Supraspinatus tendon signal alterations on adolescent shoulder MRIs: a diagnostic dilemma

Pediatric rotator cuff (RTC) injuries are uncommon, yet supraspinatus tendon (SST) signal alterations on T2-weighted imaging are frequently observed.

To compare rates of SST signal alterations on shoulder MRIs of adolescents who are considered low- and high-risk for RTC injury.

We retrospectively reviewed non-arthrogram shoulder MRI reports in 12-17-year-old patients at a large tertiary children's hospital (01/2010-09/2024). We identified a low-risk patient cohort who lacked (a) clinical concern for RTC pathology, (b) athletic history associated with RTC injuries, (c) recent trauma, or (d) prior shoulder intervention. We also identified an age- and sex-matched high-risk patient cohort who had clinical concern for RTC pathology. Two experienced pediatric radiologists independently and blindly reviewed the shoulder MRIs in a random order from these cohorts. SST was evaluated using coronal oblique fat-suppressed T2-weighted sequences. Logistic regression models were developed to investigate differences between cohorts.

Both low- and high-risk cohorts included 26 patients (14 males). Their median (inter-quartile range) ages were 14.0 (2.0) years and 14.5 (3.0) years, respectively. In the low-risk cohort, SST signal alterations were identified in 23 (88.5%) and 22 (84.6%) patients by readers 1 and 2, respectively. In the high-risk group, SST signal alterations were identified in 24 (92.3%) and 23 (88.5%) patients by readers 1 and 2, respectively. Overall inter-reader agreement was substantial (Cohen's kappa=0.63). There was no statistical difference in the SST signal alteration grades between the low- and high-risk cohorts (P≥0.07).

SST signal alterations are common in adolescent shoulder MRIs regardless of the clinical concern for RTC injury.