Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens |
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| Authors: | G F Bachmann C Melzer C M Heinrichs B Möhring M B Rominger |
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| Institution: | (1) Department of Diagnostic Radiology, Justus Liebig University, D-35 392 Giessen, Germany, DE;(2) Department of Orthopedic Surgery, Justus Liebig University, D-35 392 Giessen, Germany, DE;(3) Department of Pathology, Justus Liebig University, D-35 392 Giessen, Germany, DE |
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| Abstract: | An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI
in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination
of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint
were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal
orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind
to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator
cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings
in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness
tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs
in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive)
and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator
cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears
were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The
MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude that MRI and US are both sensitive
in detection of abnormalities of the rotator cuff. Ultrasound should be the primary diagnostic method in screening of shoulder
pain because it is economic and fast. The MRI technique should be used secondary because it provides more information about
extent of tendons and has lower risk of artefacts.
Received 15 April 1996; Revision received 29 July 1996; Accepted 31 July 1996 |
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| Keywords: | : MRI Rotator cuff Shoulder Tendons US |
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