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

Abstract

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 armbased 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.

Magnetic Resonance Imaging Evaluation of Tendon Integrity Initially After Arthroscopic Rotator Cuff Repair: Single Row Versus Suture Bridge Technique

“…MRI assessment has proven to be a good standard for assessing the rotator cuff tendon integrity after repair [18]. For full-thickness rotator cuff tears, MRI has higher sensitivity and superiority than other methods [19]. The most signi cant nding of our study was that there were 5 type IV cases in SR group and 3 type IV cases in SB group.…”

Diagnostic Value of MRA and MRI for The Articular-Sided Partial-Thickness Rotator Cuff Tears: A Meta-Analysis

“…A previous meta-analysis con rmed that 3-dimensional US is very effective and highly accurate to detect full-thickness RCTs, but may lack accuracy in the diagnosis of partial tears [15]. A recent network meta-analysis of diagnostic tests performed by our team reported that high-eld MRA had the highest diagnostic value, then low-eld MRA, followed by high-eld MRI, high-frequency ultrasound, low-eld MRI, and low-frequency ultrasound [16]. However, both of two meta-analyses were performed based on the full-, partial-or any tear.…”

“…It has become a popular topic whether contrast agent is used in the application of MRI to diagnosis RCTs. A network meta-analysis of 144 diagnostic studies involving 14059 patients (14212 shoulders) demonstrated that for the detection of full-thickness tears, partial-thickness tears, or any tear, MRA had the highest sensitivity, speci city, and superiority index in three common-used imaging modalities (MRA, MRI and US), which revealed that high-eld MRA had the highest diagnostic value for detecting any tear, followed by low-eld MRA, high-eld MRI, high-frequency US, low-eld MRI, and low-frequency US [16]. In addition, another meta-analysis included 14 studies involving 1216 patients with labral lesions, revealed that MRA had the highest sensitivity and speci city compared with those of MRI and CTA, which indicated that MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality [32].…”

“…MRI, as a noninvasive and reproducible diagnosis image, was recommended for the diagnosis of patient with suspected rotator cuff injuries [37]. Our lab's own research [16] con rmed that the diagnostic value rank (from high to low) of commonly-used modalities was 3.0-T MRA, 1.5-T MRA, 3.0-T MRI, 7.5-MHz US, 1.5-T MRI, and < 7.5-MHz US in the diagnosis of full-thickness tears; however, in the diagnosis of partial-thickness tears, the diagnostic value rank (from high to low) was 3.0-T MRA, 3.0-T MRI, 1.5-T MRA, 7.5-MHz US, 1.5-T MRI, and < 7.5-MHz US. Moreover, other research performed in our lab's con rmed that MRI had a similar sensitivity and speci city to MRA in the detection of bursal-sided PTRCTs [19].…”

Development of supraspinatus imaging guidance for primary care physicians with a focus on patient selection

“…A systematic review by Liang et al concluded that ultrasound is highly efficient in assessing supraspinatus tears due to its high sensitivity, specificity and accuracy [12]. However, a network meta-analysis by Liu compared the diagnostic values of MRA, MRI and ultrasound which showed that high-field MRA had the highest diagnostic value [13]. The decision to proceed to MR imaging usually depends on whether the ultrasound result is equivocal or if the clinical history and exam suggest further investigation or if surgery is being considered [9].…”