8/3/2019 MRI Reliability in Rotator Cuff Injury Summary

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Done By: Noor Amar Group C

Reliability of MRI Assessment of Supraspinatus Tendinopathy

Paper:Reliability of MRI assessment of supraspinatus tendinopathy

Authors: Sein, M. Walton, J. Linklater, J. Harris, C. Dugal, T. Appleyard, R.

Kirkbride, B. Kuah, D. Murrell, G.

Journal: British Journal of Sport Medicine

Publish Date: 2007

Significance of Study

Despite MRI being a useful tool for assessment of rotator cuff injuries, it had not been

proven as a reliable tool. This study was done to determine the reliability of MRI in

assessing especially supraspinatus tendinopathy.

Why this study was chosen

This study was chosen because supraspinatus tendinopathy is a common rotator cuff

injury and assessing it accurately is important for its management. Therefore from

this study, if we can conclude that MRI is a reliable tool for assessing supraspinatus

tendinopathy then it should continue to be used as the main tool. But if the study

concludes that MRI is not a reliable tool then switching to another tool that hasproven to be reliable or improving MRI are the better options.

Methods

Number of subjects. 52 elite swimmers, participated in study. The group consisted of

28 males and 24 females.

Age. Aged between 13 and 25 years.

Conditions. Swimmers were excluded if they had any previous surgery, fracture ofthe shoulder, or inability or unwillingness to participate in the MRI and clinical

shoulder examinations.

Process. Each swimmers evaluation included a shoulder pain and function

examination and a swimming training profile before the MRI. The swimmers

underwent an MRI of a single shoulder: either the dominant shoulder if asymptomatic

or the most affected shoulder if symptomatic.

Intraobserver Trial. After that one observer made three readings of the MRIs. This

was the intraobserver trial. This observer was a very experienced musculoskeletal

8/3/2019 MRI Reliability in Rotator Cuff Injury Summary

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Done By: Noor Amar Group C

radiologist who read all 52 images on three different occasions without access to the

previous images.

Interobserver Trial. The next trial named the interobserver trial had three different

observers who independently made readings on the same set of images as the trial

above. These three musculoskeletal radiologists were of different experiences: one

with 9 years experience of reading MRIs, the second 2 years experience and the third

less than that. Each radiologist read the 52 images on one occasion.

The radiologists were asked to grade the supraspinatus tendinosis on a scale from 0-3.

Grade 0 was a normal tendon, grade 1 mild tendinosis, grade 2 moderate tendinosis,

and grade 3 marked tendinosis.

Then the grades given by the radiologists in each trial were plotted on a program and

a value which was used to evaluate the reliability was obtained called the Intraclass

Correlation Coefficient (ICC).

ICC = 0.4 represents poor reliability.

ICC = 0.75 represent excellent reliability.

ICC = 0.4 - 0.75 represent fair to good reliability.

Results

Incidence of tendinosis. Of the 52 shoulders examined, 36 had MRI-assessed

tendinosis; 27 of which were grade 1, 8 of them grade 2 and 1 was grade 3.

Interobserver Reliability Trial. The ICC = 0.55. This level of agreement between

the three radiologists is rated as fair to good.

Intraobserver Reliability Trial. The ICC = 0.85. This level of agreement between

the three readings is rated as excellent.

Conclusion

The grading of MRI-determined supraspinatus tendinosis grading was reliable (which

had an ICC = 0.85) when assessed by a single well-trained observer. This indicates

that the reliability of the assessment was much greater in more experienced

radiologists and less in the junior radiologist.