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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
�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
�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
�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
�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
�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