Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies

Background: Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive. Purpose: To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs. Study Design: Systematic review; Level of evidence, 4. Methods: Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques. Results: A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable. Conclusion: This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.

[1]  E. Mascha,et al.  Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. , 2005, The Journal of bone and joint surgery. American volume.

[2]  Andreas Kröner,et al.  Sonographic versus magnetic resonance arthrographic evaluation of full-thickness rotator cuff tears in millimeters. , 2003, Journal of shoulder and elbow surgery.

[3]  S. Lee,et al.  Comparison of three-dimensional isotropic T1-weighted fast spin-echo MR arthrography with two-dimensional MR arthrography of the shoulder. , 2012, Radiology.

[4]  D. C. Wnorowski,et al.  Magnetic resonance imaging assessment of the rotator cuff: is it really accurate? , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[5]  F. I. van Moppes,et al.  Role of shoulder ultrasonography in the evaluation of the painful shoulder. , 1995, European journal of radiology.

[6]  C. Terwee,et al.  The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear , 2014, Journal of Orthopaedic Surgery and Research.

[7]  C. A. Weiss,et al.  Rotator cuff sonography: a reassessment. , 1989, Radiology.

[8]  P. Papadopoulos,et al.  Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. , 2008, European journal of radiology.

[9]  Barry A. Siegel,et al.  Prospective multicenter study of axillary nodal staging by positron emission tomography in breast cancer: a report of the staging breast cancer with PET Study Group. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  E. Craig,et al.  Ultrasonography of rotator cuff tears: A review of 500 diagnostic studies , 1988, Journal of clinical ultrasound : JCU.

[11]  W. Stetson,et al.  The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. , 2005, The Journal of bone and joint surgery. American volume.

[12]  M. Schweitzer,et al.  Special focus session. MR arthrography. , 2002, Radiographics : a review publication of the Radiological Society of North America, Inc.

[13]  J. Yoo,et al.  Comparison of indirect isotropic MR arthrography and conventional MR arthrography of labral lesions and rotator cuff tears: a prospective study. , 2009, AJR. American journal of roentgenology.

[14]  T. Miller,et al.  Gradient-echo versus fat-suppressed fast spin-echo MR imaging of rotator cuff tears. , 1998, AJR. American journal of roentgenology.

[15]  Y. Chou,et al.  Six surgery-correlated sonographic signs for rotator cuff tears: emphasis on partial-thickness tear. , 2004, Clinical imaging.

[16]  M. Schweitzer,et al.  Shoulder instability: accuracy of MR imaging performed after surgery in depicting recurrent injury--initial findings. , 2002, Radiology.

[17]  R. Schild,et al.  Three-dimensional ultrasonography in the diagnosis of rotator cuff lesions. , 2001, Ultrasound in medicine & biology.

[18]  T. Mcadams.  Ultrasonography of the Rotator Cuff: a Comparison with Arthroscopy in One-Hundred-and-Ninety Consecutive Cases , 2008 .

[19]  J. H. Brown,et al.  Labral-ligamentous complex of the shoulder: evaluation with MR arthrography. , 1994, Radiology.

[20]  H. Genant,et al.  Direct MR arthrography: a review of current use. , 2000, Clinical radiology.

[21]  R. Jordan,et al.  A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations , 2015, Skeletal Radiology.

[22]  M. Farouk,et al.  Conventional MR in rotator cuff pathology. Is it sufficient , 2017 .

[23]  C. Zorzi,et al.  MR arthrography of the shoulder: evaluation of isotropic 3D intermediate-weighted FSE and hybrid GRE T1-weighted sequences , 2017, La radiologia medica.

[24]  M. Soble,et al.  Rotator cuff tear: clinical experience with sonographic detection. , 1989, Radiology.

[25]  D. Ziegler.  The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. , 2004, Journal of shoulder and elbow surgery.

[26]  K. Meister,et al.  MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation , 2004, Skeletal Radiology.

[27]  P. Chládek,et al.  Arthroscopic evaluation of ultrasonography and magnetic resonance imaging for diagnosis of rotator cuff tear. , 2008, Ortopedia, traumatologia, rehabilitacja.

