MRI-Based Quantitative Assessment of Calcific Tendinopathy: Imaging Predictors and Thresholds for Rotator Cuff Tear Detection.

OBJECTIVE

To quantitatively evaluate MRI-derived morphologic and bursal parameters in patients with calcific tendinopathy (CaT) of the shoulder and to determine imaging thresholds predictive of rotator cuff (RC) tears.

MATERIALS AND

METHODS

In this retrospective, single-center study, 112 patients with calcific tendinopathy who met the inclusion criteria were included (January 2020 to April 2025). Patients with CaT confirmed by radiography or computed tomography were included. Exclusion criteria were prior shoulder surgery, incomplete MRI sequences, severe motion artifacts, or calcifications outside the RC tendons. MRI features recorded included tendon involvement, calcification morphology (solitary or multifocal), maximum deposit size, bursal thickness, and presence of bursitis. RC tear presence and severity were assessed in 3 planes on fluid-sensitive sequences. Receiver operating characteristic (ROC) analysis determined optimal thresholds for tear prediction.

RESULTS

Of 134 eligible patients, 112 met inclusion criteria (84 females, 28 males; mean age: 50.3±10.5 y). RC tears were identified in 42.9% of cases. Multifocal morphology was more frequent in patients with tears (79.2% vs. 25.0%, P <0.001). Mean deposit size was greater in the tear group (10.2±3.5 vs. 8.5±2.6 mm, P =0.004); ROC analysis identified a ≥9 mm cutoff (AUC=0.62). Bursal thickness was significantly higher in the tear group (5.1±2.1 vs. 2.8±1.9 mm, P <0.001), with a ≥5 mm threshold demonstrating good predictive value (AUC=0.81). Bursitis was more prevalent in tear cases (97.9% vs. 62.5%, P <0.001).

CONCLUSION

MRI-derived multifocal calcification morphology, deposit size ≥9 mm, and bursal thickness ≥5 mm are significant predictors of RC tears in CaT. Quantitative assessment of these parameters can enhance MRI interpretation and may guide early management decisions.