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Reliability of supraspinatus intramuscular fatty infiltration estimates on T1-weighted MRI in potential candidates for rotator cuff repair surgery: full-thickness tear versus high-grade partial-thickness tear

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Abstract

Objective

Patients with supraspinatus high-grade partial-thickness tear or full-thickness tear are potential candidates for rotator cuff repair surgery. We sought (1) to compare supraspinatus intramuscular fatty infiltration between these groups by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, (2) and to determine the reliability of each method.

Materials and methods

We performed a retrospective cross-sectional study of supraspinatus intramuscular fatty infiltration on T1-weighted MR images for 93 shoulders with either supraspinatus partial-thickness tear > 50% tendon thickness or full-thickness tear by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, by two observers for each method. Descriptive statistics were performed to compare groups. Inter- and intra-observer reliability was determined. Correlative analysis among the three methods was performed.

Results

Significant differences of mean supraspinatus intramuscular fatty infiltration were present when comparing supraspinatus high-grade partial-thickness tear versus full-thickness tears by Goutallier grade (p = 0.004), fuzzy C-means (p = 0.002) and orthopaedic surgeon visible percentage estimate (p = 0.001). There was no significant difference for age (55.0 ± 11.1 years versus 56.1 ± 9.6 years) or sex (35.4% male versus 47.8% male) for supraspinatus high-grade partial-thickness tear and full-thickness tear, respectively. A significant difference existed among the subgroup of full-thickness tears stratified by tear size by all three methods (p < 0.020). Inter- and intra-observer reliability was Goutallier grade 0.590 and 0.624, fuzzy C-means 0.768 and 0.925 and orthopaedic surgeon visible percentage estimate 0.858 and 0.686, respectively. For shoulders with mean Goutallier grade ≥ 2.0, inter-observer reliability was 0.878 and 0.802 for fuzzy C-means and orthopaedic surgeon visible percentage estimate, respectively. A strong correlation was present among the three methods of supraspinatus FI analysis (rho ≥ 0.72).

Conclusion

Supraspinatus full-thickness tears have higher amounts of intramuscular fatty infiltration compared to high-grade partial-thickness tear. Quantitative fuzzy C-means shows excellent inter-observer reliability for estimating supraspinatus intramuscular fat. Experienced orthopaedic surgeons’ semi-quantitative estimation of supraspinatus visible intramuscular fat may offer improved reliability as compared to semi-quantitative Goutallier grade.

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Acknowledgements

The authors acknowledge Dr. Ranyah Almardawi, Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, for her contribution to data management for this study.

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Authors and Affiliations

  1. Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD, 21201, USA

    Derik L. Davis

  2. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA

    Mohit N. Gilotra & S. Ashfaq Hasan

  3. University of Maryland School of Medicine, Baltimore, MD, USA

    Rodolfo Calderon & Andrew Roberts

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Correspondence to Derik L. Davis.

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Conflict of interest

Dr. Derik L. Davis receives partial salary support from the University of Maryland Claude D. Pepper Older Americans Independence Center (NIA 3P30AG028747-13S1) and the National Institute on Aging (NIA 1R03AG067927-01). Dr. Mohit N. Gilotra, MD is a consultant for Tigon.

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Davis, D.L., Gilotra, M.N., Calderon, R. et al. Reliability of supraspinatus intramuscular fatty infiltration estimates on T1-weighted MRI in potential candidates for rotator cuff repair surgery: full-thickness tear versus high-grade partial-thickness tear. Skeletal Radiol 50, 2233–2243 (2021). https://doi.org/10.1007/s00256-021-03805-9

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