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Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate the potential of susceptibility-weighted-magnetic-resonance-imaging (SWMR) for the detection of sub-coracoacromial spurs in patients with clinically suspected subacromial impingement syndrome (SAIS), compared to standard MR-sequences and radiographs.

Methods

Forty-four patients with suspected SAIS were included. All patients underwent radiography, standard MRI of the shoulder and SWMR. Radiograph-based identification of sub-coracoacromial spurs served as goldstandard. Radiographs identified twenty-three spurs in twenty-three patients. Twenty-one patients without spur formation served as reference group. Detection rate, sensitivity/specificity and interobserver-agreements were calculated. Linear regression was applied to determine the relationship between size measurements on radiographs and MRI.

Results

Detection rates for spurs on standard MRI and SWMR were 47.8 % and 91.3 % compared to radiography (p<0.001). SWMR demonstrated a sensitivity of 97.7 % (CI=0.92-1) and a specificity of 91.3 % (CI=0.788-1) for the identification of spurs. Standard MR-sequences achieved a sensitivity of 47.8 % (CI=0.185-0.775) and a specificity of 80.8 % (CI=0.642-0.978). Size measurements between SWMR and radiography showed a good correlation (R2=0.75;p<0.0001), while overestimating lesion size (5.7±1.2 mm; 4.3±1.3 mm;p<0.0001). Interobserver-agreement for spurs was high on SWMR (R2=0.74;p<0.0001), but low on standard MRI (R2=0.24;p<0.0001).

Conclusions

SWMR allows a reliable detection of sub-coracoacromial spur formation in patients with SAIS and is superior to standard MR-sequences using radiography as goldstandard.

Key Points

• SWMR has the potential to reliably identify sub-coracoacromial spurs without radiation exposure.

• SWMR provides comparable detection rates to conventional radiography for sub-coracoacromial spur formation.

• SWMR yields higher detection rates compared to standard-MR regarding sub-coracoacromial spur formation.

• SWMR can be implemented in routine shoulder MRI protocols.

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Acknowledgements

The scientific guarantor of this publication is Dominik Nörenberg. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (M.M.) has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects have been previously reported.

Methodology: prospective, comparative study, single centre study.

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Authors and Affiliations

  1. Department of Clinical Radiology, Munich University Hospitals Campus Großhadern, Munich, Germany

    Dominik Nörenberg & Marco Armbruster

  2. Department of Radiology, Charité – University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Yi-Na Bender, Thula Walter, Gerd Diederichs, Bernd Hamm & Marcus R. Makowski

  3. Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany

    Hans U. Ebersberger

  4. Department of Trauma and Orthopedic Surgery, Shoulder and Elbow Service, Munich University Hospitals Campus Großhadern, Munich, Germany

    Ben Ockert

  5. Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK

    Marcus R. Makowski

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  1. Dominik Nörenberg
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Correspondence to Marcus R. Makowski.

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Nörenberg, D., Armbruster, M., Bender, YN. et al. Diagnostic performance of susceptibility-weighted magnetic resonance imaging for the assessment of sub-coracoacromial spurs causing subacromial impingement syndrome. Eur Radiol 27, 1286–1294 (2017). https://doi.org/10.1007/s00330-016-4441-0

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  • DOI: https://doi.org/10.1007/s00330-016-4441-0

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