International Journal of Anatomy Radiology and Surgery (Jul 2017)
Rotator Cuff Injuries: Is Ultrasound Enough? A Correlation with MRI
Abstract
Introduction: Shoulder pain is one of the most common presentations in Orthopaedic patients. Rotator cuff pathologies consist of a significant proportion of shoulder pathologies. With progress in imaging techniques, the preoperative detection and characterisation of rotator cuff injuries has become much easier. Ultrasound (USG) and Magnetic Resonance Imaging (MRI) are the most commonly used imaging modalities for rotator cuff tears. Excellent soft tissue resolution, multiplanar imaging and non-invasive technique have made MRI the imaging modality of choice in evaluation of rotator cuff. However, high cost and limited availability prevent it from becoming the screening modality of choice. USG on the other hand is cheap and easily available and hence can be made the first modality for rotator cuff tears. Aim: To determine the efficacy of USG in detecting rotator cuff tears in comparison to MRI. Materials and Methods: We evaluated 50 patients of all age groups in Department of Radiology, Gauhati Medical College and Hospital, Assam, India, with suspicious rotator cuff tears first by high resolution USG and then by 1.5 T MRI. Both USG and MRI were performed by the same radiologist. Since MRI was always followed by USG, the radiologist was blind to the MRI results. Results: Supraspinatus was the most commonly affected tendon (79%). Partial thickness tears were the most common rotator cuff pathology. USG showed a sensitivity of 66.67%, specificity of 92.5%, PPV of 68.96% and NPV of 91.74% in detecting partial thickness tears. Whereas, USG showed excellent results in detecting full thickness tears with a sensitivity of 100%, specificity of 99.31%, PPV of 91.74% and NPV of 100%. Conclusion: USG done has a near similar accuracy for detecting full thickness rotator cuff tears as MRI and has an acceptable accuracy for detecting partial thickness tears too. Hence, due to its availability, accuracy and cost effectiveness, USG should be made the first line modality for detecting rotator cuff tears and MRI should be reserved for indeterminate or complex cases where USG does not suffice in serving the clinical purpose.
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