Is the FABS view MRI more accurate than standard MRI in detecting distal biceps pathology?

Abstract

Background: Partial biceps tendon pathology is difficult to diagnose. The Flexion Abduction Supination (FABS) view MRI has been advocated to improve the accuracy of MRI investigation. Hypothesis: The purpose of the present study is to evaluate the accuracy of the FABS view MRI in the diagnosis of distal biceps tendon pathology. Methods: 50 patients with surgically confirmed distal biceps tendon pathology and 50 patients with other elbow disorders were included. From both groups, half had standard elbow MRI (retrospective review of previously obtained MRI data) and the other half FABS view MRI. These were evaluated by two independent musculoskeletal radiologists. Sensitivity and specificity of the both MRI views were determined. Tendinosis or grade of rupture were reported from MRI and then compared to surgical findings. Results: There was no significant difference in sensitivity and specificity in detecting partial distal biceps injuries when comparing the FABS view MRI (sensitivity 84% and specificity 86%) and standard MRI (sensitivity 76% and specificity 98%). The inter-observer reliability (IRR) was 92% for the FABS view MRI with biceps pathology and 68% for standard MRI. In the control group the IRR was 88% for the FABS view MRI and 96% for standard MRI. FABS MRI was significantly better with regards to grade of injury. Conclusions: No significant differences in sensitivity and specificity were found between the FABS view and standard elbow MRI in the diagnosis of partial distal biceps tendon injuries with high sensitivity and specificity for both views. Interrater reliability was better for FABS views and FABS views were significantly more accurate in grading the extend of the pathology when compared to surgical findings.