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Diagnostic accuracy of non-contrast MRI in frozen shoulder
Thiago de Angelis Guerra Dotta1, Jorge Henrique Assunção2, Eduardo Baptista2
1Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo-IOTHCFMUSP, Rua Dr. Ovídio Pires de Campos 333 3 Floor, Cerqueira Cesar, São Paulo, SP, 05403-010, Brazil. thiagogdotta@gmail.com.
Introduction:
Despite being the most used exam today, few studies have evaluated the accuracy of findings on non-contrast magnetic resonance imaging (MRI). The primary objective of the study was to evaluate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of non-contrast MRI findings in frozen shoulder, isolated and in combination. The secondary objectives were to define the interobserver and intraobserver agreement of the assessments and the odds ratio for frozen shoulder because of the various findings of MRI.
Methods:
A retrospective diagnostic accuracy study comparing non-contrast MRI findings between the frozen shoulder group and the control group. Sensitivity, specificity, positive and negative predictive value, accuracy, odds ratio, interobserver and intraobserver agreement were calculated for each finding and their possible associations.
Results:
The hyperintensity on capsule in the axillary recess presented 84% sensitivity, 94% specificity, and 89% accuracy. The obliteration of the subcoracoid fat triangle in the rotator interval had sensitivity 34%, specificity 82% and accuracy 58%. For coracohumeral ligament thickness ≥ 2 mm had specificity 66%, 48% specificity and 57% accuracy. Capsule thickness in the axillary recess ≥ 4 mm resulted in 54% sensitivity, 82% specificity, and 68% accuracy. Regarding interobserver agreement, only the posteroinferior and posterosuperior quadrants showed moderate results, and all the others showed strong reliability. The odds ratio for hyperintensity in the axillary recess was 82.3 for frozen shoulder. The association of these findings increased specificity (95%).
Conclusion:
The accuracy of non-contrast magnetic resonance imaging is high for diagnosing frozen shoulder, especially when evaluating the hyperintensity of the axillary recess. The exam has high reliability and reproducibility. The presence of an association of signs increases the specificity of the test.
Level Of Evidence:
Level III, study of diagnostic test.
Insights
Non-contrast magnetic resonance imaging (MRI) accurately diagnoses frozen shoulder, particularly by identifying hyperintensity in the axillary recess. This imaging technique demonstrates high reliability and reproducibility for this condition.
Area of Science:
- Radiology
- Orthopedics
- Diagnostic Imaging
Background:
- Non-contrast magnetic resonance imaging (MRI) is widely used, yet its diagnostic accuracy for frozen shoulder requires further evaluation.
- Few studies have comprehensively assessed the accuracy of various non-contrast MRI findings in diagnosing frozen shoulder.
Purpose of the Study:
- To evaluate the diagnostic accuracy (sensitivity, specificity, PPV, NPV, accuracy) of non-contrast MRI findings for frozen shoulder.
- To determine interobserver and intraobserver agreement for these MRI assessments.
- To calculate the odds ratio associated with specific MRI findings for frozen shoulder.
Main Methods:
- Retrospective diagnostic accuracy study comparing non-contrast MRI in frozen shoulder patients and controls.
- Calculation of sensitivity, specificity, predictive values, accuracy, and odds ratios for identified MRI findings.
- Assessment of interobserver and intraobserver agreement for MRI interpretations.
Main Results:
- Hyperintensity in the axillary recess showed high accuracy (89%) with 84% sensitivity and 94% specificity.
- Obliteration of the subcoracoid fat triangle had 58% accuracy, while coracohumeral ligament thickness (≥2 mm) had 57% accuracy.
- Capsule thickness (≥4 mm) in the axillary recess had 68% accuracy. Combined findings increased specificity to 95%.
Conclusions:
- Non-contrast MRI is a highly accurate tool for diagnosing frozen shoulder, with axillary recess hyperintensity being a key indicator.
- The MRI examination demonstrates strong reliability and reproducibility.
- The combination of specific MRI findings significantly enhances diagnostic specificity for frozen shoulder.
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