[28]  Z. Rosenberg,et al.  Glenohumeral instability: evaluation with MR arthrography. , 1997, Radiographics : a review publication of the Radiological Society of North America, Inc.

[29]  W. Reinus,et al.  Ultrasonography of the rotator cuff: technique and normal anatomy. , 1984, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[30]  O. Levy,et al.  Recurrent rotator cuff tear: is ultrasound imaging reliable? , 2018, Journal of shoulder and elbow surgery.

[31]  F. Shellock,et al.  Evaluation of the rotator cuff and glenoid labrum using a 0.2‐Tesla extremity magnetic resonance (MR) system: MR results compared to surgical findings , 2001, Journal of magnetic resonance imaging : JMRI.

[32]  C. Satterlee,et al.  Magnetic Resonance Imaging for Evaluation of Failed Repairs of the Rotator Cuff. Relationship to Operative Findings* , 1996, The Journal of bone and joint surgery. American volume.

[33]  J. Lee,et al.  Diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears at 3.0 T , 2015, Acta radiologica.

[34]  M. Zlatkin,et al.  Comparison of fat‐saturation fast spin echo versus conventional spin‐echo MRI in the detection of rotator cuff pathology , 1997, Journal of magnetic resonance imaging : JMRI.

[35]  W. Stetson,et al.  Analysis of Low-Field MRI Scanners for Evaluation of Shoulder Pathology Based on Arthroscopy , 2014, Orthopaedic journal of sports medicine.

[36]  S. Snyder,et al.  Sonographic evaluation of the rotator cuff: correlation with arthroscopy. , 1988, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[37]  R. Gold,et al.  Labrocapsular ligamentous complex of the shoulder: normal anatomy, anatomic variation, and pitfalls of MR imaging and MR arthrography. , 1994, Radiographics : a review publication of the Radiological Society of North America, Inc.

[38]  P. Harrington,et al.  Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears , 2009, International journal of shoulder surgery.

[39]  W. Jee,et al.  Diagnostic Performance of MR Arthrography with Anterior Trans-Subscapularis versus Posterior Injection Approach for Subscapularis Tendon Tears at 3.0T , 2017, European Radiology.

[40]  W. Breidahl,et al.  Diagnostic accuracy of shoulder ultrasound performed by a single operator. , 2007, Australasian radiology.

[41]  C. Richards,et al.  Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions , 2013, Clinical Rheumatology.

[42]  J. Yoo,et al.  Three-dimensional isotropic shoulder MR arthrography: comparison with two-dimensional MR arthrography for the diagnosis of labral lesions at 3.0 T. , 2009, Radiology.

[43]  W. Jin,et al.  Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta‐analysis , 2018, Journal of magnetic resonance imaging : JMRI.

[44]  K. Rowan,et al.  Comparison of 2- and 3-Dimensional Shoulder Ultrasound to Magnetic Resonance Imaging in a Community Hospital for the Detection of Supraspinatus Rotator Cuff Tears with Improved Worktime Room Efficiency , 2012, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[45]  Ruey-Feng Chang,et al.  Computer-Aided Diagnosis of Different Rotator Cuff Lesions Using Shoulder Musculoskeletal Ultrasound. , 2016, Ultrasound in medicine & biology.

[46]  C. Gerber,et al.  Partial supraspinatus tears are associated with tendon lengthening , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[47]  Christian Smith,et al.  Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis , 2016, Skeletal Radiology.

[48]  S. Heir,et al.  Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: Results from 58 sonographic examinations with surgical correlation , 2007, Journal of clinical ultrasound : JCU.

[49]  Y. Ao,et al.  The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[50]  S. F. Quinn,et al.  Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients. , 1995, Radiology.

[51]  H. Hashizume,et al.  Ultrasonographic analysis of shoulder rotator cuff tears. , 1999, Acta medica Okayama.

[52]  C. Martinoli,et al.  Ultrasound of tendon tears. Part 1: general considerations and upper extremity , 2005, Skeletal Radiology.

[53]  Xiaobing Yu,et al.  Ultrasound in Assessment of Supraspinatus Tendon Injury: Correlation with Arthroscopy , 2016, Chinese medical journal.

