The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries
Background Management of pectoralis major (PM) injuries is largely determined by the anatomic location of the injury, with tendon avulsions from the humerus requiring surgery while myotendinous (MT) injuries are typically managed non-operatively. Because physical examination cannot reliably make thi...
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description | Background
Management of pectoralis major (PM) injuries is largely determined by the anatomic location of the injury, with tendon avulsions from the humerus requiring surgery while myotendinous (MT) injuries are typically managed non-operatively. Because physical examination cannot reliably make this distinction, MRI is often used for staging. However, correct classification can also be difficult with MRI where there is extensive soft tissue edema and distorted anatomy.
Objective
To determine the diagnostic performance of primary and secondary MRI signs of PM injury for distinguishing tendon avulsions from MT injuries in a selected sample of patients that underwent surgical repair using a practical interpretation algorithm.
Methods
In this retrospective study, 3 blinded observers independently assessed the MRI findings of 17 patients with PM injury (including 12 acute injuries, 4 chronic, and 1 of uncertain age) where subsequent surgery documented tendon avulsion (11) and MT injuries (6) by applying the primary MRI criteria of absent tendon at the humerus, retracted tendon stump, epicenter of edema, and the secondary finding of soft tissue edema contacting the anterior humeral cortex. Operative findings were used as the reference standard. Sensitivity, specificity, and positive and negative predictive value were recorded for each finding.
Results
The primary MRI finding of lack of a visible tendon at the insertion (sensitivity 82–100%, specificity 100%) and the secondary finding of edema contacting the anterior humeral cortex (sensitivity 64–91%, specificity 67–100%) were both useful for the distinction of tendon avulsion from MT injury, particularly in acute injuries. The presence of a retracted tendon stump and the epicenter of edema were not reliable findings. The use of a decision tree including the secondary finding of humeral edema increased the sensitivity and specificity for 2 of the 3 observers.
Conclusion
MRI assessment of PM injury focused on the humeral insertion of the PM tendon allows accurate distinction of tendon avulsion from MT injury.
Clinical impact
This study describes a practical approach to classifying PM injuries with MRI to distinguish injuries that require surgery from those that can potentially be managed conservatively. |
doi_str_mv | 10.1007/s00256-021-03794-9 |
format | Article |
fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2526306758</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A731361358</galeid><sourcerecordid>A731361358</sourcerecordid><originalsourceid>FETCH-LOGICAL-c403t-3ca6e78933f8c2cddf74aa0e16fffcaba31da68d99cd9de4a744f713984574ce3</originalsourceid><addsrcrecordid>eNp9kU1rFTEUhoNY7LX6B1xIwI2bsfmaZGZZih-Flhap65BmTqa5zCTXnBmh_97c3mrBhasszvO-vOEh5B1nnzhj5hQZE61umOANk6ZXTf-CbLiSohFc85dkw6RWjZCqOyavEbeMcWNa_YocS9l3gku2IXh7D3SIbkwZl-jpDkrIZXbJA82BXn2_oBjHhHTJFatIGteI9_QG_JKLmyLS2W1zoQukISfqfq0TxlwDoeSZXj3k_SGmvCKNabuWCPiGHAU3Ibx9ek_Ijy-fb8-_NZfXXy_Ozy4br5hcGumdBtP1UobOCz8MwSjnGHAdQvDuzkk-ON0Nfe-HfgDljFLB8Po11RrlQZ6Qj4feXck_V8DFzhE9TJNLUPdY0QotmTZtV9EP_6DbvJZU11WqU1oJZdQzNboJbEwhL8X5fak9M5JLzeVjlzhQvmTEAsHuSpxdebCc2b04exBnqzj7KM72NfT-acB6N8PwN_LHVAXkAcB6SiOU54X_qf0NqSmkuQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2584642474</pqid></control><display><type>article</type><title>The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Baker, Jonathan C. ; Pacheco, Rafael A. ; Bansal, Danesh ; Shah, Veer A. ; Rubin, David A.</creator><creatorcontrib>Baker, Jonathan C. ; Pacheco, Rafael A. ; Bansal, Danesh ; Shah, Veer A. ; Rubin, David A.</creatorcontrib><description>Background
Management of pectoralis major (PM) injuries is largely determined by the anatomic location of the injury, with tendon avulsions from the humerus requiring surgery while myotendinous (MT) injuries are typically managed non-operatively. Because physical examination cannot reliably make this distinction, MRI is often used for staging. However, correct classification can also be difficult with MRI where there is extensive soft tissue edema and distorted anatomy.
