MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions

Authors:

Adam W Anz, Erin P Lucas, Eric K Fitzcharles, Rachel K Surowiec, Peter J Millett, Charles P Ho

Abstract:

Evaluation of the rotator cuff has improved with advancements in conventional MRI technology. Clinicians can gain insight into the morphologic status of tendon to attachment with qualitative interpretation of images. However, the sensitivity and specificity of MRI to determine pathology has proven variable, especially in the presence of tendonopathy and partial rotator cuff tears and the evaluation of signal intensity alone may contribute to lack of reliability. Furthermore, diagnosis and monitoring of post-repair tendon health with MRI also remains largely subjective.

The degenerative process of rotator cuff tendons involves alterations in collagen structure and biochemical composition. Quantitative MRI has demonstrated to be sensitive to biochemical changes in cartilage, recently in cartilage of the glenohumeral joint, and could potentially be used to detect subtle changes in the biochemical composition of tendons associated with tendon degeneration. Initial studies have shown promise for detecting tendon pathology using quantitative MRI. Pilot clinical application reported anatomic variation in T2 values within the Achilles tendon-muscle unit in asymptomatic volunteers, and differences in T2 values between asymptomatic volunteers and those with chronic Achilles tendinopathy. To our knowledge, there are no published studies which analyze the rotator cuff tendons using quantitative MRI mapping. Quantifiable, objective data on the health status of the rotator cuff would be exceptionally useful in a clinical setting for the non-invasive diagnosis of injury and tracking post-surgical treatment response. To date, T2 mapping is the most commonly used mapping sequence within clinical practice, thus evaluation of T2 mapping for diagnosing rotator cuff pathology has high clinical relevance and potential for implementation.

Before applying T2 mapping scans to the clinical population, it is essential to appreciate normative T2 values and the distribution of these values within the rotator cuff tendons to serve as a baseline, similar to previous normative studies of the tendons utilizing classic MRI technology. Therefore, the objective of this prospective study was evaluate verified asymptomatic volunteers using T2 mapping in order to establish a quantitative MRI protocol using T2 mapping for this purpose and to determine normative T2 values in asymptomatic tendons across age groups. We hypothesized that a normal range and pattern of T2 values exists which correlates to the anatomic structure of the muscle-tendon unit. Additionally, we hypothesized that due to compositional changes which occur during aging, differences in T2 values would be observed across age groups. The results of this study will establish normative, asymptomatic T2 values for the supraspinatus tendon according to age, which can later be used as a reference and baseline for comparison for T2 mapping of damaged rotator cuff tendons and mapping of healing rotator cuff tendons after repair using these clinically relevant subregions.

For the complete study: MRI T2 mapping of the asymptomatic supraspinatus tendon by age and imaging plane using clinically relevant subregions

Peter Millett, MD

Average rating:

39 reviews

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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