[Harmonic sonography of rotator cuff tendons: are cleavage tears visible at last?].
OBJECTIVE
For some, cleavage tears remain a pitfall of sonography (US). The purpose of this study is to demonstrate the visibility of intratendinous tears of the supraspinatus and infraspinatus tendons and describe their imaging features on tissue harmonic US.


METHODS
Prospective study of 52 patients with suspected cuff pathology who underwent US prior to CT-arthrography, CT-bursography or MR arthrography. The US examinations were performed using 7-15 MHz transducers with tissue harmonic mode (pulse subtraction). An intratendinous tear was suggested by the presence of a hypoechoic intratendinous line, extending from a partial or full thickness tear. Results from US were correlated to contrast material enhanced CT or MR findings.


RESULTS
Ten cases of cleavage tears were detected on US compared to 18 on arthrographic examinations. False negative results occurred in poor US candidates (n=4), excessively retracted tendons (n=2) or postsurgical cuffs (n=2). Sensitivity was 55% and specificity was 94%, with PPV of 83% and NPV of 80% for the detection of intratendinous tear. The accuracy of US was lower for intratendinous tear associated with full thickness tears (5/11) compared to intratendinous tears associated with partial thickness tears (5/6).


CONCLUSIONS
We demonstrate that cleavage tears are now visible on US using high-frequency transducers and tissue harmonic mode. However, the sensitivity remains too low, especially in patients with full thickness tear, postsurgical patients and patients that are poor candidates to US.
Guerini
H
H
Service de radiologie B, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France. henri.guerini@cch.aphp.fr
Feydy
A
A
Campagna
R
R
Thèvenin
F
F
Fermand
M
M
Pessis
E
E
Chevrot
A
A
Drapé
J L
JL
D006801:Humans; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging*; D000070636:Rotator Cuff Injuries; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000175:diagnosis