Article Text

Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis
  1. Jean-Sébastien Roy1,2,
  2. Caroline Braën2,3,
  3. Jean Leblond2,
  4. François Desmeules3,4,
  5. Clermont E Dionne1,5,
  6. Joy C MacDermid6,
  7. Nathalie J Bureau7,
  8. Pierre Frémont1,5
  1. 1Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
  2. 2Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
  3. 3Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada
  4. 4Faculty of Medicine, School of Rehabilitation, Université de Montreal, Montreal, Quebec, Canada
  5. 5Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
  6. 6School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
  7. 7Department of Radiology, Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
  1. Correspondence to Dr Jean-Sébastien Roy, Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS), 525, boulevard Wilfrid-Hamel, local H-1710, Quebec, Canada G1M 2S8; jean-sebastien.roy{at}rea.ulaval.ca

Abstract

Background Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists.

Methods A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies.

Results Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67–0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it.

Conclusions Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option.

  • Shoulder
  • Ultrasound
  • MRI
  • Meta-analysis

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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