Ultrasound Diagnosis of Rotator Cuff Tears: The Necessity for Technical and Qualification Upgrades

The dependence of each subtype of rotator cuff tears (RCTs) on ultrasound (US) experience and technique is unknown. The aims of this study were to investigate the necessity of physician qualification and US technical upgrades - possible further diagnostic triage strategies when certain sites of involvement are not clear, by analyzing the degree of dependence of symptomatic rotator cuff on qualifications and techniques.

Two-dimensional US and contrast-enhanced US (CEUS) images of 84 patients who had undergone arthroscopy from 2014 to 2022 were retrospectively analyzed by two senior and two junior radiologists, using a randomized blinded method. A multivariable logistic model was established with the probability of correct diagnosis to investigate the extent to which qualifications, techniques, and subtypes affect the accurate diagnosis of RCTs.

Qualification, mode, and subtype were statistically different (P < 0.05), where CEUS was 10.48 times more likely to be diagnosed correctly than US and 2.43 times by senior than by junior physicians overall (P < 0.05). CEUS was 19.89, 5.15, and 10.48 times more likely than US to be diagnosed correctly when the subtypes were bursal-side partial-thickness tear (P < 0.05), articular-side partial-thickness tear, and small full-thickness tear, respectively (P < 0.05).

In clinical practice, when bursal-side tendon involvement is suspected on US, it is more practical to recommend CEUS than to improve seniority, whereas for articular-side tendon involvement, qualification upgrade is recommended first.