Quantitative MRI characterization of arthroscopically verified supraspinatus pathology: comparison of tendon tears, tendinosis and asymptomatic supraspinatus tendons with T2 mapping

Authors:

Edmund Ganal, Charles P Ho, Katharine J Wilson, Rachel K Surowiec, W Sean Smith, Grant J Dornan, Peter J Millett

Abstract:

Rotator cuff pathology accounts for over 4.5 million physician visits annually. Diagnosis of a rotator cuff tear can often be obtained with a detailed history and physical examination, with imaging commonly used to deter- mine specific clinical pathology. In particular, conventional magnetic resonance imaging (MRI) plays a significant role in differentiating tendinosis from partial and full-thickness tears, determining the quality of the tendon, detecting atrophy and fatty degeneration of the muscle, and identifying associated shoulder pathology.

Currently, MRI is the most effective imaging modality in the evaluation of the rotator cuff; however, its diagnostic sensitivity and specificity remain variable. Diagnosis of rotator cuff pathology through MRI is based on qualitative morphology and signal change and becomes increasingly difficult in the presence of partial rotator cuff tears. Tendinosis is even more challenging to diagnosis because the morphology is not affected and signal intensity alone has proven unreliable in differentiating between normal and degenerative rotator cuff tendons. A more robust method of quantifying the differences between asymptomatic and damaged rotator cuff tendons is needed to improve MRI diagnosis for treatment planning.

Conventional MRI findings provide information on tendon morphology and tear size but do not allow for earlier detection of tendon degeneration and associated histologic biochemical changes. Quantitative information would be clinically valuable to augment subjective interpretation in the diagnosis of rotator cuff pathology, predict progression of rotator cuff disease, formulate a treatment plan particularly for partial rotator cuff tears and minimally retracted full rotator cuff tears, and assess the outcome of treatment. Novel quantitative biochemical MRI techniques, such as T2 mapping, have been increasingly evaluated for their demonstrated sensitivity in detection of earlier biochemical changes (i.e. collagen bril structure, orientation, and water content) in various tissues. When evaluating the tendon, several studies have demonstrated that the bulk T2 values are multi-exponential and that T2 relaxation times may be feasible to monitor the levels of degeneration and the healing process of collagen structures in the tendon non-invasively [30]. These hypotheses have been corroborated in work performed using T2 mapping in the Achilles tendon and in the asymptomatic supraspinatus tendon. Anz described T2 mapping for the evaluation of the supraspinatus tendon in asymptomatic individuals and reported excellent inter- and intra-rater reliability. This study demonstrated that T2 values corresponded to the anatomical structure of the muscle–tendon unit with no significant effect due to the ageing process in asymptomatic individuals. However, the effect of earlier degeneration of the supraspinatus tendon on T2 values remains largely unknown.

Before T2 mapping can be implemented into the routine clinical protocol, it is essential that the T2 values of various stages of rotator cuff pathology are documented. As such, the purpose of this prospective study was to evaluate the clinical use of MRI T2 mapping for arthroscopically verified pathologic supraspinatus tendons. Our hypothesis was that there would be differences in T2 values of supraspinatus tendons with non-tear tendinosis and with partial or minimally (slightly) retracted full-thickness tears, com- pared with asymptomatic supraspinatus tendons. Using the subregions proposed by Anz, it was additionally hypothesized that the analysis would yield high inter- and intra-rater reliability measurements in this pathological cohort. The results of this study will help to con rm variability of T2 values, establish T2 values in various stages of rotator cuff pathology, and evaluate how these values differ from a screened asymptomatic cohort, and help clinicians to better predict at-risk groups and to stratify treatment options.

For the complete study: Quantitative MRI characterization of arthroscopically verified supraspinatus pathology: comparison of tendon tears, tendinosis and asymptomatic supraspinatus tendons with T2 mapping

Peter Millett, MD

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Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Quantitative MRI characterization of arthroscopically verified supraspinatus pathology: comparison of tendon tears, tendinosis and asymptomatic supraspinatus tendons with T2 mapping

Authors:

Abstract:

About the Author: Peter Millett, MD