A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

Susan van Grinsven; Corné van Loon; Maarten van Gorp; Marjolijn van Kints; Peer Konings; Albert van Kampen

doi:10.1016/j.ejrad.2015.07.016

A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

Eur J Radiol. 2015 Nov;84(11):2242-9. doi: 10.1016/j.ejrad.2015.07.016. Epub 2015 Jul 21.

Authors

Susan van Grinsven¹, Corné van Loon², Maarten van Gorp³, Marjolijn van Kints⁴, Peer Konings⁵, Albert van Kampen⁶

Affiliations

¹ Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: svangrinsven@rijnstate.nl.
² Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: cvanloon@rijstate.nl.
³ Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: mvangorp@rijnstate.nl.
⁴ Department of Radiology, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands. Electronic address: mvankints@rijnstate.nl.
⁵ Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA Arnhem, The Netherlands.
⁶ Department of Orthopaedics, Radboud University Medical Centre, PO Box 9101, 6501 HB Nijmegen, The Netherlands. Electronic address: albert.vankampen@radboudumc.nl.

PMID: 26239709
DOI: 10.1016/j.ejrad.2015.07.016

Abstract

Purpose: To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution.

Materials and methods: Forty-five surgically confirmed MRA's were used to enhance personal feedback, to discuss differences in outcome between MRA assessment and surgical findings and to fine-tune definition interpretation agreement of 7 different TASI-related lesions, between experienced musculoskeletal radiologists and experienced orthopaedic shoulder surgeons. After execution of the feedback protocol 20 new, surgically confirmed, MRA's were assessed by 2 experienced musculoskeletal radiologists using a seven-lesion standardized scoring form. Kappa coefficients, sensitivity, specificity, and differences in percentage agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per 7 lesion types to assess whether diagnostic reproducibility and accuracy was improved.

Results: Per 7 lesion types, the overall kappa and percentage of agreement, between the 2 radiologists, were dramatically increased in comparison with our former study (k=0.81 versus k=0.48 and 90.7% versus 78.2%, respectively). The overall sensitivity of radiologist 1 increased from 45.9% to 87.8%, the overall sensitivity of radiologist 2 increased from 63.5% to 79.6% and the overall specificity of radiologist 2 increased from 80.1% to 85.7%. Furthermore, the overall percentage of correct diagnosis of both radiologist was also exceedingly higher (85.7% and 83.6%) compared to our former study (74.4% and 74.8%).

Conclusion: The implementation of our feedback protocol dramatically improved the reproducibility and accuracy of high field MRA by experienced musculoskeletal radiologist in patients with traumatic anterior shoulder instability.

Keywords: Accuracy; Anterior traumatic shoulder dislocation; Arthroscopy; Magnetic resonance arthrography; Reproducibility; Shoulder joint.

MeSH terms

Adolescent
Adult
Arthrography*
Clinical Competence*
Clinical Protocols
Female
Formative Feedback
Humans
Joint Instability / diagnosis*
Magnetic Resonance Imaging*
Male
Middle Aged
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Shoulder Joint / pathology*
Young Adult