Sonographic detection of rotator cuff tears

Thirty-nine consecutive patients referred for shoulder arthrography underwent shoulder sonography to determine the ability of sonography to detect rotator cuff tears. Fifteen patients had arthrographically proven rotator cuff tears. Of these, 14 were detected by sonography, for a sensitivity of 93%. The three sonographic criteria indicative of rotator cuff tear were (1) discontinuity in the normal homogeneous echogenicity of the rotator cuff; (2) replacement of the normal homogeneous echogenicity by a central echogenic band; and (3) nonvisualization of the cuff. Twenty patients had normal sonographic examinations, 19 of which were normal by arthrography. Therefore, the predictive value of a negative sonogram was 95%. On the basis of these findings, sonography can provide a noninvasive means of screening patients with suspected rotator cuff tears.     

Rotator cuff sonography: a reassessment

This study is both a retrospective and prospective evaluation of the clinical usefulness of shoulder sonography. Ninety-eight patients suspected of having rotator cuff tears underwent sonography of both shoulders. Sixty-two patients underwent double-contrast arthrography performed on the same day as sonography, and 38 patients underwent surgery after sonography. A comparison of the results from ultrasound and arthrography, using published diagnostic criteria, demonstrated a sensitivity of 75% and a specificity of 43% for detection of a rotator cuff tear. In this study, use of more restricted criteria, a subset of the published criteria, yielded a sensitivity of 68% and a specificity of 90%. A comparison of sonography with surgery, using this study's criteria, demonstrated a sensitivity of 57% and a specificity of 76%. This report shows that shoulder sonography is less reliable than previously reported and appears to have a very limited role in the evaluation of rotator cuff injuries.     

Rotator cuff tears: diagnosis with sonography

The purpose of this study was to determine the accuracy of sonography in the detection of rotator cuff tears. Eighty-one patients were referred by orthopedic specialists because of a clinical suspicion of rotator cuff tear. The standards of comparison were arthrography in 79 cases and surgery in two cases. The sonographic technique used was based on a review of the literature and experience gained by scanning normal subjects. The sonographic criteria for the diagnosis of a complete rotator cuff tear were a focal defect in the cuff or complete absence or nonvisualization of the cuff. All sonograms were interpreted prospectively without knowledge of arthrographic or surgical results. With arthrography as the standard of comparison for the diagnosis of rotator cuff tear, sonographic results included 15 true-positives, 52 true-negatives, eight false-negatives, and four false-positives. With surgery as the standard of comparison, the results were one true-positive and one true-negative sonogram. The sensitivity of sonography in detecting rotator cuff tear was 0.67, the specificity was 0.93, and the accuracy was 0.85. Our study found lower sensitivity and accuracy results for shoulder sonography than have been previously reported.     

Limited sensitivity of ultrasound for the detection of rotator cuff tears

Bilateral rotator cuff sonography was performed on 56 patients referred for shoulder arthrography to detect rotator cuff tears. Since one patient had bilateral arthrography there were 57 arthrograms. Twenty-seven shoulders had rotator cuff tears shown on arthrography, 15 of which were detected by sonography. Eleven were false negative by sonography, and one was indeterminate. Of the 30 shoulders with negative arthrograms, 28 had normal sonograms and two were false positive. Sensitivity was 58%, specificity was 93% and overall accuracy was 77%. The positive and negative predictive values were 88% and 72%. These results suggest that sonography has limited value in screening patients for rotator cuff tears and that a positive sonographic reading is more reliable than a negative one. Theories relating to the variable anatomic configuration of a tear are postulated to explain these results, which differ from those previously reported.     

Rotator cuff tears: prospective comparison of MR imaging with arthrography, sonography, and surgery

Thirty-eight patients with suspected rotator cuff tears were examined at 1.5 T by using a loop-gap resonator surface coil. The MR findings were compared prospectively in a blinded fashion with the results from double-contrast arthrography in all 38 patients, high-resolution sonography in 23 patients, and surgery in 16 patients. In the total group of 38 patients, MR imaging detected 22 of 22 tears and 14 of 16 intact cuffs as determined by arthrography. In the 16 surgically proved cases, MR and arthrography showed identical results, with 92% sensitivity in the diagnosis of 12 tears and 100% specificity in the diagnosis of four intact cuffs. In a subgroup of 23 patients, sonography detected nine of 15 tears and seven of eight intact cuffs as determined by comparison with arthrography. In 10 surgically proved cases, sonography was 63% sensitive in the diagnosis of eight rotator cuff tears and 50% specific in the diagnosis of two intact cuffs. For the diagnosis of rotator cuff tears, MR imaging is comparable to arthrography in both sensitivity and specificity. In this study, sonography was not as accurate in the diagnosis of rotator cuff tears as were the other two techniques. These results suggest that MR imaging should be considered the noninvasive test of choice for patients with suspected rotator cuff disease.     

