Published online Mar 28, 2017. doi: 10.4329/wjr.v9.i3.126
Peer-review started: August 24, 2016
First decision: October 20, 2016
Revised: December 12, 2016
Accepted: January 2, 2017
Article in press: January 3, 2017
Published online: March 28, 2017
Processing time: 212 Days and 3.8 Hours
To determine diagnostic performance of magnetic resonance arthrography (MRA) in evaluating rotator cuff tears (RCTs) using Snyder’s classification for reporting.
One hundred and twenty-six patients (64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder’s classification was recorded. MRA examinations were evaluated by two independent radiologists (14 and 5 years’ experience) using Snyder’s classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial- and full-thickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.
On arthroscopy, 71/126 patients (56%) had a full-thickness RCT. The remaining 55/126 patients (44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed full-thickness RCTs, 66 (93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent (k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases (92%); in the remaining 5/66 cases (8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total (k = 1.000).
MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder’s classification for reporting. Snyder’s classification may be adopted for routine reporting of MRA.
Core tip: In the present study we determined the diagnostic performance of magnetic resonance arthrography (MRA) in evaluating rotator cuff tears (RCTs) using Snyder’s classification for reporting. One hundred and twenty-six patients underwent MRA and arthroscopy, which represented our reference standard. Agreement between arthroscopy and MRA on partial- and full-thickness tears was calculated. Arthroscopy findings: 71/126 patients (56%) had a full-thickness RCTs, while 55/126 patients (44%) had a partial-thickness RCTs. MRA showed high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder’s classification for reporting. Snyder’s classification may be adopted for routine reporting of MRA.