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Diagnostic performance of long head of biceps tendon tears on MRI: systematic review and meta-analysis

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this meta-analysis was to determine the diagnostic performance of conventional MRI and MR arthrography for tendinosis, and partial and complete tears of the long head of the biceps tendon (LHBT) using arthroscopy as the reference standard.

Materials and methods

A systematic review was performed using predefined data fields in PubMed, and all articles published from January 2000 up to April 2022 were retrospectively pooled and reviewed. Six MRI studies on complete tear (n = 555) and ten studies on partial tear/tendinosis (n = 2487) were included in the analysis. Two of the included studies in each group investigated the use of MR arthrography. The data sets were analyzed using a univariate approach with the DerSimonian and Laird random effects model and the proportional hazards model.

Results

MRI shows high specificities in diagnosing complete tears of the LHBT ranging from 93.0 to 99.0%. Diagnostic sensitivity was more heterogeneous ranging from 55.9 to 90.0%. The overall negative likelihood ratio was 0.29 (95% CI: 0.17–0.50) and the overall positive likelihood ratio was 37.3 (95% CI: 11.9–117.4). The mean sensitivity in diagnosing partial tear/tendinosis of the LHBT was 67.8% (95% CI: 54.3–78.9%) and the specificity was 75.9% (95% CI: 63.6–85.0%), resulting in a balanced accuracy of 71.9%. The overall negative likelihood ratio was 0.44 (95% CI: 0.32–0.59) and the overall positive likelihood ratio was 2.64 (95% CI: 1.91–3.65).

Conclusion

MRI is highly specific for the diagnosis of complete tears of the LHBT, whereas diagnostic sensitivity was more heterogeneous. The diagnosis of partial tears and/or tendinosis of the LHBT remains challenging on MRI, which may warrant complementary clinical examination or other imaging modalities to increase diagnostic confidence in equivocal cases.

Clinical relevance statement

Conventional MRI and MR arthrography have high diagnostic performance for complete tendon tear when compared to arthroscopy. The diagnosis of tendinosis/partial tears remains challenging and may require comparison with clinical tests and other imaging modalities.

Key Points

•There is no clear consensus regarding the primary imaging modality for the evaluation of LHBT disorders.

•Conventional MRI and MR arthrography are highly specific in diagnosing complete tears of the LHBT.

•Diagnosis of partial tears/tendinosis of the LHBT on conventional MRI and MR arthrography remains a diagnostic challenge.

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Abbreviations

CI:

Confidence interval

CTA:

CT arthrography

DSL:

DerSimonian-Laird

FN:

False negative

FP:

False positive

FPR:

False positive rate

LHBT:

Long head of the biceps tendon

LR:

Likelihood ratio

LR-:

Negative likelihood ratio

LR + :

Positive likelihood ratio

MRA:

MR arthrography

MRI:

Magnetic resonance imaging

PHM:

Proportional hazards model

PRISMA-DTA:

Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies

ROC:

Receiver operating characteristic

SROC :

Summary ROC curve

T:

Tesla

TN:

True negative

TNR:

True negative rate

TP:

True positive

TPR:

True positive rate

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Gonçalo G. Almeida, Simon Wildermuth, Tim Fischer, Stephan Waelti, Sebastian Leschka & Tobias Johannes Dietrich

  2. Clinical Trials Unit, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Nicole Graf

  3. Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland

    Simon Wildermuth, Tim Fischer, Stephan Waelti, Sebastian Leschka & Tobias Johannes Dietrich

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Matthijs Jacxsens

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  1. Gonçalo G. Almeida
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Correspondence to Gonçalo G. Almeida.

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Guarantor

The scientific guarantor of this publication is Gonçalo Garcia Galvão de Almeida.

Conflict of interest

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.

Statistics and biometry

Dr. Nicole Graf kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was not required for this study because only previously published data was used for the analysis.

Ethical approval

Institutional Review Board approval was not required because only previously published data was used for the analysis.

Study subjects or cohorts overlap

All data used in the systematic review and meta-analysis were previously independently published in various journals (Skeletal Radiology, Open Access Journal of Sports Medicine, Knee Surgery Sports Traumatology & Arthroscopy, BMC Musculoskeletal Disorders, The Journal of Arthroscopic & Related Surgery and Revista Brasileira de Ortopedia).

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Almeida, G.G., Graf, N., Wildermuth, S. et al. Diagnostic performance of long head of biceps tendon tears on MRI: systematic review and meta-analysis. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10521-6

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