MR EVALUATION OF ROTATOR CUFF PATHOLOGY USING T2-WEIGHTED FAST SPIN-ECHO TECHNIQUE WITH AND WITHOUT FAT-SUPPRESSION

OBJECTIVE. This study was designed to compare MR imaging findings from T2-weighted fast spin-echo images with and without fat suppression an d then to compare surgical results with those MR imaging interpretatio ns in the evaluation of rotator cuff disease. SUBJECTS AND METHODS. T2 -weighted fast spin-echo images-with and without fat suppression-of 17 7 shoulder MR imaging studies were reviewed separately in a retrospect ive, randomized, and blinded fashion. Both sets of images were read in conjunction with the corresponding proton density-weighted images, Th e diagnosis of normal tendon, tendinosis, degeneration, and partial- a nd full-thickness tears was made using established criteria. RESULTS. T2-weighted fast spin-echo techniques with and without fat suppression showed excellent agreement in the diagnosis of normal tendon (kappa = .90) and full-thickness tears (kappa = .98), good agreement for parti al tears (kappa = .70) and moderate agreement for the combined group o f tendinosis and degeneration (kappa = .53). MR imaging and surgical c orrelation in 43 patients showed 86% specificity (95% confidence inter val, 65-96%) for intact tendons, and 100% sensitivity (95% confidence interval, 82-100%) for full-thickness tears on T2-weighted fast spin-e cho imaging-both without and with fat suppression. For partial fears, MR imaging showed a sensitivity of 92% (95% confidence interval, 65-99 %) with fat suppression and 67% (95% confidence interval, 39-86%) with out fat suppression. CONCLUSION. T2-weighted fast spin-echo imaging-wi th or without fat suppression-is a highly sensitive technique in the d iagnosis of normal tendons and complete tears of the rotator cuff. Bec ause of increased lesion conspicuity, fat suppression tends to perform better in the diagnosis of partial tears.