24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai...

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Robert Lucas MD, Drew Lansdown MD, Sonia Lee MD, Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD,

C.Benjamin Ma MD

May 8, 2014

�I have no relevant disclosures

� Increasing prevalence with the aging population, significant burden on health care system. � Colvin. JBJS 2012. � AAOS. 2004� Yamaguchi. AAOS Jan 2011� Fucentese. JBJS 2012

� Durable results 10 years post op. � Fucentese. JBJS 2012

� Functional outcome correlates with repair integrity.� Fuchs. JBJS 2006

� Predictors of failure:� Age� Tear size� Muscle atrophy� Fatty infiltration

� Boileau. JBJS 2005� Lafosse. JBJS 2007� Adamson. JSES 1993

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� Increasing prevalence with the aging population, significant burden on health care system. � Colvin. JBJS 2012. � AAOS. 2004� Yamaguchi. AAOS Jan 2011� Fucentese. JBJS 2012

� Durable results 10 years post op. � Fucentese. JBJS 2012

� Functional outcome correlates with repair integrity.� Fuchs. JBJS 2006

� Predictors of failure:� Age� Tear size� Muscle atrophy� Fatty infiltration

� Boileau. JBJS 2005� Lafosse. JBJS 2007� Adamson. JSES 1993

� Correlates with:� Size and duration of the tear

� Goutallier. JSES 2003.� Higher risk of repair failure

� Gladstone. AJSM 2007.� Gerber. JSES 2007.

� Tear size progression� Maman. JBJS 2009.

� Worse clinical and radiographic outcomes� Maman. JBJS 2009.� Jost. JBJS 2000.� Zingg. JBJS 2007.

* p<0.05

� Subjective� Qualitative� Questionable reliability

� Moderate intra (K 0.43) and inter-observer reliabilty (K 0.56)

� Slabaugh. AJSM 2012. � Poor inter-observer agreement (K 0.1)

� Spencer. AJSM 2008.

0 1 2 3 4

� Quantitative fat measurement� Reeder. J Magn Reson. Imag. 2005.

� Validated in vivo:� Lipid extraction � Quantitative histologic analysis � Chemical analysis

� Hines. Radiology 2010.� Hu. Int J Body Compos Res 2011.

� Previously proven reliable in shoulder� Excellent ICC 0.94� Correlates with Goutallier’s Classification

� Nardo. J Magn Reson Imaging 2013

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� IDEAL MRI fat quantification will provide a continuous objective variable that correlates with rotator cuff tendon pathology.

� 182 patients underwent MRI scans for shoulder pain�IDEAL MRI scans

�Manually segmented for regions of interest�Fat content quantified with computer program

�Clinical MRI scans�AP Rotator Cuff tendon tear size�Tear retraction �Supraspinatus atrophy (occupation ratio)

37 74 7101020304050607080

No Tear- Partial thickness tear Full thickness tear

Pathology

Num

ber

of

pat

ien

ts

18 29 14 1005101520253035

Small Medium Large Massive

Full Thickness Cuff Tears

37 74 7101020304050607080

No Tear- Partial thickness tear Full thickness tear

Pathology

Num

ber

of

pat

ien

tsN

umb

er o

f p

atie

nts

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Spearman Rho CorrelationsClinical Variable Supraspinatus

IDEALInfraspinatus IDEAL

SupraspinatusOccupation Ratio

0.728* 0.57*

Anterior Posterior Rotator Cuff Tear Size

0.638* 0.449*

Tear Retraction 0.631* 0.39*

IS IDEAL fat fraction value

0.79* --

Age 0.468* 0.391*

Chronicity 0.24* 0.165*

0

5

10

15

20

25

30

35

� none � small �medium � large �massive

InfraspinatusSupraspinatus

IDE

AL

fat

fra

ctio

n v

alu

e

Rotator Cuff Tear Size

IDEAL Fat Fraction vs Rotator Cuff Tear Size

* *

* p<0.05

0

5

10

15

20

25

30

35

� none � small �medium � large �massive

InfraspinatusSupraspinatus

IDE

AL

fat

fra

ctio

n v

alu

e

Rotator Cuff Tear Size

IDEAL Fat Fraction vs Rotator Cuff Tear Size

*

* p<0.05

0

5

10

15

20

25

30

35

� none � small �medium � large �massive

InfraspinatusSupraspinatus

IDE

AL

fat

fra

ctio

n v

alu

e

Rotator Cuff Tear Size

IDEAL Fat Fraction vs Rotator Cuff Tear Size

*

* p<0.05

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�5

0

5

10

15

20

25

30

35

40

� noneless than 1cm

� less than humeralhead

� humeral head toglenoid

� glenoid

SupraspinatusInfraspinatus

Rotator Cuff tear retraction

IDE

AL

fat

fra

ctio

n v

alu

e

IDEAL Fat Fraction vs Rotator Cuff Tear Retraction

*

*

* p<0.05

0

5

10

15

20

25

30

35

40

� noneless than 1cm

� less than humeralhead

� humeral head toglenoid

� glenoid

SupraspinatusInfraspinatus

Rotator Cuff tear retraction

IDE

AL

fat

fra

ctio

n v

alu

e

IDEAL Fat Fraction vs Rotator Cuff Tear Retraction

*

*

* p<0.05

0

5

10

15

20

25

30

35

40

� noneless than 1cm

� less than humeralhead

� humeral head toglenoid

� glenoid

SupraspinatusInfraspinatus

Rotator Cuff tear retraction

IDE

AL

fat

fra

ctio

n v

alu

e

IDEAL Fat Fraction vs Rotator Cuff Tear Retraction

*

*

* p<0.05

0

5

10

15

20

25

30

35

40

0-0.24 0.25-0.49 0.5-0.74 0.75-1

IDEAL vs Supraspinatus Occupation Ratio

InfraspinatusSuprapinatus

*

IDE

AL

fat

fra

ctio

n v

alu

e

Supraspinatus Occupation ratio

**

*

* p<0.05

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� IDEAL MRI provides a continuous objective variable with which to quantify rotator cuff muscular fatty infiltration. � IDEAL MRI fat fraction values significantly correlate with the severity of rotator cuff tendon pathology.

� Longitudinal study� Pre and post operative evaluation

� Natural history of rotator cuff muscle degeneration� Guidance in clinical decision making