Sunday, August 23, 2015

Rotator cuff tears - is the 'fat fraction' of value?

Magnetic resonance rotator cuff fat fraction and its relationship with tendon tear severity and subject characteristics.

These authors studied 182 subjects with shoulder symptoms who underwent shoulder MR imaging including additional sequences for fat quantitation. Then, fat fraction maps were manually segmented, and custom software was used to compute the fat fraction. They suggest that "Accurate fat quantification would help better define the relationship with other subject factors and may help us identify those who will benefit from surgical repair with greater sophistication."

They found that rotator cuff fat fraction assessed by chemical shift MR demonstrated a significant linear relationship with tendon tear severity, age, BMI, and gender but not with symptom duration.

The article concludes, "We believe this study has proved the utility of MR fat fraction as a diagnostic tool in research and demonstrated its potential in clinical management of RC tears.". 

Comment: The authors do not indicate how the added information would improve the care of a patients with a cuff tear nor do they provide data on the cost in terms of dollars or time for the use of the 'custom software'. As a result, we are unable to determine the value (incremental benefit divided by incremental cost) of the technique.
For example, it would have been of great interest if they had provided data on the relationship of the repairability of the cuff tears to the fat fraction.

Our approach to the treatment of cuff tears is shown here. We get most of the information on repairability from the history (how chronic is the tear, what degree of trauma caused it, how old is the patient, how many steroid shots have they had, etc) and the physical exam (which cuff muscles are weak, which are atrophic, how big a gap can be palpated). While it is apparent that sophisticated software can get more information, one must ask whether this added information is of value to the patient. 


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