[54]  K. Finlay,et al.  Sonography of full-thickness supraspinatus tears: comparison of patient positioning technique with surgical correlation. , 2005, AJR. American journal of roentgenology.

[55]  Hung-Maan Lee,et al.  Quantitative diffusion-weighted magnetic resonance imaging for the diagnosis of partial-thickness rotator cuff tears. , 2016, Journal of shoulder and elbow surgery.

[56]  Harpreet Singh,et al.  Evaluation of ultrasound as a tool for etiological diagnosis of painful arc syndrome , 2010 .

[57]  A. Jawa,et al.  Computed tomography underestimates rotator cuff pathology in patients with glenohumeral osteoarthritis. , 2018, Journal of shoulder and elbow surgery.

[58]  A. Fotiadou,et al.  Evaluating the success of preoperative imaging for diagnosing rotator cuff tears in a regional centre. , 2014, Acta orthopaedica Belgica.

[59]  Jose R. Perez,et al.  Rotator cuff tears in the pediatric population: Comparing findings on arthroscopic evaluation to pre-operative magnetic resonance imaging. , 2017, Journal of clinical orthopaedics and trauma.

[60]  R. Seitz,et al.  MR imaging of the shoulder after surgery. , 1997, AJR. American journal of roentgenology.

[61]  F. Song,et al.  Comparing the diagnostic accuracy of five common tumour biomarkers and CA19-9 for pancreatic cancer: a protocol for a network meta-analysis of diagnostic test accuracy , 2017, BMJ Open.

[62]  C. Yücesoy,et al.  Comparison of the results of ultrasonographic evaluation and arthroscopy in patients scheduled for surgery of the supraspinatus tendon rupture , 2014, Annals of Saudi medicine.

[63]  K. Yamaguchi,et al.  Ultrasonography of the Rotator Cuff: A Comparison of Ultrasonographic and Arthroscopic Findings in One Hundred Consecutive Cases* , 2000, The Journal of bone and joint surgery. American volume.

[64]  W. Eyler,et al.  US depiction of partial-thickness tear of the rotator cuff. , 1995, Radiology.

[65]  Evaluation of ultrasonography as a diagnostic technique in the assessment of rotator cuff tendon tears , 1992, The American journal of sports medicine.

[66]  H. Smith,et al.  Diagnostic ultrasound of the shoulder—a method for experts only? , 2005, Acta orthopaedica.

[67]  C. Gerber,et al.  Subscapularis tendon tears: detection and grading at MR arthrography. , 1999, Radiology.

[68]  C. Gerber,et al.  MR arthrography of the glenohumeral joint: two concentrations of gadoteridol versus Ringer solution as the intraarticular contrast material. , 2001, Radiology.

[69]  R. Hollinshead,et al.  Comparison of magnetic resonance imaging and arthroscopy in the evaluation of shoulder pathology. , 1999, Journal of shoulder and elbow surgery.

[70]  N. Subhas,et al.  Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears. , 2017, Journal of shoulder and elbow surgery.

[71]  A. Peduto,et al.  MR imaging of the rotator cuff mechanism: comparison of spin-echo and turbo spin-echo sequences. , 1996, AJR. American journal of roentgenology.

[72]  S. Punwar,et al.  Pre-operative departmental ultrasound of the rotator cuff: sensitivity and specificity in a regional specialist orthopaedic centre , 2014, Shoulder & elbow.

[73]  L. Jazrawi,et al.  Physician Training Ultrasound and Accuracy of Diagnosis in Rotator Cuff Tears. , 2016, Bulletin of the Hospital for Joint Disease.

[74]  R. Dias,et al.  Diagnostic difficulties in the radiological assessment of subscapularis tears. , 2018, Journal of orthopaedics.

[75]  Hsin-Hua Chen,et al.  Diagnostic Utility of US for Detecting Rotator Cuff Tears in Rheumatoid Arthritis Patients: Comparison with Magnetic Resonance Imaging , 2014 .

[76]  Nicola J Cooper,et al.  Network meta-analysis of diagnostic test accuracy studies identifies and ranks the optimal diagnostic tests and thresholds for health care policy and decision-making. , 2018, Journal of clinical epidemiology.

[77]  Young Joo Kim,et al.  Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation , 2010, Korean journal of radiology.

