Prospective study of 41 surgical shoulders comparing CT and MRI for grading rotator cuff fatty degeneration using the Goutallier classification. Asks three questions: Are each modality's grades reproducible? Do CT and MRI grades agree with each other? Does fatty degeneration grade correlate with quantitative muscle atrophy?
When you order imaging to assess rotator cuff muscle quality preoperatively, the choice of modality matters less than consistency: either CT or MRI using the Goutallier criteria is reproducible on its own, but the two modalities give systematically different grades and cannot be cross-compared.
This paper is why you should never compare a patient's old CT-based Goutallier grade to a new MRI-based grade when tracking disease progression — the fair-to-moderate cross-modality kappa (0.21–0.71 depending on scale) means apparent worsening may simply reflect the modality switch.
When counseling a patient on repair candidacy, document both Goutallier grade and muscle cross-sectional area: this study confirms they are significantly correlated but not redundant, and neither alone fully captures muscle quality.
The finding that three-tendon tears carry nearly double the mean Goutallier grade of single-tendon tears is a concrete reminder that muscle quality deteriorates with tear propagation. A practical argument for repairing extensible tears before they advance.
Prospective study of 41 surgical shoulders comparing CT and MRI for grading rotator cuff fatty degeneration using the Goutallier classification. Asks three questions: Are each modality's grades reproducible? Do CT and MRI grades agree with each other? Does fatty degeneration grade correlate with quantitative muscle atrophy?
When you order imaging to assess rotator cuff muscle quality preoperatively, the choice of modality matters less than consistency: either CT or MRI using the Goutallier criteria is reproducible on its own, but the two modalities give systematically different grades and cannot be cross-compared.
This paper is why you should never compare a patient's old CT-based Goutallier grade to a new MRI-based grade when tracking disease progression — the fair-to-moderate cross-modality kappa (0.21–0.71 depending on scale) means apparent worsening may simply reflect the modality switch.
When counseling a patient on repair candidacy, document both Goutallier grade and muscle cross-sectional area: this study confirms they are significantly correlated but not redundant, and neither alone fully captures muscle quality.
The finding that three-tendon tears carry nearly double the mean Goutallier grade of single-tendon tears is a concrete reminder that muscle quality deteriorates with tear propagation. A practical argument for repairing extensible tears before they advance.