Rotator Cuff Tendon Assessment in Symptomatic and Control Groups Using Quantitative MRI

Background: Relatively weak correlations between patient symptoms and rotator cuff tendon (RCT) tearing have been reported; however, the relationship between symptoms and tendinosis has been less well-studied.

Purpose/hypothesis: To use quantitative MRI to assess the bilateral RCTs in shoulders of both patients with unilateral symptomatic tendinopathy and control subjects. We hypothesized that quantitative MRI measures would differ between symptomatic patients and controls.

Study type: Prospective imaging study.

Population/subjects: In all, 48 shoulders from 24 subjects (mean age, 32.8 years), including 14 patients with unilateral symptomatic tendinopathy and 10 asymptomatic controls.

Field strength/sequence: 3T/3D ultrashort echo time Cones sequence with magnetization transfer preparation (UTE-Cones-MT) and Carr-Purcell-Meiboom-Gill.

Assessment: Macromolecular fraction (MMF) and T₂ relaxation were measured in four regions of the superior RCT, including all-segments, and lateral-third, bursal-sided, and articular-sided segments. The Western Ontario Rotator Cuff (WORC) index and visual analog scale were assessed.

Statistical tests: Three shoulder groups were evaluated, including symptomatic shoulders, contralateral asymptomatic shoulders in patients, and asymptomatic controls. MMF and T₂ values were compared between groups using a bootstrap-based comparison of means.

Results: Significant differences were found in both MMF and T₂ values between symptomatic and control RCTs when analyzing all-segments (P = 0.027 and P = 0.006, respectively) and articular-sided segments (both P = 0.001). Significant differences between asymptomatic RCTs in patients and control RCTs were also found, including MMF in all four anatomic regions analyzed (P = 0.024-0.044), as well as T₂ in all-segments (P = 0.003), bursal-sided segments (P = 0.021), and articular-sided segments (P = 0.002). No significant differences in MMF (P = 0.420-0.950) or T₂ (P = 0.380-0.910) were seen between ipsilateral symptomatic and contralateral asymptomatic RCTs in patients.

Data conclusion: Symptomatic RCTs showed significantly lower MMF values and higher T₂ values compared with control RCTs. In patients with unilateral symptomatic tendinopathy, the contralateral shoulder can demonstrate asymptomatic tendinopathy, which can be quantified using MMF or T₂ .

Evidence level: 2 TECHNICAL EFFICACY: Stage 2. J. Magn. Reson. Imaging 2020;52:864-872.