Ultrasonography of the rotator cuff. Normal and pathologic anatomy

Forty-eight patients with shoulder pain and 15 normal volunteers underwent rotator cuff imaging using high resolution real time ultrasound. The potential diagnostic value of sonography in detecting rotator cuff tears was evaluated by correlating ultrasound findings with surgical findings in 19 patients, 12 of whom also underwent preoperative arthrography. The preoperative ultrasound diagnosis was correct in 18 of the 19 patients undergoing surgery for possible rotator cuff tears. In the group of 12 surgical patients undergoing both preoperative arthrography and sonography, ultrasound correctly predicted the presence of a rotator cuff tear in 12 of 12 patients, while arthrography predicted cuff tears in only nine of 12. Good anatomic definition of the rotator cuff was obtained in both symptomatic and asymptomatic groups. The characteristic appearance of the normal and pathologic rotator cuff is described. Rotator cuff sonography promises to be a valuable new diagnostic tool for evaluating patients with suspected rotator cuff tears.     

MR imaging of the shoulder: diagnosis of rotator cuff tears

Twenty-five patients with known or suspected tears of the rotator cuff in 26 shoulders underwent MR imaging. All patients also underwent arthrography or surgery. MR visualized abnormalities consistent with a tear in 20 of the 22 tears diagnosed by arthrography or surgery. In most cases, tears were seen as regions of increased signal intensity within the cuff on long-TR pulse sequences, although two cases simply showed an almost complete absence of normal cuff. The MR appearance of the two cases with partial tears was similar to that of full-thickness tears. Of the four cases with normal arthrograms, one case had MR findings consistent with a tear. We conclude that MR has good potential for the noninvasive diagnosis of rotator cuff tears. Its ultimate role in this diagnosis must await prospective studies comparing its accuracy with that of sonography, CT, and arthrography.     

Standard sonography and arthrosonography in the study of rotator cuff tears

PURPOSE: The aim of this study was to evaluate the sensitivity of ultrasonography, integrating standard ultrasound and arthrosonography after injecting a saline solution into the glenohumeral cavity in cases of suspected rotator cuff tears. MATERIALS AND METHODS: We prospectively examined 40 patients awaiting shoulder arthroscopy for suspected or diagnosed tears of the rotator cuff. A radiologist, unaware of the pre-operative diagnosis, performed an ultrasound scan on all the patients before and after the injection of saline solution into the glenohumeral cavity. The parameters considered were presence or absence of a rotator cuff injury; type of injury according to Snyder and its extent along the longitudinal and transverse planes; presence or absence of effusion into the articular cavity; subacromial/subdeltoid bursal distension. All the patients underwent arthroscopy either the same day or the day after the ultrasound examination. RESULTS: Standard sonography showed 26 complete rotator cuff tears (type C according to Snyder), 2 partial tears (type B according to Snyder) and 12 intact rotator cuffs.Arthrosonography detected 31 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs.Arthroscopy identified 32 complete rotator cuff tears (type C according to Snyder), 1 partial tear (type B according to Snyder) and 8 intact rotator cuffs.Analysis of the results shows that, taking arthroscopy as the gold standard, the sensitivity of normal sonography is 81.2%, whereas that of arthrosonography is 96.8% (p < 0.05). CONCLUSIONS: On the basis of the data obtained in this study, standard sonography, integrated with the injection of a saline solution into the glenohumeral cavity, considerably increases the diagnostic sensitivity for rotator cuff tears. The authors suggest that arthrosonography can be used in the event of suspected rotator cuff tears, when MRI is contraindicated.     

肩袖损伤的MRI诊断比较研究

目的:比较常规MRI和MRI间接关节造影检查对肩袖撕裂伤的诊断价值.方法:搜集2002年11月～2006年8月共40例肩袖损伤病例,20例行常规MRI检查,20例行MRI间接关节造影检查.以肩关节镜作为诊断标准,比较两种影像学方法诊断肩袖损伤的敏感性和特异性.结果:肩袖完全撕裂中,常规MRI检查的敏感度为45.5%,特异度为66.7%,准确度为55%;MRI间接关节造影的敏感度为92.3%,特异度为85.7%,准确度为90%.肩袖不全撕裂中,常规MRI检查敏感度为57.1%,特异度为53.8%,准确度为55%;而间接关节造影敏感度为83.3%,特异度为92.8%,准确度则为90%.经Fisher确切概率统计法统计,MRI间接关节造影诊断肩袖全层撕裂敏感性及准确性明显高于常规MRI(P＜0.05),在诊断肩袖部分撕裂时,MRI间接关节造影的特异性及准确性明显高于MRI(P＜0.05).结论:MRI间接关节造影较常规MRI诊断肩袖撕裂准确性较高.同时对盂唇等其它病变诊断有帮助.     

