Advertisement

Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy

Abstract

Objective

To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for detection of instability and tears of the proximal long head of biceps tendon (LHBT). To assess intraobserver and interobserver agreement.

Materials and methods

We performed a retrospective analysis of prospectively collected data of 100 consecutive shoulders who underwent non-contrast 1.5-T MRI prior to arthroscopic surgery due to rotator cuff injury. Images were independently analyzed by two musculoskeletal radiologists. LHBT was evaluated for presence of tearing (intact, longitudinal split, partial-thickness, or full-thickness) and position (normal, subluxated, and dislocated). Anterosuperior rotator cuff tears were also assessed. The reference standard was arthroscopic surgery. The ramp test was performed in order to evaluate LHBT stability. Diagnostic performance measures were determined and Kappa coefficients assessed agreement.

Results

Concerning the detection of overall tears, sensitivity ranged from 71 to 73% and specificity was 73%. The specificity for full-thickness tears ranged from 75 to 96%. Overall displacement showed sensitivity ranging from 51 to 58% and specificity ranging from 70 to 86%. The specificity of overall displacement combined with anterosuperior rotator cuff tears ranged from 73 to 91%. Interobserver Kappa values were between 0.59 and 0.69. Intraobserver Kappa values were between 0.74 and 0.82.

Conclusions

MRI has moderate accuracy and good agreement for detection of LHBT tears and instability. There is a tendency for increased specificity for full-thickness tears and for instability in the coexistence of anterosuperior rotator cuff tears.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 199

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

MRI:

Magnetic resonance imaging

LHBT:

Long head of biceps tendon

MRA:

Magnetic resonance arthrography

References

  1. 1.

    Watson ST, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS. Comparison of outcomes 1 year after rotator cuff repair with and without concomitant biceps surgery. Arthroscopy. 2017;33:1928–36.

  2. 2.

    Alpantaki K. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg. 2005;87:1580–3.

  3. 3.

    Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003;180:633–9.

  4. 4.

    Williams GR. Painful shoulder after rotator cuff surgery. J Am Acad Orthop Surg. 1997;5:97–108.

  5. 5.

    Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg (Br). 2007;89:1001–9.

  6. 6.

    Gilmer BB, DeMers AM, Guerrero D, Reid JB, Lubowitz JH, Guttmann D. Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy. 2015;31:29–34.

  7. 7.

    Holtby R, Razmjou H. Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20:231–6.

  8. 8.

    Creech MJ, Yeung M, Denkers M, Simunovic N, Athwal GS, Ayeni OR. Surgical indications for long head biceps tenodesis: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24:2156–66.

  9. 9.

    Morag Y, Bedi A, Jamadar DA. The rotator interval and long head biceps tendon: anatomy, function, pathology, and magnetic resonance imaging. Magn Reson Imaging Clin N Am. 2012;20:229–59.

  10. 10.

    Tuckman GA. Abnormalities of the long head of the biceps tendon of the shoulder: MR imaging findings. AJR Am J Roentgenol. 1994;163:1183–8.

  11. 11.

    Lee RW, Choi SJ, Lee MH, Ahn JH, Shin DR, Kang CH, et al. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears. Skelet Radiol. 2016;45:1705–15.

  12. 12.

    Borrero CG, Costello J, Bertolet M, Vyas D. Effect of patient age on accuracy of primary MRI signs of long head of biceps tearing and instability in the shoulder: an MRI-arthroscopy correlation study. Skelet Radiol. 2018;47:203–14.

  13. 13.

    De Maeseneer M, Boulet C, Pouliart N, Kichouh M, Buls N, Verhelle F, et al. Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography. Eur J Radiol. 2012;81:934–9.

  14. 14.

    Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elb Surg. 2016;25:38–44.

  15. 15.

    Omoumi P, Bafort A-C, Dubuc J-E, Malghem J, Vande Berg BC, Lecouvet FE. Evaluation of rotator cuff tendon tears: comparison of multidetector CT arthrography and 1.5-T MR arthrography. Radiology. 2012;264:812–22.

  16. 16.

    Mohtadi NG, Vellet AD, Clark ML, Hollinshead RM, Sasyniuk TM, Fick GH, et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elb Surg. 2004;13:258–65.

  17. 17.

    Tadros AS, Huang BK, Wymore L, Hoenecke H, Fronek J, Chang EY. Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skelet Radiol. 2015;44:1263–72.

  18. 18.

    Dubrow SA, Streit JJ, Shishani Y, Robbin MR, Gobezie R. Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI. Open Access J Sports Med. 2014;5:81–7.

  19. 19.

    Zanetti M, Weishaupt D, Gerber C, Hodler J. Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography. AJR Am J Roentgenol. 1998;170:1557–61.

  20. 20.

    Malavolta EA, Assunção JH, Guglielmetti CLB, de Souza FF, Gracitelli MEC, Ferreira Neto AA. Accuracy of preoperative MRI in the diagnosis of disorders of the long head of the biceps tendon. Eur J Radiol. 2015;84:2250–4.

