Teefey, J Bone Joint Surg Am 2004 - Detection and Quantification of Rotator Cuff Tears. Comparison of Ultrasonographic, Magnetic Resonance Imaging, and Arthroscopic Findings in Seventy-One Consecutive Cases
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Detection and Quantification of Rotator Cuff Tears. Comparison of Ultrasonographic, Magnetic Resonance Imaging, and Arthroscopic Findings in Seventy-One Consecutive Cases
Teefey, Yamaguchi, et al.·J Bone Joint Surg Am·2004·490 citations·Prospective cohort
Teefey and colleagues compared ultrasonography and MRI for detecting rotator cuff tears and measuring their size, using arthroscopy as the reference.
Prospective study of 124 consecutive patients with shoulder pain who had both scans at Mallinckrodt Institute of Radiology, St. Louis, of whom 71 went on to arthroscopy and formed the study group.
Methods
Design
Prospective diagnostic study
Mallinckrodt Institute of Radiology, St. Louis
Patients
124 consecutive patients with shoulder pain had both scans
71 had arthroscopy and formed the study group
At arthroscopy: 46 full‑thickness tears
19 partial‑thickness tears
6 intact cuffs
Index test
Ultrasonography
MRI
Reference standard
Arthroscopic findings
Outcomes
Detection of full- and partial‑thickness tears
Retraction and width of full‑thickness tears
Length and width of partial‑thickness tears
Key Findings
Each test correctly classified the cuff as full‑thickness tear, partial‑thickness tear or intact in 87% of patients (62 of 71, 95% CI 80% to 95%), with no significant difference between them (p > 0.05).
Ultrasound detected 45 of 46 full‑thickness tears (98%), and MRI detected all 46.
Both tests detected partial‑thickness tears less reliably, ultrasound finding 13 of 19 (68%) and MRI 12 of 19 (63%), and most misses were called full‑thickness (ultrasound 4, MRI 7).
Almost every tear whose size either test got wrong was large to massive, measuring 20 to 45 mm wide at arthroscopy.
The study could not rule out a difference, since the authors calculated that 100 paired cases were needed for the specificity difference and 200 for size measurement.
Specificity was only 67% for both tests (4 of 6 intact cuffs), and only 8% of shoulders had no tear at surgery.
Board pearl
Ultrasound matched MRI here in the hands of fellowship‑trained radiologists with more than 10 years of experience, and the authors call it the most operator‑dependent shoulder imaging test.
Authors' conclusion
Ultrasonography and magnetic resonance imaging had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. When an investigator has comparable experience with both imaging tests, the decision regarding which test to perform for rotator cuff assessment does not need to be based on accuracy concerns. The choice can be based on other factors, such as the importance of ancillary clinical information (regarding lesions of the glenoid labrum, joint capsule, or surrounding muscle or bone), the presence of an implanted device, patient tolerance, and cost.
Detection and Quantification of Rotator Cuff Tears. Comparison of Ultrasonographic, Magnetic Resonance Imaging, and Arthroscopic Findings in Seventy-One Consecutive Cases
Teefey, Yamaguchi, et al.·J Bone Joint Surg Am·2004·490 citations·Prospective cohort
Teefey and colleagues compared ultrasonography and MRI for detecting rotator cuff tears and measuring their size, using arthroscopy as the reference.
Prospective study of 124 consecutive patients with shoulder pain who had both scans at Mallinckrodt Institute of Radiology, St. Louis, of whom 71 went on to arthroscopy and formed the study group.
Methods
Design
Prospective diagnostic study
Mallinckrodt Institute of Radiology, St. Louis
Patients
124 consecutive patients with shoulder pain had both scans
71 had arthroscopy and formed the study group
At arthroscopy: 46 full‑thickness tears
19 partial‑thickness tears
6 intact cuffs
Index test
Ultrasonography
MRI
Reference standard
Arthroscopic findings
Outcomes
Detection of full- and partial‑thickness tears
Retraction and width of full‑thickness tears
Length and width of partial‑thickness tears
Key Findings
Each test correctly classified the cuff as full‑thickness tear, partial‑thickness tear or intact in 87% of patients (62 of 71, 95% CI 80% to 95%), with no significant difference between them (p > 0.05).
Ultrasound detected 45 of 46 full‑thickness tears (98%), and MRI detected all 46.
Both tests detected partial‑thickness tears less reliably, ultrasound finding 13 of 19 (68%) and MRI 12 of 19 (63%), and most misses were called full‑thickness (ultrasound 4, MRI 7).
Almost every tear whose size either test got wrong was large to massive, measuring 20 to 45 mm wide at arthroscopy.
The study could not rule out a difference, since the authors calculated that 100 paired cases were needed for the specificity difference and 200 for size measurement.
Specificity was only 67% for both tests (4 of 6 intact cuffs), and only 8% of shoulders had no tear at surgery.
Board pearl
Ultrasound matched MRI here in the hands of fellowship‑trained radiologists with more than 10 years of experience, and the authors call it the most operator‑dependent shoulder imaging test.
Authors' conclusion
Ultrasonography and magnetic resonance imaging had comparable accuracy for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. When an investigator has comparable experience with both imaging tests, the decision regarding which test to perform for rotator cuff assessment does not need to be based on accuracy concerns. The choice can be based on other factors, such as the importance of ancillary clinical information (regarding lesions of the glenoid labrum, joint capsule, or surrounding muscle or bone), the presence of an implanted device, patient tolerance, and cost.