Rotator cuff tears: diagnostic performance of MR imaging

To determine the diagnostic performance of magnetic resonance (MR) imaging in the evaluation of suspected rotator cuff tears, eight asymptomatic volunteers and 32 patients with rotator cuff tendonopathy who underwent surgery were examined with MR imaging. Twenty-four of these patients also underwent contrast arthrography. The ability of MR imaging to depict the size of cuff tears and the quality of torn tendon edges was also evaluated. The MR imaging and arthrographic studies were reviewed without knowledge of surgical results or of the other studies. A scoring system was developed and a score assigned to each patient's MR study. The sensitivity of MR imaging for all tears (partial and full thickness) was 0.91, and the specificity was 0.88; whereas the sensitivity and specificity of arthrography were each 0.71. The scoring system improved the sensitivity to 1.0 and the specificity to 0.92. Linear regression analysis showed excellent correlation between preoperative assessment of the size of rotator cuff tears and measurement at surgery (r = .95).     

Rotator cuff tears: correlation of sonographic and surgical findings

High-resolution, real-time sonography of the rotator cuff was performed in 51 shoulders, and the results were correlated with findings obtained during subsequent surgery. Prospective sensitivity of sonography in detection of a tear was 100%; specificity, 75%; and accuracy, 92%. Retrospective estimation of tear size on sonograms correlated well with the intraoperative measurements for small and moderate lesions. Large lesions were often underestimated sonographically. Retrospectively, partial tears were correctly diagnosed in seven patients, and bursal thickening was recognized in 17 patients. Sonography of the shoulder proved to be an accurate, noninvasive method for the diagnosis of complete rotator cuff tears. It is useful for estimating tear size and location and may be useful in recognizing partial tears.     

MR imaging diagnosis of rotator cuff tears

Thirty-one symptomatic patients were studied with MR imaging to evaluate the sensitivity and specificity of shoulder MR in the diagnosis of rotator cuff tears. Correlative studies included arthroscopy in 19 patients and arthrography in 12 patients. Images were obtained on either a 0.5- or 1.5-T Philips superconducting magnet using spin-echo pulse sequences (650-850/30 [TR, TE], 2000/30, 100) with 5-mm slices oriented in an oblique coronal plane perpendicular to the glenohumeral joint. The MR studies were initially interpreted without knowledge of the results of other diagnostic procedures. The MR diagnosis of cuff tear was made when irregularity, discontinuity, and increased signal were identified in the rotator cuff. MR images showed tears in 10 patients (32%) and were negative for tear in 21 patients (68%). MR correlated with arthroscopy and arthrography in 17 of 18 normal patients, in eight of 10 patients with complete tears, and in one of three patients with partial tears. For complete rotator cuff tears, the sensitivity, specificity, and accuracy were 80%, 94%, and 89%, respectively. For all tears (partial and complete), the sensitivity, specificity, and accuracy were 69%, 94%, and 84%, respectively. These data suggest that MR imaging is an accurate procedure for the diagnosis of complete rotator cuff tears. The number of partial tears (three) in this series is too small to evaluate the value of MR imaging in the diagnosis of partial tears.     

肩关节损伤的MR影像诊断

目的 探讨常规MRI和MR间接关节造影对肩关节损伤的诊断价值.方法 回顾分析经关节镜证实的90例肩关节损伤患者肩关节常规MRI和MR问接关节造影表现,其中肩袖病变组57例、盂肱关节不稳组33例.对常规MRI和MR间接关节造影诊断结果进行Fisher确切概率法比较.结果 (1)肩袖病变组中MR间接关节造影37例,显示部分撕裂10例,1例漏诊;显示完全撕裂17例,2例误诊,7例肩袖无撕裂.MR间接关节造影显示部分撕裂的敏感度、特异度、准确度分别为90.9%(10/11)、92.3%(24/26)、91.9%(34/37);显示完全撕裂的敏感度、特异度、准确度分别为89.5%(17/19)、94.4%(17/18)、91.9%(34/37).MR间接关节造影诊断肩袖部分及完全撕裂的敏感度及准确度均高于常规MRI(P<0.05).(2)盂肱关节不稳组中,盂唇损伤26例,Hill-sachs病变27例、反Hill-sachs病变2例、骨陛Bankart损伤7例、关节囊损伤18例.间接关节造影20例,显示盂唇损伤14例,1例漏诊,5例正常.MR间接关节造影显示盂唇损伤的敏感度、特异度、准确度分别为93.3%(14/15)、100.0%(5/5)、95.0%(19/20).前者诊断盂唇损伤的敏感度及准确度明显高于常规MRI(P<0.05).结论 MR检查特别是MR间接关节造影能够准确显示肩关节常见病变及相关组织的病理发展过程,为临床诊断及治疗提供影像学依据.     

