Magnetic Resonance Imaging Identification of Rotator Cuff Pathology: Inter-rater Realibilty

Background. The shoulder MRI is one of the main methods for the rotator cuff injuries diagnostics and determination of the further treatment tactics. The agreement in the MRI data interpretation among specialists regarding different types of shoulder ruptures is an integral part of diagnostic test validity evaluation. The purpose of this study was to assess the agreement in the MRI data interpretation in the patients with shoulder rotator cuff pathology among trauma surgeons, as well as between trauma surgeons and a radiologist. Materials and Methods. The study was a retrospective analysis of the MRI data and surgical reports regarding 57 patients with various shoulder pathologies undergone the shoulder MRI and arthroscopic shoulder revisions in the period from 2017 to 2019. There were 38 (67%) men and 19 (33%) women among the patients. The average age of the patients was 52.7±13.6 years. The sensitivity and specificity, as well as the shoulder MRI inter-rater reliability were assessed in the course of the study. Results. The rotator cuff pathology was revealed in 52 patients: supraspinatus tendon injury in 98% of cases, supraspinatus and infraspinatus tendon — in 26%, isolated subscapularis tendon injury — in 2%, supraspinatus and subscapularis tendon — in 39%. The maximal concordance in the MRI data interpretation was achieved in the patients with full-thickness supraspinatus tendon rupture, as well as with the supraspinatus tendon calcifications. However, significant disagreement was found between orthopedists with different work experience in determination of the presence and type of infraspinatus and subscapularis tendons pathology and supraspinatus tendon incomplete ruptures and tendinitis. Conclusion. The high agreement in the MRI data interpretation in determining the pathology of the shoulder rotator cuff among trauma surgeons, as well as between trauma surgeons and radiologists, was observed only regarding the supraspinatus tendon, calcifying tendonitis and full-thickness injury. The diagnosis of tendinitis and incomplete tendon rupture remains difficult. Their interpretation results vary greatly. It is also worth noting the heterogeneity of the results of diagnostics of the infraspinatus and subscapularis tendon pathology.