The Evolving Roles of MRI and Ultrasound in First-Line Imaging of Rotator Cuff Injuries

Area of Science:

• Musculoskeletal Radiology
• Orthopedic Imaging
• Diagnostic Imaging

Background:

• Rotator cuff tears are a common cause of shoulder pain and disability in adults.
• Accurate diagnosis is essential for guiding surgical planning and improving clinical outcomes.
• Radiography is the initial imaging test, but MRI and ultrasound (US) are evolving as first-line imaging modalities.

Purpose of the Study:

• To describe a practical approach to imaging rotator cuff pathology.
• To leverage current literature and expert experience in musculoskeletal radiology.
• To compare the roles and effectiveness of different imaging modalities for rotator cuff tears.

Main Methods:

• Review of current literature on rotator cuff imaging.
• Incorporation of practical experience from subspecialty musculoskeletal radiologists.
• Discussion of MRI, ultrasound, CT, and MR arthrography for rotator cuff pathology.

Main Results:

• Both MRI and ultrasound are accurate in identifying rotator cuff tears, each with distinct advantages and limitations.
• Practice variation exists regarding the first-line use of MRI versus ultrasound.
• Ultrasound is a cost-effective modality that warrants optimized quality and increased referrer confidence.

Conclusions:

• Radiologists can positively impact the diagnosis and treatment of rotator cuff injuries through judicious selection and performance of imaging examinations.
• Optimizing shoulder ultrasound quality and building referrer confidence are important.
• Consideration of various imaging modalities, including CT and MR arthrography, is necessary for comprehensive evaluation.