[78]  C. Arend,et al.  Diagnostic value of tendon thickness and structure in the sonographic diagnosis of supraspinatus tendinopathy: room for a two-step approach. , 2014, European journal of radiology.

[79]  D. Resnick,et al.  MR arthrography of the glenohumeral joint: a tailored approach. , 2001, AJR. American journal of roentgenology.

[80]  S. Bipat,et al.  Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography? , 2009, Skeletal Radiology.

[81]  T. Magee.  Can isotropic fast gradient echo imaging be substituted for conventional T1 weighted sequences in shoulder MR arthrography at 3 Tesla? , 2007, Journal of magnetic resonance imaging : JMRI.

[82]  T. Magee,et al.  3.0-T MRI of the supraspinatus tendon. , 2006, AJR. American journal of roentgenology.

[83]  S. Higano,et al.  High-resolution magnetic resonance imaging of rotator cuff tears using a microscopy coil: noninvasive detection without intraarticular contrast material , 2011, Japanese Journal of Radiology.

[84]  J. Roy,et al.  Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis , 2015, British Journal of Sports Medicine.

[85]  D. Sonnabend,et al.  The clinical role of shoulder ultrasound. , 1997, The Australian and New Zealand journal of surgery.

[86]  A. Hussain,et al.  Effectiveness Of Plain Shoulder Radiograph In Detecting Degenerate Rotator Cuff Tears. , 2018, Journal of Ayub Medical College, Abbottabad : JAMC.

[87]  D Resnick,et al.  Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation. , 1992, Radiology.

[88]  S. K. Park,et al.  Comparison of three-dimensional isotropic and conventional MR arthrography with respect to the diagnosis of rotator cuff and labral lesions: focus on isotropic fat-suppressed proton density and VIBE sequences. , 2014, Clinical radiology.

[89]  C. Gerber,et al.  Rotator cuff tears: correlation of sonographic and surgical findings. , 1988, Radiology.

[90]  M. Matava,et al.  Partial-Thickness Rotator Cuff Tears , 2005, The American journal of sports medicine.

[91]  K. Yamaguchi,et al.  Accuracy of Ultrasound Imaging of the Rotator Cuff in Shoulders That Are Painful Postoperatively , 2003, The Journal of bone and joint surgery. American volume.

[92]  J. Beltrán,et al.  Glenohumeral instability: evaluation using MR arthrography of the shoulder , 1999, Skeletal Radiology.

[93]  W. Mallon,et al.  Ultrasonography of the rotator cuff: Analysis of results in a community setting. , 1993, Journal of shoulder and elbow surgery.

[94]  N. Bureau,et al.  Economics of Musculoskeletal Ultrasound , 2016, Current Radiology Reports.

[95]  D. Howlett,et al.  Evaluation of the symptomatic supraspinatus tendon—a comparison of ultrasound and arthroscopy , 2002 .

[96]  M. Rominger,et al.  Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens , 1997, European Radiology.

[97]  M. Kurol,et al.  Sonography for diagnosis of rotator cuff tear. Comparison with observations at surgery in 58 shoulders. , 1991, Acta orthopaedica Scandinavica.

[98]  A. Napoli,et al.  MRI of adhesive capsulitis of the shoulder: distension of the bursa in the superior subscapularis recess is a suggestive sign of the pathology. , 2014, European journal of radiology.

[99]  G. Murrell,et al.  A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. , 2002, Journal of shoulder and elbow surgery.

[100]  W. Jeong,et al.  Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation , 2009, Skeletal Radiology.

[101]  Joon-Yong Jung,et al.  Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences , 2012, Skeletal Radiology.

[102]  L. Funk,et al.  Comparison of magnetic resonance arthrography with arthroscopy for imaging of shoulder injuries: retrospective study , 2017, Annals of the Royal College of Surgeons of England.

[103]  V. Chandnani,et al.  Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography. , 1995, Radiology.

[104]  Michael C. Mosier,et al.  In-office diagnostic arthroscopy for knee and shoulder intra-articular injuries its potential impact on cost savings in the United States , 2014, BMC Health Services Research.

[105]  L. Sconfienza,et al.  Dynamic high-resolution ultrasound of the shoulder: how we do it. , 2015, European journal of radiology.

