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5/8/2014 1 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

24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

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Page 1: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�1

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

Page 2: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�2

� 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

Page 3: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�3

� 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

Page 4: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�4

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

Page 5: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�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

Page 6: 24LucasQuantitativeAssessmentOfRotatorCuffFattyInfiltratio ...€¦ · Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 2014 I have no relevant disclosures

�5/8/2014

�6

� 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