Diagnostic Accuracy of Imaging Techniques for Rotator Cuff Pathology: An Evidence-to-Practice Review

Abstract

When comparing imaging techniques for rotator cuff pathologies, clinicians tend to consider musculoskeletal ultrasonography (MSK US), magnetic renaissance imaging (MRI), and magnetic renaissance imaging with arthrogram (MRA) as diagnostic imaging techniques. Since the most recent systematic review on imaging conducted in 2003, imaging technology has improved, indicating the need for a meta-analysis to evaluate the accuracy of new diagnostic techniques (MSK US) for evaluating rotator cuff pathologies. The accuracy of MSK US readings between radiologists and non-radiologists was also analyzed. Data were extracted from three different databases and included articles exploring diagnostic imaging and the accuracy of technique at the shoulder joint. All research findings were then rated for any risk of bias using the revised version of the quality assessment of diagnostic accuracy studies (QUADAS-2). Statistically, the authors used hierarchical summary receiver-operating characteristics to compare accuracy of diagnostic imaging techniques across the literature. The results from the guiding manuscript indicated that MSK US, MRI, and MRA were considered highly sensitive diagnostic imaging techniques for full-thickness rotator cuff tears (Sn: US: 0.86-0.94, MRI: 0.85-0.95, MRA: 0.83-0.95). For partial-thickness rotator cuff tears, likelihood ratios indicated an increased accuracy in MRA diagnostic ability (Sn: MRA: 0.83), though MSK US and MRI were still considered highly sensitive for diagnosing partial-thickness rotator cuff tears (Sn: MSK US: 0.68, MRI: 0.67). When comparing radiologists and non-radiologists use of MSK US, there was no significant difference in diagnostic accuracy based on the reading provider. As the diagnosis based on imaging determines the need for surgical intervention, the guiding review indicated that all three diagnostic tools  (MSK US, MRI and MRA) were considered highly sensitive for rotator cuff pathologies (average SN of all diagnostic tools: 0.90-0.91). Determining which imaging technique to use should be based on patient-centered factors, such as possibility of the presence of other shoulder pathology, invasiveness of the procedure, and financial implications. Diagnostic MSK US optimizes these factors, in addition to being highly sensitive.