Overall Sn and Sp of US, MRI and MRA in the characterisation of full-thickness or partial-thickness RC tears
| (A) Full or partial rotator cuff tears | ||||||
|---|---|---|---|---|---|---|
| N (studies) | N (shoulders) | Sn (CI 95%) | Sp (CI 95%) | LR+ | LR− | |
| US | 35a | 2774 | 0.91 (0.86 to 0.95) | 0.86 (0.80 to 0.92) | 6.5 | 0.1 |
| MRI | 21b | 1575 | 0.90 (0.84 to 0.96) | 0.90 (0.84 to 0.95) | 9.0 | 0.1 |
| MRA | 14c | 979 | 0.90 (0.79 to 0.97) | 0.90 (0.79 to 0.97) | 9.0 | 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 | 7d | 552 | 0.76 (0.59 to 0.90) | 0.90 (0.80 to 0.98) | 7.6 | 0.3 | 24g | 1749 | 0.93 (0.88 to 0.97) | 0.84 (0.76 to 0.91) | 5.8 | 0.1 |
| MRI | 10e | 685 | 0.91 (0.82 to 0.97) | 0.89 (0.78 to 0.97) | 8.3 | 0.1 | 8h | 467 | 0.92 (0.76 to 1) | 0.88 (0.74 to 0.97) | 7.8 | 0.1 |
| MRA | 7f | 556 | 0.83 (0.66 to 0.96) | 0.95 (0.86 to 1.0) | 16.6 | 0.2 | 6i | 355 | 0.93 (0.78 to 1.0) | 0.73 (0.44 to 0.94) | 3.4 | 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 | 22j | 1912 | 0.91 (0.86 to 0.96) | 0.87 (0.80 to 0.93) | 7.0 | 0.1 | 12m | 830 | 0.93 (0.84 to 1) | 0.85 (0.70 to 0.96) | 6.2 | 0.1 |
| MRI | 17k | 1243 | 0.89 (0.81 to 0.95) | 0.89 (0.82 to 0.95) | 8.1 | 0.1 | 2n | 198 | 0.81 (0.45 to 1) | 0.94 (0.58 to 1) | 13.5 | 0.2 |
| MRA | 9l | 540 | 0.86 (0.72 to 0.97) | 0.86 (0.66 to 0.98) | 6.1 | 0.2 | 5o | 439 | 0.89 (0.64 to 1) | 0.91 (0.70 to 1) | 9.9 | 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 | 1 333 | 0.89 (0.81 to 0.96) | 0.85 (0.76 to 0.93) | 5.9 | 0.1 | 9q | 861 | 0.88 (0.74 to 0.98) | 0.89 (0.80 to 0.96) | 8 | 0.1 |
Included studies: (a) Refs 19–53 (b) Refs 28 ,31 ,47 ,54–71 (c) Refs 29 ,42 ,57–59 ,61 ,69 ,72–78 (d) Refs 19 ,31 ,35 ,36 ,39 ,44 ,46 (e) Refs 31 ,57 ,61 ,62 ,64 ,66–70 (f) Refs 57 ,61 ,69 ,73 ,75 ,77 ,78 (g) Refs 20–23 ,25 ,27–30 ,32–34 ,37 ,38 ,40–43 ,45 ,47–50 ,52 (h) Refs 28 ,47 ,55 ,56 ,58 ,63 ,65 ,70 (i) Refs 29 ,42 ,58 ,72 ,74 ,76 (j) Refs 19 ,21 ,23 ,24–28 ,30–32 ,38 ,39 ,42–46 ,48 ,50 ,52 ,53 (k) Refs 28 ,31 ,47 ,54–59 ,63–66 ,68–71 (l) Refs 42 ,57–59 ,69 ,73 ,76–78 (m) Refs 20 ,22 ,29 ,33 ,35–37 ,40 ,41 ,47 49 51 ,49 ,51(n) Refs 60 ,61 (o) Refs 29 ,61 ,72 ,74 ,75 (p) Refs 19 ,22 ,24 ,25 ,27–31 ,34 ,37 ,38 ,40 ,42 ,43 ,44 ,46 ,47 (q) Refs 35 ,36 ,37 ,39 ,45 ,48 ,51–53.
LR−, negative likelihood ratio; LR+, positive likelihood ratio; MRA, MR arthrography; n, number of studies or shoulders; RC, rotator cuff; Sn, sensitivity; Sp, specificity; US, ultrasonography.