Objective
To determine the diagnostic performance of primary and secondary MRI signs of PM injury for distinguishing tendon avulsions from MT injuries in a selected sample of patients that underwent surgical repair using a practical interpretation algorithm.
Methods
In this retrospective study, 3 blinded observers independently assessed the MRI findings of 17 patients with PM injury (including 12 acute injuries, 4 chronic, and 1 of uncertain age) where subsequent surgery documented tendon avulsion (11) and MT injuries (6) by applying the primary MRI criteria of absent tendon at the humerus, retracted tendon stump, epicenter of edema, and the secondary finding of soft tissue edema contacting the anterior humeral cortex. Operative findings were used as the reference standard. Sensitivity, specificity, and positive and negative predictive value were recorded for each finding.
Results
The primary MRI finding of lack of a visible tendon at the insertion (sensitivity 82–100%, specificity 100%) and the secondary finding of edema contacting the anterior humeral cortex (sensitivity 64–91%, specificity 67–100%) were both useful for the distinction of tendon avulsion from MT injury, particularly in acute injuries. The presence of a retracted tendon stump and the epicenter of edema were not reliable findings. The use of a decision tree including the secondary finding of humeral edema increased the sensitivity and specificity for 2 of the 3 observers.
Conclusion
MRI assessment of PM injury focused on the humeral insertion of the PM tendon allows accurate distinction of tendon avulsion from MT injury.
Clinical impact
This study describes a practical approach to classifying PM injuries with MRI to distinguish injuries that require surgery from those that can potentially be managed conservatively.</description><identifier>ISSN: 0364-2348</identifier><identifier>EISSN: 1432-2161</identifier><identifier>DOI: 10.1007/s00256-021-03794-9</identifier><identifier>PMID: 33982130</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Algorithms ; Classification ; Decision trees ; Diagnostic systems ; Edema ; Humans ; Humerus ; Imaging ; Injuries ; Insertion ; Magnetic Resonance Imaging ; Medical diagnosis ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Nuclear Medicine ; Observers ; Orthopedics ; Pathology ; Patients ; Pectoralis Muscles ; Radiology ; Retrospective Studies ; Scientific Article ; Soft tissues ; Surgery ; Tendon Injuries - diagnostic imaging ; Tendons</subject><ispartof>Skeletal radiology, 2021-12, Vol.50 (12), p.2395-2404</ispartof><rights>ISS 2021</rights><rights>2021. ISS.</rights><rights>COPYRIGHT 2021 Springer</rights><rights>ISS 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-3ca6e78933f8c2cddf74aa0e16fffcaba31da68d99cd9de4a744f713984574ce3</citedby><cites>FETCH-LOGICAL-c403t-3ca6e78933f8c2cddf74aa0e16fffcaba31da68d99cd9de4a744f713984574ce3</cites><orcidid>0000-0001-6078-612X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00256-021-03794-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00256-021-03794-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33982130$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baker, Jonathan C.</creatorcontrib><creatorcontrib>Pacheco, Rafael A.</creatorcontrib><creatorcontrib>Bansal, Danesh</creatorcontrib><creatorcontrib>Shah, Veer A.</creatorcontrib><creatorcontrib>Rubin, David A.</creatorcontrib><title>The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries</title><title>Skeletal radiology</title><addtitle>Skeletal Radiol</addtitle><addtitle>Skeletal Radiol</addtitle><description>Background
Management of pectoralis major (PM) injuries is largely determined by the anatomic location of the injury, with tendon avulsions from the humerus requiring surgery while myotendinous (MT) injuries are typically managed non-operatively. Because physical examination cannot reliably make this distinction, MRI is often used for staging. However, correct classification can also be difficult with MRI where there is extensive soft tissue edema and distorted anatomy.
