Citations

Objective This study aimed to investigate the effect of calcific tendinosis on the diagnosis of rotator cuff tears (RCTs) on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA). Materials and Methods Calcific tendinosis was confirmed radiographically. Two musculoskeletal radiologists then retrospectively and independently reviewed the MRI/MRA examinations, with surgery or arthroscopy performed within 90 days of the MRI. Rotator cuffs were categorized as no tear, partial-thickness tear, and full-thickness tear. Partial-thickness tear/full-thickness tear groups were combined for analysis. Results Forty-eight MRI (mean age, 63.4 years; range, 37–83 years; female-to-male ratio, 29:19) and 7 MRA (mean age, 49.2 years; range, 25–60 years; female-to-male ratio, 4:3) patients were included. Reader 1 and reader 2 sensitivity/specificity values for RCTs on MRI were 95%/50% and 89%/30%, and the values on MRA were 100%/67% and 100%/100%, respectively. Overall agreement was present in 87% (48 of 55; κ = 0.55 [95% confidence interval, 0.26–0.85]). Conclusions Magnetic resonance imaging has decreased specificity in diagnosing RCTs when calcific tendinosis is present. Magnetic resonance arthrography performed better in this population and could be considered.

Purpose The purpose of this investigation is to assess the incidence of rotator cuff tears in cases of calcific tendonitis and evaluate for differences in the incidences of rotator cuff tears by magnetic resonance imaging (MRI) between calcific lesions of different morphology, size, or location. Methods This single‐center study involved a retrospective chart review searching for patients from January 2010 to April 2017 with a diagnosis of calcific tendonitis of the shoulder based on review of all MRI reads done on patients with shoulder pain. Anteroposterior radiographic and MRI studies were reviewed by a musculoskeletal radiologist to assess calcific tendonitis morphology, size, distance from cuff insertion, and any rotator cuff tear. An additional radiologist evaluated calcific tendonitis size, morphology, and location to evaluate the reliability of these variables. Results In the final cohort of 318 shoulders with calcific tendonitis, the incidence of concomitant rotator cuff tears was 56%. Of all 177 tears, 164 (93%) were partial‐thickness and 13 (7%) were complete. Type III calcification morphology (cloudy with soft contour) was most frequently associated with rotator cuff tears and demonstrated an increased odds of tear by a factor of 1.8 (CI 95% 1.1‐2.9).There was no statistical difference regarding calcification size or location prognosticating rotator cuff tears or tear thickness. Intraclass correlation coefficients for calcification size, morphology, and location were 0.78, 0.30, and 0.50, respectively. Conclusions The incidence of rotator cuff tears in cases of calcific tendonitis in this cohort of patients who underwent MRI is higher than previously reported. Cloudy‐appearing calcified lesions showed a significant association with rotator cuff tears with an odds ratio of 1.8. Specific locations or sizes of calcified lesions do not appear to be reliable factors to predict concomitant rotator cuff tears. Interobserver agreement for these radiographic variables ranged from fair to substantial and prompt a cautious interpretation of these results. Level of Evidence IV Retrospective Case Series.