Sunday, August 30, 2015

MRI imaging of cuff tears - is 3D imaging worth it?

These authors performed a retrospective review of 34 patients with arthroscopically proven full-thickness rotator cuff tears which were classified by the surgeons with respect to tear shape:  crescent, longitudinal, U- or L-shaped longitudinal, and massive type. 

Two musculoskeletal radiologists reviewed the corresponding MRI studies to characterize the shape on the basis of the tear's retraction and size using 2D MRI. 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. 

The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 70.6% for reader 1 and 67.6% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 97.1% for reader 1 and 82.4% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 76.9% (10 of 13). The overall accuracy of 3D MRI was 82.4% (56 of 68), significantly different (P = .021) from 2D MRI accuracy (64.7%).

Comment: "The authors assert that the shape of a rotator cuff tear can play an important role in the surgeon’s approach and election to repair as well as in the likelihood of clinical success after the repair. Having this information before surgery is useful to the surgeon as it will permit more complete surgical planning and allow the surgeon to provide prognostic information to the patient based on the surgical success of certain shaped tears.The accurate determination of the shape of the tear could also help in deciding whether the tear is reparable as well as if it would be worthwhile to proceed with surgery. In addition, a correctly defined tear shape could help determine if there is enough tendon tissue remaining to allow marginal convergence during the repair."

In trying to determine the value of the 3D reconstructions we need to know (1) whether the 3D images were predictive of the reparability of the cuff defect in these 34 patients (in other words, was the rationale proposed in the quote above demonstrated in this group of patients)? and (2) what was the incremental cost in terms of time and money for the 3D reconstructions?

It is always tempting to apply high levels of technology, but higher tech is higher cost. However, unless the increased cost produces better results for the patient, we may want to spend our precious health care on something more valuable.


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