Study of Rotator Cuff Disorders By Ultrasound With Magneticresonance Imaging Correlation

Abstract

Background

Rotator cuff disorders are a significant contributor to shoulder pain, weakness and decreased motion. Correct diagnosis of tendon lesions is critical for correct clinical management. Magnetic resonance imaging (MRI) is used to provide a comprehensive assessment of the rotator cuff and associated soft-tissue structures but because of cost, availability, examination time and contraindications, this can limit its use as a primary investigation. High-resolution ultrasonography (USG) is a real time, dynamic, non-ionizing and relatively cost-effective way to evaluate the shoulder, and has specific value in examining superficial tendon abnormalities. In the present study, high-resolution USG is compared to MRI to assess its diagnostic accuracy in the diagnosis of rotator cuff disorders.

Objectives

The aims were to assess patients with shoulder pain or limited ROM using ultrasonography as a primary imaging tool for the diagnosis of rotator cuff disorders and to assess the validity and diagnostic capacity of ultrasonography based on its correlation with MRI results.

Materials and Methods

A prospective comparative study was done at Department of Radiodiagnosis, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya, Karnataka. Thirty patients with pain, restriction of movements or clinical suspicion of impingement or rotator cuff pathologies were included who were aged 18–70 years. Avoid patients who are known to have had a prior surgery or prosthesis on the shoulder, or those with contraindications to MRI. The high-resolution grey-scale USG was performed by using 7.5–12 MHz linear-array transducers and the 1.5-Tesla MRI using a dedicated shoulder coil. The rotator cuff tendons, biceps tendon, bursae, acromioclavicular joint and dynamic impingement were evaluated. Data were analyzed descriptively (frequencies and percentages) and the values of sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated for USG findings compared to MRI.

Results

All of the patients were between 20 and 68 years of age (mean = 40.7). This sample consisted of 73% males and 27% females. 76.7% of patients had a right shoulder affection and 80% of patients had a dominant hand side affection. The most common affected tendon was supraspinatus. USG identified supraspinatus abnormality in 66.7% while MRI identified 80%. In cases of supraspinatus pathology, the sensitivity of USG was 75%, specificity was 66.7%, PPV was 90% and accuracy was 73.7%. For subscapularis pathology, sensitivity was 66.7%, specificity 95.8% and accuracy 90%. Sensitivity was 50%, specificity 100% and accuracy 96.7% for infraspinatus pathology. USG was 58.3% sensitive, 100% specific, 100% PPV, 78.2% NPV and 83.3% accurate with partial-thickness rotator cuff tears. For full thickness tears, sensitivity was 100%, specificity 96.4%, positive predictive value 75%, negative predictive value 100% and accuracy 100%.

Conclusion

High resolution USG showed good diagnostic accuracy for the rotator cuff tears, especially when the tear was full thickness, and less in partial thickness tears and associated periarticular abnormalities. MRI was used to identify tendon, bursal, biceps sheath and acromioclavicular abnormalities, and more of these were identified. High resolution USG can thus be used as an effective initial examination in suspected cases of rotator cuff disease and may be used for complementary evaluation in cases of uncertain diagnosis or in patients with complex soft-tissue, osseous or preoperative disease.