Concordância interobservador na avaliação de lesões do tendão subescapular usando imagens de Ressonância Nuclear Magnética
Authors: Tanure Aleixo Abreu , Maia Roberto Barreto , Fortaleza Thiago Alencar , Alves Rezende Luis Guilherme Rosifini , Cabral Adriana Vieira Pedreira , Barros Rogério Meira 
Published: April 2019

Introdução: As lesões do tendão musculo subescapular (TMSE) do manguito rotador passaram a ter aumento de sua incidência com as avançadas técnicas de diagnostico por imagem e artroscópicas. A Ressonância Nuclear Magnética (RM) apresenta boa sensibilidade e especificidade permitindo adequada acurácia diagnóstico. Objetivo: avaliação da concordância interobservador da RM para Lesões do TMSE comparada à artroscopia. Métodologia: 49 pacientes sintomáticos foram submetidos à RM para diagnóstico de lesão do TMSE e avaliação da Classificação de Lafosse, tendo sua concordância avaliada através da Artroscopia diagnostica. Resultados: A acurácia global foi 68% para concordância diagnóstica da Lesão do TMSE e 57,1% para concordância na classificação de Lafosse. Discussão: obteve-se concordância para o diagnóstico de Lesão ou ausência de Lesão do TMSE de 0,49 e a concordância para a Classificação de Lafosse foi de 0,30. Conclusão: o diagnóstico da lesão do TMSE através da RM é de difícil realização.Descritores: Manguito Rotador; Artroscopia; Imagem por Ressonância Magnética.ReferênciasTicker JB, Warner JJ. Single-tendon tears of the rotator cuff: evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears. Orthop Clin North Am. 1997; 28(1):99-116.  Codman EA. Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. The Shoulder. 2nd Ed. Boston: Thomas Todd; 1934. p. 262-312.  Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25(1):13-22.Li XX, Schweitzer ME, Bifano JA, Lerman J, Manton GL, El-Noueam KI. MR evaluation of subscapularis tears. J Comput Assist Tomogr. 1999;23(5):713-17.  Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26(11):1427-33.Adams CR, Brady PC, Koo SS, Narbona P, Arrigoni P, Karnes GJ et al. A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2012; 28(11):1592-600.Pfirrmann CWA, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: Detection and grading at MR ar- thrography. Radiology. 1999; 213:709-714.Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg. 2013;22(9):1186-92.Beltran J. The use of magnetic resonance imaging about the shoulder. J Shoulder Elbow Surg. 1992; 1(6):321-33.Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg. 2011; 20(4):537-42.Burks RT, Crim J, Brown N, Fink B, Greis PE. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med. 2009;37(4):674-82. Gyftopoulos S, O' Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience. Skeletal Radiol. 2013;42(9):1269-75.Pfirrmann CW1, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999;213(3):709-14.Spencer EE Jr, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008;36(1):99-103.Toussaint B, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y et al. New endoscopic classification for subscapularis lesions. Orthop Traumatol Surg Res. 2012;98(8 Suppl):S186-92.Lafosse L, Jost B, Reiland Y, Audebert S, Tousaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subescapularis tears. J Bone Joint Surg Am. 2007;89(6):1184-93.Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.Balich SM, Sheley RC, Brown TR, Sauser DD, Quinn SF. MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology. 1997; 204(1):191-94.Robertson PL, Schweitzer ME, Mitchell DG, Schlesinger F, Epstein RE, Frieman BG et al. Rotator cuff disor- ders: interobserver and intraobserver variation in diagnosis with MR imaging. Radiology. 1995;194(3):831-35.Singson RD, Hoang T, Dan S, Friedman M. MR evaluation of rotator cuff pathology using T2-weighted fast spin-echo technique with and without fat suppression. AJR Am J Roentgenol. 1996; 166:1061-65.Szymanski C1, Staquet V, Deladerrière JY, Vervoort T, Audebert S, Maynou C. Reproducibility and reliability of subscapularis tendon assessment using CT-arthrography. Orthop Traumatol Surg Res. 2013;99(1):2-9.