Jae Hyun Cho MD, Abstract Co-Author: Nothing to Disclose

Kyu Sung Kwack, Presenter: Nothing to Disclose

Sun Yong Kim MD, Abstract Co-Author: Nothing to Disclose

Eun-Jin Kim, Abstract Co-Author: Nothing to Disclose

In daily practice, we frequently observed focal osteopenia in lateral aspect of the humeral head in patients with rotator cuff tear, shown on shoulder MRI. In spite of normal radiolucency in the apophyseal portion of the long bone(s), the focal osteopenia was significantly prominent in patient with rotator cuff tear. We named it as "dark humeral head sign” and tested the diagnostic efficacy by comparing it with non-rotator cuff tear group.

We chose 101 plain shoulder AP radiography in patients with non-traumatic shoulder pain, and divided them into rotator cuff tear group (RCT) and non-tear group (non-RCT) diagnosed by MRI. The number of RCT group was 69 and non RCT group was 32. Four scale scoring system was adopted for the evaluation of the degree of radiolucency. The area of humeral head and neck was devided into 5 zones. The score of individual zone was added by various combinations so as to find most reliable zones and scoring method. Two experienced musculoskeletal radiologists evaluated image set by consensus without knowing the MR findings. One way ANOVA test and ROC curve analysis were done using SPSS version 11.0.

The mean score of radiolucency in RCT group was 2.10±0.546, and in non-RCT group, 1.84±0.628. In 4 of 5 zones, the degree and frequency of radiolucency in RCT group were more higher than in non-RCT group. The score of radiolucency was significantly higher in RCT group (p<0.05). In ROC curve analysis, area under the curve(AUC) with combination of 3 zones was 0.69. The sensitivity and specificity of the dark humeral head sign were 87% and 34.4% with cutoff value of 2.50. Interestingly, the AUC showed increasing tendency with the ages of the patients. If the patient's age was over 49 years old, dark humeral head sign showed the moderate accuracy (AUC=0.76).

Dark humeral head sign may be a useful cost-effective predictor of the rotator cuff tear. If one see dark humeral head sign in plain radiograph of patient with shoulder pain, shoulder MR examination is needed for possible rotator cuff tear.

Dark humeral head sign may be a useful cost-effective predictor of the rotator cuff tear.

Cho, J, Kwack, K, Kim, S, Kim, E, Dark Humeral Head Sign on Plain Radiography: A Diagnostic Indicator of Rotator Cuff Tear.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5016413.html