Nitin B Jain1, Jamie Collins2, Joel S Newman3, Jeffrey N Katz4, Elena Losina5, Laurence D Higgins6. 1. Departments of Physical Medicine and Rehabilitation, and Orthopaedics, Vanderbilt University Medical Center, Nashville, TN; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA(∗). Electronic address: nitin.jain@vanderbilt.edu. 2. Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA† 3. Department of Radiology, New England Baptist Hospital, Boston, MA‡ 4. Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA§ 5. Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA|| 6. Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA¶
Abstract
BACKGROUND: Physiatrists encounter patients with rotator cuff disorders, and imaging is frequently an important component of their diagnostic assessment. However, there is a paucity of literature on the reliability of magnetic resonance imaging (MRI) assessment between shoulder specialists and musculoskeletal radiologists. OBJECTIVE: We assessed inter- and intrarater reliability of MRI characteristics of the rotator cuff. DESIGN: Cross-sectional secondary analyses in a prospective cohort study. SETTING: Academic tertiary care centers. PATIENTS: Subjects with shoulder pain were recruited from orthopedic and physiatry clinics. METHODS: Two shoulder-fellowship-trained physicians (a physiatrist and a shoulder surgeon) jointly performed a blinded composite MRI review by consensus of 31 subjects with shoulder pain. Subsequently, MRI was reviewed by one fellowship-trained musculoskeletal radiologist. MAIN OUTCOME MEASUREMENTS: We calculated the Cohen kappa coefficients and percentage agreement among the 2 reviews (composite review of 2 shoulder specialists versus that of the musculoskeletal radiologist). Intrarater reliability was assessed among the shoulder specialists by performing a repeated blinded composite MRI review. In addition to this repeated composite review, only one of the physiatry shoulder specialists performed an additional review. RESULTS: Interrater reliability (shoulder specialists versus musculoskeletal radiologist) was substantial for the presence or absence of tear (kappa 0.90 [95% confidence interval {CI}, 0.72-1.00]), tear thickness (kappa 0.84 [95% CI, 0.70-0.99]), longitudinal size of tear (kappa 0.75 [95% CI, 0.44-1.00]), fatty infiltration (kappa 0.62 [95% CI, 0.45-0.79]), and muscle atrophy (kappa 0.68 [95% CI, 0.50-0.86]). There was only fair interrater reliability of the transverse size of tear (kappa 0.20 [95% CI, 0.00-0.51]). The kappa for intrarater reliability was high for tear thickness (0.88 [95% CI, 0.72-1.00]), longitudinal tear size (0.61 [95% CI, 0.22-0.99]), fatty infiltration (0.89 [95% CI, 0.80,-0.98]), and muscle atrophy (0.87 [95% CI, 0.76-0.98]). Intrarater reliability for the individual shoulder specialist was similar to that of the composite reviews. CONCLUSIONS: There was high interrater and intrarater reliability for most findings on shoulder MRI. Analysis of our data supports the reliability of MRI assessment by shoulder specialists for rotator cuff disorders.
BACKGROUND: Physiatrists encounter patients with rotator cuff disorders, and imaging is frequently an important component of their diagnostic assessment. However, there is a paucity of literature on the reliability of magnetic resonance imaging (MRI) assessment between shoulder specialists and musculoskeletal radiologists. OBJECTIVE: We assessed inter- and intrarater reliability of MRI characteristics of the rotator cuff. DESIGN: Cross-sectional secondary analyses in a prospective cohort study. SETTING: Academic tertiary care centers. PATIENTS: Subjects with shoulder pain were recruited from orthopedic and physiatry clinics. METHODS: Two shoulder-fellowship-trained physicians (a physiatrist and a shoulder surgeon) jointly performed a blinded composite MRI review by consensus of 31 subjects with shoulder pain. Subsequently, MRI was reviewed by one fellowship-trained musculoskeletal radiologist. MAIN OUTCOME MEASUREMENTS: We calculated the Cohen kappa coefficients and percentage agreement among the 2 reviews (composite review of 2 shoulder specialists versus that of the musculoskeletal radiologist). Intrarater reliability was assessed among the shoulder specialists by performing a repeated blinded composite MRI review. In addition to this repeated composite review, only one of the physiatry shoulder specialists performed an additional review. RESULTS: Interrater reliability (shoulder specialists versus musculoskeletal radiologist) was substantial for the presence or absence of tear (kappa 0.90 [95% confidence interval {CI}, 0.72-1.00]), tear thickness (kappa 0.84 [95% CI, 0.70-0.99]), longitudinal size of tear (kappa 0.75 [95% CI, 0.44-1.00]), fatty infiltration (kappa 0.62 [95% CI, 0.45-0.79]), and muscle atrophy (kappa 0.68 [95% CI, 0.50-0.86]). There was only fair interrater reliability of the transverse size of tear (kappa 0.20 [95% CI, 0.00-0.51]). The kappa for intrarater reliability was high for tear thickness (0.88 [95% CI, 0.72-1.00]), longitudinal tear size (0.61 [95% CI, 0.22-0.99]), fatty infiltration (0.89 [95% CI, 0.80,-0.98]), and muscle atrophy (0.87 [95% CI, 0.76-0.98]). Intrarater reliability for the individual shoulder specialist was similar to that of the composite reviews. CONCLUSIONS: There was high interrater and intrarater reliability for most findings on shoulder MRI. Analysis of our data supports the reliability of MRI assessment by shoulder specialists for rotator cuff disorders.
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