A Retrospective Analysis of the Effectiveness of MRI and Ultrasound in Identifying Rotator Cuff Tears

Abstract

Magnetic Resonance Imaging (MRI) and Ultrasound (US) imaging are both routinely used in the assessment of rotator cuff pathology. Factors influencing the frequency of use of the respective technologies include access to equipment, provider preference, and cost. The purpose of our study was to compare the accuracy of in clinic ultrasound with that of MRI in diagnosing pathology of the rotator cuff in a large sample size with limited exclusionary criteria. 500 patient profiles assessed by each imaging type, MRI and ultrasound, who then proceeded to arthroscopic surgery were gathered and analyzed for interobserver agreement between the image interpretation and the surgical observations. While ultrasound displayed slightly higher sensitivity and specificity ratings in the diagnosis of full tears (0.90 and 0.92 vs. 0.86 and 0.91), MRI had a higher sensitivity (0.87 vs. 0.80) and Ultrasound had a higher specificity (0.86 vs. 0.76) for general cuff damage. The Weighted Kappa Values for both MRI (0.699) and Ultrasound (0.668) both indicate a substantial strength of agreement between the image interpretation and surgical findings. While there was a balanced distribution of errors observed in the MRI category, the most common error made in the Ultrasound assessment was a false negative assessment of a partial tear. The data indicate that in a clinical setting Ultrasound imaging is a cost-effective and accurate alternative to MRI and can be a valuable addition to the diagnostic assessment of rotator cuff injury and pathology.

Diagnostic Accuracy and Agreement between Magnetic Resonance Imaging and Ultrasound Finding for the Diagnosis of Rotator Cuff Tears

“…These results are in line with the current literature. Meiers et al 10 did not find a considerable difference between the MR imaging and ultrasound sensitivity values. Additionally, a large number of studies and meta-analyses done across a variety of populations for comparing the ultrasound and MR imaging showed similar finding.…”

“…In short, in light of the agreement of the current study findings and previously published literature, ultrasound can very well be used as a first line screening modality to determine and observe the recovery of rotator-cuff tears, with MR imaging as required for a more detailed look when needed. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]…”

“…9 In various international studies, MR imaging is reported to have high diagnostic accuracy for determining full and partial-thickness tears of the rotator cuff. 10 A thorough literature search has revealed that this topic should be addressed in Pakistan. Therefore, this motivated us to conduct a study to determine the accuracy and agreement of ultrasound compared to the gold standard, MR imaging, for determining rotator-cuff tears in our cohort.…”