Ultrasonography may be reliable in diagnosis of subscapularis tears
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Ultrasonography may be a reliable and accurate diagnostic method for subscapularis tears, according to published results.
Researchers performed and interpreted preoperative ultrasonography and MRI among 437 patients who underwent arthroscopic rotator cuff repair from January 2019 to December 2020. Using arthroscopic findings as the gold standard, researchers calculated the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasonography and MRI.
At the time of arthroscopy, researchers identified subscapularis tears in 157 patients, of whom 126 had partial-thickness tears. Results showed 122 of 157 patients with subscapularis tears were correctly diagnosed by ultrasonography, yielding an overall sensitivity of 77.7%. Researchers noted ultrasonography had a significantly greater sensitivity compared with MRI, which had a sensitivity of 49.7%.
Ultrasonography also correctly diagnosed partial-thickness subscapularis tears in 93 of 126 positive patients and 276 of 311 negative patients, resulting in a sensitivity of 73.8%, a specificity of 88.7% and an accuracy of 84.4%, according to results. Researchers found diagnosis of partial-thickness subscapularis tears with MRI had a sensitivity of 38.1%, a specificity of 86.5% and an accuracy of 72.5%. Although lesser tuberosity cysts and subcoracoid cysts had high specificity with MRI at 98.2% and 94.6%, respectively, researchers noted both signs had relatively low sensitivities at 19.8% and 33.8%.
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In this study, the authors compared preoperative ultrasound vs. MRI and the ability to detect subscapularis tears when correlated with intraoperative arthroscopic findings. Interestingly, the ultrasound exams were more sensitive and specific for identifying subscapularis tears, especially partial-thickness lesions. The authors noted that MRI imaging only correctly identified partial-thickness subscapularis tears in 38% of patients compared with 74% of patients in the ultrasound cohort when correlated with intraoperative evaluation.
It should be noted that diagnostic ultrasound results can be operator dependent and the skill of the ultrasonographer plays a role. The accuracy these authors demonstrated with the use of ultrasound may not be able to be extrapolated to all ultrasound exams and sonographers. Also of note, the MRI scanner used in this study was 1.5 T scanner and it is unknown if the higher resolution 3.0 T scanner that is currently used in many imaging centers would yield better results when compared to ultrasound.
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