The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries

Zoga, Adam C.; Kamel, Sarah; Hynes, John P.; Kavanagh, Eoin C.; O’Connor, Philip; Forster, Bruce B.

doi:10.2214/ajr.21.25606

Cited by 19 publications

(17 citation statements)

References 45 publications

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“…Ultrasonography (US) is a good first-line test for the assessment of rotator cuff pathology due to its widespread accessibility, low cost, and superior spatial resolution. 6 A linear 12-15 Hz transducer ensures high spatial resolution without sacrificing depth penetration, although lower frequency transducers may be required for larger patients. 5 On US, the normal rotator cuff tendons are hyperechoic with fibrillar architecture.…”

Section: Ultrasonographymentioning

confidence: 99%

“…MRI has higher interobserver reliability in determining tear size and degree of retraction compared with US. 6 A metaanalysis in 2020 suggested that 1.5-or 3-T magnetic resonance arthrography (MRA) has the highest diagnostic value to detect partial articular-sided and full-thickness rotator cuff tears, followed by conventional non-MRA 3-T imaging; however, the marginal increase in sensitivity with MRA may be offset by the added cost and resources required. 6,8 The tendons of the rotator cuff should appear low signal on short and long TE sequences with smooth margins and no areas of intervening high signal.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…3 Typical US features of calcific tendinopathy include punctate or coarse echogenic foci within the substance of the tendon with variable posterior acoustic shadowing. 6 On MRI, these calcifications appear as globular hypointense foci within the tendon or surrounding structures. In the acute phase, there may be markedly increased signal or edema around the calcification on fluid-sensitive sequences, reflecting inflammation.…”

Section: Tendinopathymentioning

confidence: 99%

“…S1). 6 Care should be taken not to mistake the rotator cable, a normal thickened hypointense band of signal frequently seen on the undersurface of the supraspinatus, as a partial-thickness articular-sided tear. 18 Tear size should be measured in both the anteroposterior and mediolateral dimensions.…”

Section: Rotator Cuff Tears: What To Include In Your Reportmentioning

confidence: 99%

“…As described in the American College of Radiology Appropriateness Criteria, radiographs are an appropriate first-line investigation for the assessment of rotator cuff injury and demonstrate ancillary findings of rotator cuff disease. 6 Typical views obtained include anteroposterior (AP) external rotation, internal rotation, and a scapular Y view. Radiographic findings of rotator cuff tear include superior migration of the humeral head and narrowed acromiohumeral interval, < 6 mm, best seen on the active abduction/AP external rotation view.…”

Section: Imaging the Rotator Cuff: Pathology And Pitfallsmentioning

confidence: 99%

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Rotator Cuff Injury and Repair

Fitzpatrick

Atinga

White

et al. 2022

Semin Musculoskelet Radiol

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Rotator cuff pathology is a commonly encountered clinical and radiologic entity that can manifest as tendinopathy or tearing. Magnetic resonance imaging (MRI) and ultrasonography offer similar sensitivity and specificity for the evaluation of the native rotator cuff, and the chosen modality may vary, depending on local practice and accessibility. MR arthrography is frequently used in the postoperative setting as a problem-solving tool. Key findings to include in the preoperative MRI report include the size and location of the tear, thickness of the tendon involved (partial versus full thickness), and overall tendon quality. The report should also address features associated with poor surgical outcomes, such as fatty atrophy, a decreased acromiohumeral interval, and evidence of rotator cuff arthropathy. Musculoskeletal radiologists should be familiar with the various surgical techniques and expected postoperative imaging appearance of rotator cuff repairs. Imaging also plays a role in identifying recurrent tearing, graft failure, hardware loosening, infection, and other complications.

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Section: Ultrasonographymentioning

confidence: 99%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Tendinopathymentioning

confidence: 99%

Section: Rotator Cuff Tears: What To Include In Your Reportmentioning

confidence: 99%

Section: Imaging the Rotator Cuff: Pathology And Pitfallsmentioning

confidence: 99%

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Rotator Cuff Injury and Repair

Fitzpatrick

Atinga

White

et al. 2022

Semin Musculoskelet Radiol

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Delamination of rotator cuff tears: Real‐time dynamic ultrasound findings

Wang

Teng

Fang

et al. 2023

J of Clinical Ultrasound

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Purpose The purpose of this study was to evaluate the value of diagnosing delaminated tears and ultrasonic characteristics on real‐time dynamic ultrasound. Materials and Methods We enrolled 143 consecutive patients who underwent arthroscopic rotator cuff repair between April 2020 and January 2021. All patients were examined using real‐time dynamic ultrasound of the shoulder within 2 weeks before arthroscopy. In our study, delaminated tears were defined as intratendinous horizontal splitting with or without the retraction of the articular or bursal layer of tendon. Delaminated tears were classified into three types on the basis of their shape: greater retraction of the articular layer (type I), greater retraction of the bursal layer (type II), and equal retraction of both layers (type III). The sensitivity and specificity of real‐time dynamic ultrasound for evaluation of delaminated tears were calculated using arthroscopy findings as the gold standard. Ultrasonic imaging appearances of delaminated rotator cuff tears were further described. Results Of the 143 patients, 47 (32.9%) had delaminated tears as confirmed by arthroscopy; 35 of these tears involved the supraspinatus tendon and 12 involved both supraspinatus and infraspinatus tendons. Real‐time dynamic ultrasound correctly diagnosed 36 of 47 delaminated tears with sensitivity 72.0% (57.2%–83.3%) and specificity 96.7% (90.2%–99.2%). Moreover, type I tear (n = 32) was more common than type II (n = 11) and type III tears (n = 4). Real‐time dynamic ultrasound evaluated shape of type I, type II, and type III with a sensitivity and specificity of 56% and 80%, 72% and 83%, and 100% and 98%, respectively. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the suffering tendon were the three signs observed during real‐time dynamic ultrasound examination. These three signs were indicative of a diagnosis of delaminated rotator cuff tears with high specificities (100.0%, 100.0%, and 97.9%, respectively) but relatively low sensitivities (25.5%, 25.5%, and 36.2%, respectively). Conclusion Real‐time dynamic ultrasound can be practically used for diagnosing delamination of rotator cuff tears with medium sensitivity and high specificity. Anechoic horizontal linear splitting of tendon, unequal retraction of the bursal and articular layers, and thinning of the involved tendon are the three important ultrasonic signs for diagnosis of delaminated rotator cuff tears.

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