Objective
To determine the diagnostic performance of primary and secondary MRI signs of PM injury for distinguishing tendon avulsions from MT injuries in a selected sample of patients that underwent surgical repair using a practical interpretation algorithm.
Methods
In this retrospective study, 3 blinded observers independently assessed the MRI findings of 17 patients with PM injury (including 12 acute injuries, 4 chronic, and 1 of uncertain age) where subsequent surgery documented tendon avulsion (11) and MT injuries (6) by applying the primary MRI criteria of absent tendon at the humerus, retracted tendon stump, epicenter of edema, and the secondary finding of soft tissue edema contacting the anterior humeral cortex. Operative findings were used as the reference standard. Sensitivity, specificity, and positive and negative predictive value were recorded for each finding.
Results
The primary MRI finding of lack of a visible tendon at the insertion (sensitivity 82–100%, specificity 100%) and the secondary finding of edema contacting the anterior humeral cortex (sensitivity 64–91%, specificity 67–100%) were both useful for the distinction of tendon avulsion from MT injury, particularly in acute injuries. The presence of a retracted tendon stump and the epicenter of edema were not reliable findings. The use of a decision tree including the secondary finding of humeral edema increased the sensitivity and specificity for 2 of the 3 observers.
Conclusion
MRI assessment of PM injury focused on the humeral insertion of the PM tendon allows accurate distinction of tendon avulsion from MT injury.
Clinical impact
This study describes a practical approach to classifying PM injuries with MRI to distinguish injuries that require surgery from those that can potentially be managed conservatively.</description><subject>Algorithms</subject><subject>Classification</subject><subject>Decision trees</subject><subject>Diagnostic systems</subject><subject>Edema</subject><subject>Humans</subject><subject>Humerus</subject><subject>Imaging</subject><subject>Injuries</subject><subject>Insertion</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical diagnosis</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Nuclear Medicine</subject><subject>Observers</subject><subject>Orthopedics</subject><subject>Pathology</subject><subject>Patients</subject><subject>Pectoralis Muscles</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Scientific Article</subject><subject>Soft tissues</subject><subject>Surgery</subject><subject>Tendon Injuries - diagnostic imaging</subject><subject>Tendons</subject><issn>0364-2348</issn><issn>1432-2161</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1rFTEUhoNY7LX6B1xIwI2bsfmaZGZZih-Flhap65BmTqa5zCTXnBmh_97c3mrBhasszvO-vOEh5B1nnzhj5hQZE61umOANk6ZXTf-CbLiSohFc85dkw6RWjZCqOyavEbeMcWNa_YocS9l3gku2IXh7D3SIbkwZl-jpDkrIZXbJA82BXn2_oBjHhHTJFatIGteI9_QG_JKLmyLS2W1zoQukISfqfq0TxlwDoeSZXj3k_SGmvCKNabuWCPiGHAU3Ibx9ek_Ijy-fb8-_NZfXXy_Ozy4br5hcGumdBtP1UobOCz8MwSjnGHAdQvDuzkk-ON0Nfe-HfgDljFLB8Po11RrlQZ6Qj4feXck_V8DFzhE9TJNLUPdY0QotmTZtV9EP_6DbvJZU11WqU1oJZdQzNboJbEwhL8X5fak9M5JLzeVjlzhQvmTEAsHuSpxdebCc2b04exBnqzj7KM72NfT-acB6N8PwN_LHVAXkAcB6SiOU54X_qf0NqSmkuQ</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Baker, Jonathan C.</creator><creator>Pacheco, Rafael A.</creator><creator>Bansal, Danesh</creator><creator>Shah, Veer A.</creator><creator>Rubin, David A.</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6078-612X</orcidid></search><sort><creationdate>20211201</creationdate><title>The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries</title><author>Baker, Jonathan C. ; Pacheco, Rafael A. ; Bansal, Danesh ; Shah, Veer A. ; Rubin, David A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-3ca6e78933f8c2cddf74aa0e16fffcaba31da68d99cd9de4a744f713984574ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Algorithms</topic><topic>Classification</topic><topic>Decision trees</topic><topic>Diagnostic systems</topic><topic>Edema</topic><topic>Humans</topic><topic>Humerus</topic><topic>Imaging</topic><topic>Injuries</topic><topic>Insertion</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical diagnosis</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Nuclear Medicine</topic><topic>Observers</topic><topic>Orthopedics</topic><topic>Pathology</topic><topic>Patients</topic><topic>Pectoralis Muscles</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Scientific Article</topic><topic>Soft tissues</topic><topic>Surgery</topic><topic>Tendon Injuries - diagnostic imaging</topic><topic>Tendons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baker, Jonathan C.