[106]  T. Magee.  MR versus MR arthrography in detection of supraspinatus tendon tears in patients without previous shoulder surgery , 2013, Skeletal Radiology.

[107]  D. Mitchell,et al.  Rotator cuff disorders: interobserver and intraobserver variation in diagnosis with MR imaging. , 1995, Radiology.

[108]  Susan Mallett,et al.  QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies , 2011, Annals of Internal Medicine.

[109]  H. Hashizume,et al.  Comparative studies of MRI and operative findings in rotator cuff tear. , 2001, Acta medica Okayama.

[110]  E. Craig,et al.  Sonography of the postoperative rotator cuff. , 1986, AJR. American journal of roentgenology.

[111]  J. Romero,et al.  Ultrasonographic and magnetic resonance images of rotator cuff lesions compared with arthroscopy or open surgery findings. , 2001, Journal of shoulder and elbow surgery.

[112]  C. Hing,et al.  Diagnostic accuracy of ultrasound for rotator cuff tears in adults: a systematic review and meta-analysis. , 2011, Clinical radiology.

[113]  A. Carr,et al.  An independent learning method for orthopaedic surgeons performing shoulder ultrasound to identify full-thickness tears of the rotator cuff. , 2013, The Journal of bone and joint surgery. American volume.

[114]  L. Nazarian.  The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. , 2008, AJR. American journal of roentgenology.

[115]  N. Nacey,et al.  Postoperative Shoulder Imaging: Rotator Cuff, Labrum, and Biceps Tendon. , 2016, Radiographics : a review publication of the Radiological Society of North America, Inc.

[116]  S. Bhonsle,et al.  Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. , 2016, Journal of clinical and diagnostic research : JCDR.

[117]  H. Genant,et al.  Indirect MR arthrography: optimization and clinical applications. , 1996, Radiology.

[118]  S. Seltzer,et al.  Arthrosonography: gray-scale ultrasound evaluation of the shoulder. , 1979, Radiology.

[119]  A. DeSmet,et al.  Diagnosis of partial and complete rotator cuff tears using combined gradient echo and spin echo imaging , 1994, Skeletal Radiology.

[120]  G. Murrell,et al.  Not all ultrasounds are created equal: general sonography versus musculoskeletal sonography in the detection of rotator cuff tears , 2016, Shoulder & elbow.

[121]  A. Ekin,et al.  Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures , 2001, European Radiology.

[122]  Matthieu J. C. M. Rutten,et al.  Detection of rotator cuff tears: the value of MRI following ultrasound , 2009, European Radiology.

[123]  Marc Aerts,et al.  ANOVA model for network meta-analysis of diagnostic test accuracy data , 2016, Statistical methods in medical research.

[124]  S. Erickson,et al.  Rotator cuff: evaluation with US and MR imaging. , 1999, Radiographics : a review publication of the Radiological Society of North America, Inc.

[125]  L. Mack,et al.  Sonographic Evaluation of the Rotator Cuff: Accuracy in Patients Without Prior Surgery , 1988, Clinical orthopaedics and related research.

[126]  A. Al-shawi,et al.  The detection of full thickness rotator cuff tears using ultrasound. , 2008, The Journal of bone and joint surgery. British volume.

[127]  K. Yamaguchi,et al.  Sonography of the rotator cuff: analysis of interobserver variability. , 2004, AJR. American journal of roentgenology.

[128]  J. Read,et al.  Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. , 1998, Journal of shoulder and elbow surgery.

[129]  K. Yamaguchi,et al.  Detection and quantification of rotator cuff tears. Comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. , 2004, The Journal of bone and joint surgery. American volume.

[130]  U. Väätäinen,et al.  Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging - a prospective study in 77 consecutive patients with a surgical reference. , 2010, Ultrasound in medicine & biology.

[131]  J. Lee,et al.  Rotator cuff tears noncontrast MRI compared to MR arthrography , 2015, Skeletal Radiology.

[132]  K. Kreitner,et al.  MR arthrography of the shoulder: comparison of low-field (0,2 T) vs high-field (1.5 T) imaging , 2009, European Radiology.

[133]  M. Flannery,et al.  Accuracy of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in Detection of Rotator Cuff Tears in District General Hospital , 2017, Polish journal of radiology.

