER position significantly improved sensitivity and increased diagnostic confidence for partial-thickness tears of the supraspinatus tendon. Interobserver agreement was improved for both full- and partial-thickness tears.
authors.affiliation: Department of Diagnostic Radiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, D-93042 Regensburg, Germany. thomas.herold@klinik.uni-regensburg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Herold
authors.forename: Maike
authors.initials: M
authors.lastname: Bachthaler
authors.forename: Okka W
authors.initials: OW
authors.lastname: Hamer
authors.forename: Reiner
authors.initials: R
authors.lastname: Hente
authors.forename: Stefan
authors.initials: S
authors.lastname: Feuerbach
authors.forename: Claudia
authors.initials: C
authors.lastname: Fellner
authors.forename: Michael
authors.initials: M
authors.lastname: Strotzer
authors.forename: Markus
authors.initials: M
authors.lastname: Lenhart
authors.forename: Christian
authors.initials: C
authors.lastname: Paetzel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001175:Arthrography / Q000379:methods*; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011187:Posture; D011446:Prospective Studies; D017006:Rotator Cuff / Q000473:pathology; D000070636:Rotator Cuff Injuries; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology; D013708:Tendon Injuries / Q000175:diagnosis*