title: Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis.
abstract: BACKGROUND
  Different diagnostic imaging modalities, such as ultrasonography (US), MRI, MR arthrography (MRA) are commonly used for the characterisation of rotator cuff (RC) disorders. Since the most recent systematic reviews on medical imaging, multiple diagnostic studies have been published, most using more advanced technological characteristics. The first objective was to perform a meta-analysis on the diagnostic accuracy of medical imaging for characterisation of RC disorders. Since US is used at the point of care in environments such as sports medicine, a secondary analysis assessed accuracy by radiologists and non-radiologists.
  
  
  METHODS
  A systematic search in three databases was conducted. Two raters performed data extraction and evaluation of risk of bias independently, and agreement was achieved by consensus. Hierarchical summary receiver-operating characteristic package was used to calculate pooled estimates of included diagnostic studies.
  
  
  RESULTS
  Diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears was high with overall estimates of sensitivity and specificity over 0.90. As for partial RC tears and tendinopathy, overall estimates of specificity were also high (>0.90), while sensitivity was lower (0.67-0.83). Diagnostic accuracy of US was similar whether a trained radiologist, sonographer or orthopaedist performed it.
  
  
  CONCLUSIONS
  Our results show the diagnostic accuracy of US, MRI and MRA in the characterisation of full-thickness RC tears. Since full thickness tear constitutes a key consideration for surgical repair, this is an important characteristic when selecting an imaging modality for RC disorder. When considering accuracy, cost, and safety, US is the best option.
authors: Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.
authors: Jean-Sébastien
authors: JS
authors: Roy
authors: Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada.
authors: Caroline
authors: C
authors: Braën
authors: Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.
authors: Jean
authors: J
authors: Leblond
authors: Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Quebec, Canada Faculty of Medicine, School of Rehabilitation, Université de Montreal, Montreal, Quebec, Canada.
authors: François
authors: F
authors: Desmeules
authors: Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada.
authors: Clermont E
authors: CE
authors: Dionne
authors: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
authors: Joy C
authors: JC
authors: MacDermid
authors: Department of Radiology, Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
authors: Nathalie J
authors: NJ
authors: Bureau
authors: Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada Centre de recherche du Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada.
authors: Pierre
authors: P
authors: Frémont
mesh_terms: D001175:Arthrography / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods; D017006:Rotator Cuff; D012421:Rupture / Q000175:diagnosis; D012680:Sensitivity and Specificity; D000070599:Shoulder Injuries; D052256:Tendinopathy / Q000175:diagnosis*; D013708:Tendon Injuries / Q000175:diagnosis*
keywords: MRI; Meta-analysis; Shoulder; Ultrasound