Overall Sn and Sp of US, MRI and MRA in the characterisation of full-thickness rotator cuff tears
| (A) Rotator cuff full-thickness tear | ||||||
|---|---|---|---|---|---|---|
| N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | |
| US | 30a | 2402 | 0.91 (0.86 to 0.94) | 0.93 (0.91 to 0.96) | 13.0 | 0.1 |
| MRI | 23b | 1581 | 0.90 (0.85 to 0.95) | 0.93 (0.89 to 0.97) | 12.9 | 0.1 |
| MRA | 14c | 1544 | 0.90 (0.83 to 0.95) | 0.95 (0.91 to 0.98) | 18.0 | 0.1 |
| (B) Secondary analysis based on risk of bias | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Studies with low risk of bias in patient selection | Studies with high risk of bias in patient selection | |||||||||||
| N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | |
| US | 8d | 587 | 0.87 (0.72 to 0.97) | 0.94 (0.88 to 0.99) | 14.5 | 0.1 | 23g | 1825 | 0.90 (0.85 to 0.94) | 0.93 (0.90 to 0.97) | 12.9 | 0.1 |
| MRI | 7e | 484 | 0.83 (0.75 to 0.95) | 0.91 (0.80 to 0.97) | 9.2 | 0.2 | 13h | 759 | 0.90 (0.80 to 0.97) | 0.93 (0.86 to 0.98) | 12.9 | 0.2 |
| MRA | 8f | 1181 | 0.83 (0.68 to 0.93) | 0.96 (0.91 to 1) | 20.8 | 0.2 | 6i | 295 | 0.93 (0.86 to 0.98) | 0.90 (0.82 to 0.96) | 9.3 | 0.1 |
| (C) Secondary analysis based on equipment characteristics | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ≤7.5 MHz (US), ≤ 1.5 T (MRI and MRA) | > 7.5 MHz (US), 3.0 T (MRI and MRA) | |||||||||||
| N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | |
| US | 17j | 1535 | 0.88 (0.80 to 0.94) | 0.94 (0.89 to 0.97) | 14.7 | 0.1 | 13m | 910 | 0.90 (0.82 to 0.96) | 0.93 (0.88 to 0.97) | 12.9 | 0.1 |
| MRI | 21k | 1238 | 0.90 (0.86 to 0.95) | 0.92 (0.88 to 0.96) | 11.3 | 0.1 | 2n | 198 | 0.89 (0.54 to 1) | 0.89 (0.59 to 1) | 8.1 | 0.1 |
| MRA | 10l | 1299 | 0.87 (0.78 to 0.94) | 0.95 (0.90 to 0.99) | 17.4 | 0.1 | 3o | 177 | 0.90 (0.63 to 1) | 0.90 (0.68 to 1) | 9.0 | 0.1 |
| (D) Secondary analysis based on the specialist who performed the US examination | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Radiologists | Sonographers and orthopaedists | |||||||||||
| N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | |
| US | 18p | 1185 | 0.89 (0.82 to 0.94) | 0.93 (0.89 to 0.97) | 12.7 | 0.1 | 10q | 916 | 0.86 (0.75 to 0.94) | 0.94 (0.88 to 0.98) | 14.3 | 0.1 |
Included studies: (a) Refs 19 ,22 ,27–29 ,31 ,33 ,35 ,37 ,39 ,40 ,42 ,44–48 ,50 ,53 ,79 ,80–88 (b) Refs 4 ,28 ,31 ,47 ,54 ,56–60 ,63 ,65 ,66 ,68–70 ,80 ,82 ,84 ,89 ,90 ,91 (c) Refs 29 ,42 ,57–59 ,69 ,72 ,73 ,75 ,76 ,78 ,92–94 (d) Refs 19 ,31 ,35 ,36 ,39 ,44 ,46 ,82 (e) Refs 31 ,57 ,66 ,68 ,69 ,82 ,90 (f) Refs 57 ,69 ,73 ,75 ,78 ,92 ,94 (g) Refs 22 ,27–29 ,33 ,37 ,40 ,42 ,45 47 48 50 53 79–81 83–88 ,47 ,48 ,50 ,53 ,79–81 ,83–88 (h) Refs 4 ,28 ,47 ,56 ,58 ,63 ,65 ,70 ,80 ,84 ,89 ,91 (i) Refs 29 ,42 ,58 ,72 ,76 ,93 (j) Refs 19 ,27 ,28 ,31 ,39 ,42 ,44–46 ,48 ,50 ,53 ,79 ,83–85 ,87 (k) Refs 4 ,28 ,31 ,47 ,54 ,56–59 ,63 ,65 ,66 ,68 ,69 ,70 ,80 ,84 ,91 (l) Refs 42 ,57 ,58 ,69 ,73 ,76 ,78 ,92 ,93 ,94 (m) Refs 22 ,29 ,33 ,35 ,36 ,37 ,40 ,47 ,80 ,81 ,86 ,88 (n) Refs 60 ,90 (o) Refs 29 ,72 ,75 (p) Refs 19 ,22 ,27 ,29 ,31 ,37 ,40 ,42 ,44 ,46 ,47 ,80–84 ,88 (q) Refs 28 ,35–37 ,39 ,45 ,48 ,53 79 85,79 ,85.
LR−, negative likelihood ratio; LR+, positive likelihood ratio; MRA, MR arthrography; n, number of studies or shoulders; Sn, sensitivity; Sp, specificity; US, ultrasonography.