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A quantitative alternative to the Goutallier classification system using Lava Flex and Ideal MRI techniques: volumetric intramuscular fatty infiltration of the supraspinatus muscle, a cadaveric study

  • Jose H. TrevinoIII
  • Krzysztof R. Gorny
  • Angel Gomez-Cintron
  • Chunfeng Zhao
  • Hugo GiambiniEmail author
Short Communication
  • 63 Downloads

Abstract

Objective

The Goutallier classification system is the most commonly used method for grading intramuscular fatty infiltration in rotator cuff tears. This grading system presents low inter-observer reliability and an inability to provide quantitative and repeatable outcomes for intramuscular fat. We determined the correlation and reliability of two methods, the Lava Flex and Ideal IQ MRI techniques, in quantifying volumetric intramuscular fat, while also comparing to the Goutallier method.

Materials and methods

The supraspinatus muscles of seventeen cadaveric shoulders were scanned using the Lava Flex and Ideal IQ MRI imaging protocols. Histological analysis was performed on the same muscles. Agreement, reliability, and correlation analyses were performed to compare all outcomes.

Results

The Lava Flex protocol took an average of ~ 4 min, while the Ideal IQ required about ~ 11 min to complete. Bland–Altman analysis showed good agreement between the Lava Flex and Ideal IQ [LOA (− 0.10 and 0.05)], and ICC analyses showed excellent reliability (ICC (1,1) 0.948; ICC (2,1) 0.947). There was a 91% correlation between the Lava Flex and Ideal IQ MR protocols. Weighted Kappa analysis between histology and the Goutallier classification showed fair-to-moderate agreement.

Discussion

The Lava Flex technique, taking about 30% of the acquisition time, may prevent motion artifacts in outcomes associated with the longer Ideal IQ technique. However, potential magnetic field inhomogeneities should be considered. The Lava Flex technique may be a faster and valid alternative to the Goutallier classification system.

Keywords

Magnetic resonance imaging Muscle properties Rotator cuff tear Fat infiltration Goutallier classification 

Notes

Acknowledgements

The study was funded internally by the University of Texas at San Antonio and an award from the Mayo Clinic.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest that may have influenced or imparted bias on the work.

Ethical standard

Cadaveric shoulders used in this study were obtained after institutional review board approval.

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Copyright information

© European Society for Magnetic Resonance in Medicine and Biology (ESMRMB) 2019

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringThe University of Texas at San AntonioSan AntonioUSA
  2. 2.Department of RadiologyMayo ClinicRochesterUSA
  3. 3.Department of RadiologyThe University of Texas Health Science Center, San AntonioSan AntonioUSA
  4. 4.Department of Orthopedic SurgeryMayo ClinicRochesterUSA

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