</creatorcontrib><creatorcontrib>Pacheco, Rafael A.</creatorcontrib><creatorcontrib>Bansal, Danesh</creatorcontrib><creatorcontrib>Shah, Veer A.</creatorcontrib><creatorcontrib>Rubin, David A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Skeletal radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baker, Jonathan C.</au><au>Pacheco, Rafael A.</au><au>Bansal, Danesh</au><au>Shah, Veer A.</au><au>Rubin, David A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries</atitle><jtitle>Skeletal radiology</jtitle><stitle>Skeletal Radiol</stitle><addtitle>Skeletal Radiol</addtitle><date>2021-12-01</date><risdate>2021</risdate><volume>50</volume><issue>12</issue><spage>2395</spage><epage>2404</epage><pages>2395-2404</pages><issn>0364-2348</issn><eissn>1432-2161</eissn><abstract>Background
Management of pectoralis major (PM) injuries is largely determined by the anatomic location of the injury, with tendon avulsions from the humerus requiring surgery while myotendinous (MT) injuries are typically managed non-operatively. Because physical examination cannot reliably make this distinction, MRI is often used for staging. However, correct classification can also be difficult with MRI where there is extensive soft tissue edema and distorted anatomy.
Objective
To determine the diagnostic performance of primary and secondary MRI signs of PM injury for distinguishing tendon avulsions from MT injuries in a selected sample of patients that underwent surgical repair using a practical interpretation algorithm.
Methods
In this retrospective study, 3 blinded observers independently assessed the MRI findings of 17 patients with PM injury (including 12 acute injuries, 4 chronic, and 1 of uncertain age) where subsequent surgery documented tendon avulsion (11) and MT injuries (6) by applying the primary MRI criteria of absent tendon at the humerus, retracted tendon stump, epicenter of edema, and the secondary finding of soft tissue edema contacting the anterior humeral cortex. Operative findings were used as the reference standard. Sensitivity, specificity, and positive and negative predictive value were recorded for each finding.
Results
The primary MRI finding of lack of a visible tendon at the insertion (sensitivity 82–100%, specificity 100%) and the secondary finding of edema contacting the anterior humeral cortex (sensitivity 64–91%, specificity 67–100%) were both useful for the distinction of tendon avulsion from MT injury, particularly in acute injuries. The presence of a retracted tendon stump and the epicenter of edema were not reliable findings. The use of a decision tree including the secondary finding of humeral edema increased the sensitivity and specificity for 2 of the 3 observers.
Conclusion
MRI assessment of PM injury focused on the humeral insertion of the PM tendon allows accurate distinction of tendon avulsion from MT injury.
Clinical impact
This study describes a practical approach to classifying PM injuries with MRI to distinguish injuries that require surgery from those that can potentially be managed conservatively.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33982130</pmid><doi>10.1007/s00256-021-03794-9</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6078-612X</orcidid></addata></record> |
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subjects | Algorithms Classification Decision trees Diagnostic systems Edema Humans Humerus Imaging Injuries Insertion Magnetic Resonance Imaging Medical diagnosis Medical research Medicine Medicine & Public Health Medicine, Experimental Nuclear Medicine Observers Orthopedics Pathology Patients Pectoralis Muscles Radiology Retrospective Studies Scientific Article Soft tissues Surgery Tendon Injuries - diagnostic imaging Tendons |
title | The diagnostic performance of MRI signs to distinguish Pectoralis major tendon avulsions from Myotendinous injuries |
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