[134]  M. Recht,et al.  Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience , 2013, Skeletal Radiology.

[135]  E. Craig,et al.  Ultrasonography of the rotator cuff. Normal and pathologic anatomy. , 1984, Investigative radiology.

[136]  P. Bertrand,et al.  Diagnostic value of angled oblique sagittal images of the supraspinatus tendon for the detection of rotator cuff tears on MR imaging. , 2017, Diagnostic and interventional imaging.

[137]  S. Feuerbach,et al.  Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. , 2006, Radiology.

[138]  M. Itoman,et al.  Ultrasonography for diagnosis of rotator cuff tear , 1996, Skeletal Radiology.

[139]  W. Seitz,et al.  Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options. , 1993, AJR. American journal of roentgenology.

[140]  N. Obuchowski,et al.  Comparison of a Fast 5-Minute Shoulder MRI Protocol With a Standard Shoulder MRI Protocol: A Multiinstitutional Multireader Study. , 2017, AJR. American journal of roentgenology.

[141]  Rotator Cuff: Evaluation with Us and Mr Imaging , 1999 .

[142]  M. Bordalo-Rodrigues,et al.  Accuracy of preoperative MRI in the diagnosis of subscapularis tears , 2016, Archives of Orthopaedic and Trauma Surgery.

[143]  Andrea J. Frangos,et al.  Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. , 2009, AJR. American journal of roentgenology.

[144]  J. Leppilahti,et al.  Ultrasound and operative evaluation of arthritic shoulder joints , 1998, Annals of the rheumatic diseases.

[145]  H. Jaroma,et al.  Sonographic detection of tears of the anterior portion of the rotator cuff (subscapularis tendon tears). , 1996, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[146]  S. F. Quinn,et al.  MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. , 1997, Radiology.

[147]  D. Mitchell,et al.  Rotator cuff tears: prospective comparison of MR imaging with arthrography, sonography, and surgery. , 1989, AJR. American journal of roentgenology.

[148]  J. Yoo,et al.  Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder , 2009, Skeletal Radiology.

[149]  D. Mitchell,et al.  MR imaging shoulder injuries in professional baseball players , 1991, Journal of magnetic resonance imaging : JMRI.

[150]  K. Yamaguchi,et al.  Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors. , 2005, AJR. American journal of roentgenology.

[151]  T. Magee.  3-T MRI of the shoulder: is MR arthrography necessary? , 2009, AJR. American journal of roentgenology.

[152]  Kurt P. Spindler,et al.  Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value , 1991 .

[153]  J. Milosavljević,et al.  Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases , 2005, Acta radiologica.

[154]  T. Lang,et al.  Distinction between supraspinatus, infraspinatus and subscapularis tendon tears with ultrasound in 332 surgically confirmed cases. , 2002, Ultrasound in medicine & biology.

[155]  T. Kubo,et al.  Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. , 2014, Journal of shoulder and elbow surgery.

[156]  The usefulness of the three-dimensional enhanced T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology: comparison with two-dimensional enhanced T1 fat saturation MR. , 2015, The British journal of radiology.

[157]  Tatsuya Koike,et al.  Evaluation of Rotator Cuff Tears with Magnetic Resonance Arthrography , 2005, Clinical orthopaedics and related research.

[158]  Y. Chevalier,et al.  Effectiveness of 3-dimensional shoulder ultrasound in the diagnosis of rotator cuff tears , 2018, Medicine.

[159]  H. Potter,et al.  Magnetic resonance imaging of painful shoulder arthroplasty. , 2002, Journal of shoulder and elbow surgery.

[160]  R. Vinci,et al.  Lesions of the rotator cuff footprint: diagnostic performance of MR arthrography compared with arthroscopy , 2013, MUSCULOSKELETAL SURGERY.

[161]  P. Kolowich,et al.  Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis. , 2004, Radiology.

[162]  R. R. Slater.  Indirect MR Arthrography of the Shoulder: Use of Abduction and External Rotation to Detect Full- and Partial-Thickness Tears of the Supraspinatus Tendon , 2007 .

