Comparison Of The Diagnostic Accuracy Of Ultrasound For Detection Of Rotator Cuff Tear With Magnetic Resonance Imaging (Mri)

Abstract

Background Rotator cuff disease is a common cause of shoulder pain and weakness presenting to primary care physicians, internists, rheumatologists, and orthopedists. The proper understanding of the anatomy of the rotator cuff tendons and its underlying pathogenesis aids in the diagnosis, which is mainly dependent on history, specific physical examination tests and radiological findings. Imaging will further define the pathology and aid in the evaluation of other causes of shoulder pain. Both invasive and noninvasive methods of diagnosing rotator cuff disease are important. Invasive methods of diagnosis include arthrography and noninvasive techniques include ultrasound and MRI. The main objectives are to assess the accuracy of ultrasound in detecting and evaluating the morphology and extent of rotator cuff tears as compared to Magnetic Resonance Imaging and to Evaluate the role of ultrasound in diagnosing rotator cuff injuries in comparison with Magnetic Resonance Imaging.

Materials & Methods 50 patients were subjected for investigations at the Department of Radiology at a Tertiary Care Hospital in Puducherry, who were suspicious of rotator cuff tear.  All the patients underwent USG and MRI following detailed history and clinical examination. USG was performed out on Siemens Accuson 300 machine using a high frequency transducer of 5-10 MHz’s. USG was done in various position in order to examine the rotator cuff tendons, muscles, ACJ, joint cavity and bursae. Dynamic examination of shoulder was also done for impingement. Comparison was done with the opposite side. MRI was performed using 1.5 tesla MRI scanner (Siemens), using a dedicated surface coil for shoulder.

Results Pain was the most common complaint along with decreased range of motions in rotator cuff tears. Male predominance, increasing age, dominant hand, trauma history and type II/III acromion were predisposing factors for rotator cuff tears. Peribicipital tendon fluid, joint effusion, bursal fluid and acromio-clavicular joint hypertrophy have significant association with rotator cuff tears. Most common tendon to be injured in the shoulder is supraspinatus. Partial tears were more common than the full thickness tears. Among the partial tears most common are articular surface tears. Clinical examinations with USG and MRI are helpful in diagnosing rotaor cuff tears. There was an increased sensitivity and specificity in all the parameters, except specificity of fluid along sheath, related to Biceps.

 Conclusion From this study it is concluded as that there was an increased sensitivity and specificity in all the parameters, related to Supraspinatus, Subscapularis and Infraspinatus. Although, MRI is the gold standard diagnostic tool in identification of Rotator-cuff pathologies, USG can be used as an alternative in diagnosis and management of Rotator-cuff pathologies.