title: Diagnostic shortcomings of magnetic resonance arthrography to evaluate partial rotator cuff tears in adolescents.
abstract: BACKGROUND
  Recent evidence suggests an increase in the incidence of partial articular-sided rotator cuff tears in adolescent athletes, but the accuracy of diagnostic studies has not been previously assessed in this cohort. This study was performed to assess the ability of magnetic resonance imaging with arthrography (MRIa) to diagnose partial rotator cuff (PRC) pathology in the adolescent age group.
  
  
  METHODS
  All patients under the age of 19 years who underwent shoulder arthroscopy, between August 2008 and August 2010, were grouped based on the presence of a PRC tear diagnosed by either MRIa or arthroscopy. The control cohort included children without evidence of an intraoperative PRC. Surgical findings were then correlated with the preoperative MRIa findings and the accuracy of MRIa reading. Interclass coefficient was then determined for the MRIa reviewers.
  
  
  RESULTS
  Thirty-one of 89 adolescents (mean age, 15.9 y; 36% girls and 64% boys) who underwent arthroscopic shoulder surgery were found to have radiographic or arthroscopic evidence of a PRC injury. There were 17 boys and 14 girls in the PRC group, with a mean age of 15.6 years. The PRC injuries involved either the supraspinatus tendon, infraspinatus tendon, or both. MRIa was 44% sensitive and 87% specific, with a positive predictive value of 64% and a negative predictive value of 74% with arthroscopic findings used as the gold standard. The ICC between reviewers was κ=0.57, with an absolute agreement of 84%.
  
  
  CONCLUSIONS
  The overall diagnostic accuracy of the MRIa with regard to adolescent PRC injuries was 72%. MRIa was found to be specific, but not sensitive for the diagnosis of this pathology. The high false-negative rate seen in this adolescent cohort indicates that a PRC injury may be present even with a negative MRIa. Therefore, if clinical suspicion indicates a PRC injury, then the treating physician should consider management for rotator cuff pathology despite negative MRIa findings.
  
  
  METHODS
  Level III--retrospective cohort study.
authors: Departments of *Orthopedic Surgery §Radiology, Rady Children's Hospital †Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA ‡Department of Orthopedics, Joe DiMaggio Children's Hospital, Hollywood, FL.
authors: Eric W
authors: EW
authors: Edmonds
authors: Eric A
authors: EA
authors: Eisner
authors: Peter G
authors: PG
authors: Kruk
authors: Joanna H
authors: JH
authors: Roocroft
authors: Jerry D
authors: JD
authors: Dwek
mesh_terms: D000293:Adolescent; D001175:Arthrography / Q000379:methods*; D001182:Arthroscopy / Q000379:methods / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D015599:Trauma Severity Indices