[163]  W. Palmer,et al.  Cystic changes at supraspinatus and infraspinatus tendon insertion sites: association with age and rotator cuff disorders in 238 patients. , 2007, Radiology.

[164]  W. Jee,et al.  Magnetic resonance arthrography including aber view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements , 2010, Acta radiologica.

[165]  J. Orwin,et al.  Angled oblique sagittal MR imaging of rotator cuff tears: comparison with standard oblique sagittal images , 2001, Skeletal Radiology.

[166]  L. Higgins,et al.  Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[167]  David Moher,et al.  Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement , 2018, JAMA.

[168]  Emmanuel Lesaffre,et al.  A general framework for comparative Bayesian meta-analysis of diagnostic studies , 2015, BMC Medical Research Methodology.

[169]  J. H. Brown,et al.  Rotator cuff: evaluation with fat-suppressed MR arthrography. , 1993, Radiology.

[170]  Frank G Shellock,et al.  Assessment of the rotator cuff and glenoid labrum using an extremity MR system: MR results compared to surgical findings from a multi‐center study , 2004, Journal of magnetic resonance imaging : JMRI.

[171]  H. Chiou,et al.  Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears. , 2002, Clinical imaging.

[172]  P. Algra,et al.  Sonography and magnetic resonance imaging equivalent for the assessment of full-thickness rotator cuff tears. , 1999, Arthritis and rheumatism.

[173]  H. Genant,et al.  Indirect MR arthrography: techniques and applications , 1998, European Radiology.

[174]  E. Edmonds,et al.  Diagnostic Shortcomings of Magnetic Resonance Arthrography to Evaluate Partial Rotator Cuff Tears in Adolescents , 2015, Journal of pediatric orthopedics.

[175]  S. Kook,et al.  Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR. , 2015, The British journal of radiology.

[176]  K. Takagishi,et al.  Prevalence and risk factors of a rotator cuff tear in the general population. , 2010, Journal of shoulder and elbow surgery.

[177]  P. Stefani,et al.  Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation , 2002, European Radiology.

[178]  Adnan Saithna,et al.  Accuracy of abduction-external rotation MRA versus standard MRA in the diagnosis of intra-articular shoulder pathology. , 2013, Orthopedics.

[179]  P. Paavolainen,et al.  Ultrasonography and arthrography in the diagnosis of tears of the rotator cuff. , 1994, The Journal of bone and joint surgery. American volume.

[180]  M. Vlychou,et al.  Symptomatic partial rotator cuff tears: Diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation , 2009, Acta radiologica.

[181]  M. V. van Holsbeeck,et al.  Ultrasound of the rotator cuff with MRI and anatomic correlation. , 2007, European journal of radiology.

[182]  G. Fick,et al.  A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. , 2004, Journal of shoulder and elbow surgery.

[183]  E. Rummeny,et al.  Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation , 2007, European Radiology.

[184]  H. Yoshioka,et al.  Comparison Between Isotropic 3-Dimensional Fat-Suppressed T2-Weighted Fast Spin Echo (FSE) and Conventional 2-Dimensional Fat-Suppressed Proton-Weighted FSE Shoulder Magnetic Resonance Imaging at 3-T in Patients With Shoulder Pain , 2018, Journal of computer assisted tomography.

[185]  Richard J Hawkins,et al.  Accuracy of magnetic resonance imaging in determining the presence and size of recurrent rotator cuff tears. , 2002, Journal of shoulder and elbow surgery.

[186]  O. Kim,et al.  Delaminated tears of the rotator cuff: prevalence, characteristics, and diagnostic accuracy using indirect MR arthrography. , 2015, AJR. American journal of roentgenology.

[187]  J. Schoolfield,et al.  Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[188]  R. Lenkinski,et al.  Rotator cuff tears: diagnostic performance of MR imaging. , 1989, Radiology.

[189]  D. Resnick,et al.  MR arthrography of the labral capsular ligamentous complex in the shoulder: imaging variations and pitfalls. , 2000, AJR. American journal of roentgenology.

[190]  J. Lee,et al.  Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears , 2014, Korean journal of radiology.

[191]  M. Gerami,et al.  Assessment of Correlation Between MRI and Arthroscopic Pathologic Findings in the Shoulder Joint. , 2015, The archives of bone and joint surgery.