  21. 21.

    Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elb Surg. 2011;20:537–42.

  22. 22.

    Oku EC, Andrade AP, Stadiniky SP, Carrera EF, Tellini GG. Tradução e adaptação cultural do modified-University of California at Los Angeles Shoulder Rating Scale para a língua Portuguesa. Rev Bras Reumatol. 2006;46:246–52.

  23. 23.

    Knaut L, Moser AD, Melo SDA, Richards RR. Tradução e adaptação cultural à língua portuguesa do American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) para avaliação da função do ombro. Rev Bras Psiquiatr. 2010;50:176–83.

  24. 24.

    Gaskin CM, Anderson MW, Choudhri A, Diduch DR. Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: MR imaging findings, surgical correlation, and clinical significance. Skelet Radiol. 2009;38:959–65.

  25. 25.

    Buck FM, Grehn H, Hilbe M, Pfirrmann CWA, Manzanell S, Hodler J. Degeneration of the long biceps tendon: comparison of MRI with gross anatomy and histology. AJR Am J Roentgenol. 2009;193:1367–75.

  26. 26.

    Yamaguchi K, Bindra R. Disorders of the biceps tendon. In: Iannott JP, Willians G, Miniaci A, Zuckerman J, editors. Disorders of the shoulder: diagnosis and management. 1st ed. Philadelphia: Lippincott Willians and Wilkins; 1999.

  27. 27.

    Walch G, Nove-Josserand L, Levigne C, Renaud E. Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elb Surg. 1994;3:353–60.

  28. 28.

    Spritzer CE, Collins AJ, Cooperman A, Speer KP. Assessment of instability of the long head of the biceps tendon by MRI. Skelet Radiol. 2001;30:199–207.

  29. 29.

    Habermeyer P. Rotatorenintervall und lange bizepssehne. Rotatorenmanschette. Munchen: Jena, Urban and Ficher; 2002. p. 333–74.

  30. 30.

    Festa A, Allert J, Issa K, Tasto JP, Myer JJ. Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy. Arthroscopy. 2014;30:1413–7.

  31. 31.

    Motley GS, Osbahr DC, Holovac TF, Speer KP. An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test. Arthroscopy. 2002;18:1–5.

  32. 32.

    Landis JRL, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

  33. 33.

    Braun S, Horan MP, Elser F, Millett PJ. Lesions of the biceps pulley. Am J Sports Med. 2011;39:790–5.

  34. 34.

    Baumann B, Genning K, Böhm D, Rolf O, Gohlke F. Arthroscopic prevalence of pulley lesions in 1007 consecutive patients. J Shoulder Elb Surg. 2008;17:14–20.

  35. 35.

    Kang Y, Lee JW, Ahn JM, Lee E, Kang HS. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skelet Radiol. 2017;46:1335.

  36. 36.

    Weishaupt D, Zanetti M, Tanner A, Gerber C, Hodler J. Lesions of the reflection pulley of the long biceps tendon. MR arthrographic findings. Investig Radiol. 1999;34:1–10.

  37. 37.

    Jung JY, Yoon YC, Yi SK, Yoo J, Choe BK. Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder. Skelet Radiol. 2009;38:659–67.

  38. 38.

    Skendzel JG, Jacobson JA, Carpenter JE, Miller BS. Long head of biceps brachii tendon evaluation: accuracy of preoperative ultrasound. AJR Am J Roentgenol. 2011;197:942–8.

  39. 39.

    Bennett WF. Visualization of the anatomy of the rotator interval and bicipital sheath. Arthroscopy. 2001;17:107–11.

  40. 40.

    Smith TO, Daniell H, Geere J, Toms AP, Hing CB. The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging. 2012;30:336–46.

  41. 41.

    De Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol. 2009;192:1701–7.

  42. 42.

    Taylor SA, Khair MM, Gulotta LV, Pearle AD, Baret NJ, Newman AM, et al. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex. Arthroscopy. 2015;31:215–24.

  43. 43.

    Kuhn JE, Dunn WR, Ma B, Wright RW, Jones G, Spencer EE, et al. Interobserver agreement in the classification of rotator cuff tears. Am J Sports Med. 2007;35:437–41.

  44. 44.

    Lenza M, Buchbinder R, Takwoingi Y, Rv J, Nca H, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered (review). Cochrane Database Syst Rev. 2013;24(9):CD009020.

Download references

Author information

Correspondence to Eduardo Baptista.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

(MP4 43685 kb)

ESM 1

(MP4 43685 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Baptista, E., Malavolta, E.A., Gracitelli, M.E.C. et al. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skeletal Radiol 48, 1723–1733 (2019) doi:10.1007/s00256-019-03214-z

Download citation

Keywords

  • MRI
  • Long head of biceps tendon
  • Tendon tears
  • Instability
  • Diagnostic accuracy