Background Ultrasound (US) and magnetic resonance imaging (MRI) are valid diagnostic modalities in detecting, characterizing and discriminating the rotator cuff disorders, with no significant comparable difference . MRI is the procedure of choice for the evaluation of occult fractures and the shoulder soft tissues. US, with appropriate local expertise, is an excellent evaluation of the rotator cuff, long head of the biceps tendon, and interventional procedures . The choice of which imaging test to perform should be based on the patient's clinical information, equipment availability, personal expertise and preference , patient preference , cost, and imaging experience of the radiology department .
Objectives To identify the concordance between US and MRI abnormalities in patients with shoulder pain.
Methods All 51 hospitalised patients with noninflammatory painful shoulder (median age 57±9.9 years, 70.6% female) enrolled in our clinic between November and March 2013 had abnormal changes in US and MRI. The assessment had included demographic dates, medical history, a clinical assessment for diagnosis, an ultrasonographic assessment in grey scale with static and dynamic examination and an MRI assessment with static examination. The followed ultrasonographic and MRI changes were rotator cuff tendinopathies (tendinitis, tendinosis, tears), bicipital tendinopathy and other changes (subacromial bursitis, impingement syndrome, retractile capsulitis).
Results Ultrasound was found to be sensitive enough in detecting supraspinos tendinopathy and more specific in detecting bicipital and subscapular tendinopathy. We had found tendinopathy of supraspinos (70.6% visible in US and 82.4% in MRI), of biceps (37.3% visible in US and 54.9% in MRI), of subscapular (27.5% visible in US and 31.4% in MRI), of infraspinos (5.9% visible in US and 11.8% in MRI) and of terres minor (3.9% visible in US and 2% in MRI). We had identifed any accordance between ultrasound and MRI for infraspinos tendinopathy, suscapular and terres minor tendinopathy. There was a poor concordance (Cohen's Kappa=0-0,20) between US and MRI for supraspinos tendinopathy, subacromial bursitis, impingement syndrome, capsulitis, but a moderate agreement between these methods in the assessment of biceps tendinopathy (overall accuracy: 70%, likelihood ratio=4.07,Cohen's Kappa=0,426, p=0.001).
Conclusions The shoulder US remains a useful method to complete clinical examination for bicipital tendinopathy.
Mohamed Ahmed Youssef et al, Ultrasonographic and MR diagnosis of rotator cuff disorders & shoulder joint instability The Egyptian Journal of Radiology and Nuclear Medicine, volume 44, Issue 4,Pages 835-844,December 2013.
Wise JN et al, ACR Appropriateness Criteria® on acute shoulder pain, J Am Coll Radiol. 2011 Sep;8(9):602-9. Doi: 10.1016/j.jacr.2011.05.008.
Matthieu J. C. M. Rutten et al, Detection of rotator cuff tears: the value of MRI following ultrasound, Eur Radiol (2010) 20: 450–457 DOI 10.1007/s00330-009-1561-9.
WD et al, Sonography and MRI of the shoulder: comparison of patient satisfaction, AJR Am J Roentgenol. 2004;183(5):1449-52.
Ardic F et al, Shoulder impingement syndrome: relationships between clinical, functional, and radiologic findings. Am J Phys Med Rehabil. 2006 Jan;85(1):53-60.
Disclosure of Interest : None declared