title: Are radiologists superior to orthopaedic surgeons in diagnosing instability-related shoulder lesions on magnetic resonance arthrography? A multicenter reproducibility and accuracy study.
abstract: BACKGROUND
  We compared the diagnostic reproducibility and accuracy of musculoskeletal radiologists with orthopaedic shoulder surgeons in 2 large medical centers in assessing magnetic resonance arthrograms (MRAs) of patients with traumatic anterior shoulder instability.
  
  
  METHODS
  Forty-five surgically confirmed MRAs were assessed by 4 radiologists, 4 orthopaedic surgeons, 2 radiologic teams, and 2 orthopaedic teams. During MRA assessment and surgery, the same 7-lesion scoring form was used. κ Coefficients, sensitivity, specificity, and differences in percentage of agreement or correct diagnosis (P < .05, McNemar test) were calculated per lesion and overall per the 7 lesion types.
  
  
  RESULTS
  The overall κ between the individual radiologists (κ = 0.51, κ = 0.46) and orthopaedic surgeons (κ = 0.46, κ = 0.41) was moderate. Although the overall percentage of agreement between the radiologists was slightly higher than that between the orthopaedic surgeons in both centers (80.0% vs 77.5% and 75.2% vs 73.7%), there was no significant difference. In each medical center, however, the most experienced orthopaedic surgeon was exceedingly more accurate than both radiologists per the 7 lesion types (81.9% vs 72.4%/74.6% and 76.5% vs 67.3%/73.7%). In 3 of 4 cases, this difference was significant. Overall accuracy improvement through consensus assessment was merely established for the weakest member of each team.
  
  
  CONCLUSIONS
  Experienced orthopaedic surgeons are more accurate than radiologists in assessing traumatic anterior shoulder instability-related lesions on MRA. In case of diagnosis disagreement, these orthopaedic surgeons should base their treatment decision on their own MRA interpretation.
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: svangrinsven@rijnstate.nl.
authors.forename: Susan
authors.initials: S
authors.lastname: van Grinsven
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Thijs A
authors.initials: TA
authors.lastname: Nijenhuis
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Peer C
authors.initials: PC
authors.lastname: Konings
authors.affiliation: Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: van Kampen
authors.affiliation: Department of Orthopaedics, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Corné J M
authors.initials: CJ
authors.lastname: van Loon
mesh_terms: D000328:Adult; D001175:Arthrography; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards; D011871:Radiology / Q000592:standards; D015203:Reproducibility of Results; D012783:Shoulder Dislocation / Q000175:diagnosis*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000473:pathology*
keywords: Shoulder joint; accuracy; agreement; anterior traumatic shoulder dislocation; instability; magnetic resonance arthrography; reproducibility; sensitivity and specificity