肩关节造影和MRI诊断肩袖损伤

目的评定肩关节造影、MRI诊断肩袖损伤的价值.材料和方法将33例临床诊断肩袖损伤患者的术前关节造影和MRI检查结果与术中观察结果的比较.另有13例复发性肩关节不稳、无肩袖损伤症状和体征的年轻患者术前的关节造影和MRI结果以及术中观察结果作为正常肩袖对照.结果在诊断肩袖完全断裂中,肩关节造影的敏感性为91%,特异性为100%;MRI的敏感性为95%,特异性为88%.结论关节造影诊断肩袖完全撕裂方法简单、迅速且费用低,易于广泛开展.但不能直接显示病变部位.MRI不但能够准确显示断裂的部位,反映肩袖病变的病理过程,而且能同时显示相邻组织的病理改变,更利于诊断和鉴别诊断.     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

Role of shoulder ultrasonography in the evaluation of the painful shoulder

The purpose of this study was to determine the accuracy of ultrasonography in the detection of rotator cuff tears. In a prospective study of 41 patients, the ultrasound results could be compared with the combined results of (CT) arthrography, arthroscopy and operation. The sensitivity of sonography in detecting partial and total rotator cuff tears was 86%, the specificity 91%, the positive predictive value 96% and the negative predictive value 73%. In spite of the relatively small size of this series, our results are comparable with those of most other studies. Based on these results, sonography can provide a non-invasive, rapid and inexpensive diagnostic method for screening patients with shoulder complaints. A disadvantage of the method is its long learning curve.     

超声诊断肩袖撕裂的临床指导价值研究

目的：探讨肩袖撕裂的超声特征,评价超声检查肩袖撕裂的应用价值及对临床治疗的指导意义。方法：对临床怀疑有肩袖损伤的66例患者（70个肩关节）进行超声检查,并与手术、肩关节造影或磁共振结果进行比较。结果：肩袖撕裂的主要超声表现为：肩袖内局灶性异常回声,肩袖部分缺失,肩袖不显示。超声诊断的敏感性为98%（54/55）,特异性为81%（17/21）,准确性为93%（65/70）。结论：超声诊断肩袖撕裂有很高的应用价值,对临床治疗有很好的指导意义。     

Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study

A prospective evaluation of the coexistence of calcific tendinitis and tear of the rotator cuff demonstrated by arthrography was made in patients presenting with shoulder pain. Patients were X-rayed using conventional views and impingement views. Eighty-one patients (mean age 61.2 years) with calcific tendinitis underwent arthrography. Arthrography showed 22 partial or complete tears of the rotator cuff. A small rather than a large amount of calcification was more likely to be associated with a rotator cuff tear (p = 0.005). The coexistence of calcific tendinitis with rotator cuff tear is not uncommon, especially in older age groups.     

MRI and sonography of the shoulder

We prospectively evaluated the diagnostic value of sonography and magnetic resonance imaging (MRI) in 24 shoulders in 23 patients with suspected rotator cuff tears using arthrography as gold standard. Sonography demonstrated 14 of 15, MRI 10 of 15 rotator cuff tears, respectively. Sonography diagnosed seven of nine intact rotator cuffs correctly, MRI eight of nine. In a retrospective study we reviewed the diagnostic value of sonography and MRI in other pathologies of the shoulder including intra-articular pathology, humeral head and acromioclavicular joint pathology, and calcification. We conclude that with regard to cost and patient compliance, sonography should be the first radiologic examination in suspected rotator cuff tears if performed by an experienced sonographer. MRI is superior in depicting additional pathology and is less operator dependent. It may thus become the method of choice for the evaluation of the rotator cuff and related pathology in the future.     

常规MRI及MRI肩关节造影在肩袖撕裂中的应用

目的:探讨常规MRI及MRI肩关节造影在肩袖撕裂诊断中的价值。方法:226例肩关节损伤的患者,分别行常规MRI及MRI肩关节造影检查,以近期肩关节镜检查为金标准,对比2种检查方法的敏感性及特异性。结果:常规MRI对肩袖撕裂诊断的敏感性为70.8%(17/24),特异性100%(2/2),准确性65.4%(17/26);MRI肩关节造影对肩袖撕裂的敏感性为95.8%(23/24),特异性100%(2/2),准确性88.5%(23/26)。两者的诊断敏感性差异有统计学意义(P=0.016)。结论:MRI肩关节造影可以显著提高肩袖撕裂诊断的敏感性。