Correlation of magnetic resonance imaging findings with arthroscopy in the evaluation of rotator cuff pathology

Abstract

Objective: The purpose of this study was to compare the accuracy of magnetic resonance imaging in clinically diagnosed rotator cuff disease based upon the radiologist’s interpretation with actual intraoperative arthroscopic findings being used as the reference standard in a Kenyan outpatient practice. Design: This was a retrospective cohort study. Setting: The study was carried out at Plaza Advanced Imaging Centre over a period of one year from December 2011 to November 2012. Methods: Using the University of Nairobi and Kenyatta National Hospital Ethics Committee approved protocol medical records of thirty four randomly selected consecutive patients with shoulder pain were evaluated. The records of these patients were reviewed to determine the demographics, radiologists MRI interpretations, and the surgeon’s operative findings. Results: Thirty four (79%) patients out of the targeted sample size of 43 were successfully evaluated with an aim of establishing the accuracy and sensitivity of MRI in the diagnosis of rotator cuff pathology in relation to arthroscopic findings. Twenty one (62%) of the patients were male, while the female patients s were 13 (38%). Conclusions: In the present study the sensitivity of MRI in diagnosing of rotator cuff pathology was low but the specificity was high. This means that MRI missed a number of lesions, but of those that were picked the specificity was high. Given the relatively low sensitivity findings of the study compared to previous studies done elsewhere there is need to have a trained dedicated musculoskeletal radiologist. However, there exists a significant correlation between the diagnoses made under MRI and arthroscopy. Results from this study will serve as a useful guide to orthopaedic surgeons in planning the management pathway for patients with rotator cuff pathology and will also highlight areas in need of improving interpretation skills and imaging protocols for radiologists in the country.