Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy.
BACKGROUND
The purpose of this study was to determine the prevalence of glenohumeral articular cartilage lesions in patients with rotator cuff tendinopathy and to assess the accuracy of noncontrast magnetic resonance imaging (MRI) in detecting these defects compared with the "gold standard" of arthroscopy.


METHODS
Noncontrast MRI studies obtained in 84 consecutive patients undergoing shoulder arthroscopy for rotator cuff tendinopathy (mean age, 54.8 years; range, 17-82 years) were prospectively evaluated for glenohumeral cartilage lesions. Two fellowship-trained, experienced musculoskeletal radiologists were blinded from the arthroscopic findings and independently evaluated the glenoid and humeral head cartilage on 2 separate occasions.


RESULTS
At arthroscopy, cartilage lesions of the humeral head were detected in 23 patients (frequency, 27.4%), and glenoid cartilage lesions were found in 20 patients (frequency, 23.8%). For detection of a humeral lesion on MRI, the radiologists' combined accuracy was 78%, sensitivity was 43%, and specificity was 91%. The combined accuracy for detection of glenoid lesions on MRI was 84%, sensitivity was 53%, and specificity was 93%. Combining the readers, low-grade lesions (International Cartilage Repair Society grades 1 and 2) of the glenoid and humerus were read as negative on MRI in 63% and 86% of cases, respectively.


CONCLUSIONS
Overall accuracy of noncontrast MRI for detection of glenohumeral articular cartilage lesions is good; however, interpretation is reader dependent, and accuracy is significantly reduced for detection of low-grade lesions. On the basis of these findings, we recommend that patients with rotator cuff tendinopathy undergoing arthroscopy be informed that the presence and severity of cartilage lesions may be underestimated on MRI.
Shoulder and Elbow Service, Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA.
Corinne
C
VanBeek
OrthoCarolina, Charlotte, NC, USA.
Bryan J
BJ
Loeffler
Shoulder and Elbow Service, Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA.
Alexa
A
Narzikul
Shoulder and Elbow Service, Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA.
Victoria
V
Gordon
Department of Radiology, New York-Presbyterian Hospital/Columbia University, New York, NY, USA.
Michael J
MJ
Rasiej
Department of Radiology, New York-Presbyterian Hospital/Columbia University, New York, NY, USA.
Jonathan K
JK
Kazam
Shoulder and Elbow Service, Thomas Jefferson University, Rothman Institute, Philadelphia, PA, USA. Electronic address: Joseph.abboud@rothmaninstitute.com.
Joseph A
JA
Abboud
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002357:Cartilage Diseases / Q000175:diagnosis* / Q000601:surgery; D002358:Cartilage, Articular / Q000473:pathology*; D005260:Female; D006801:Humans; D058430:Humeral Head; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery; D012540:Scapula; D012785:Shoulder Joint; D052256:Tendinopathy / Q000473:pathology / Q000601:surgery; D055815:Young Adult
Magnetic resonance imaging; glenohumeral cartilage; rotator cuff; shoulder arthroscopy