title: Diagnosis of rotator cuff tears using 3-Tesla MRI versus 3-Tesla MRA: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T.
  
  
  METHODS
  A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability.
  
  
  RESULTS
  Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA.
  
  
  CONCLUSIONS
  Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears.
authors.affiliation: Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. cpj.mcgarvey@googlemail.com.
authors.forename: Ciaran
authors.initials: C
authors.lastname: McGarvey
authors.affiliation: Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. ziadharb@doctors.org.uk.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Harb
authors.affiliation: Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. drccsmith@doctors.org.uk.
authors.forename: Christian
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Radiology, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. rus9000@hotmail.com.
authors.forename: Russell
authors.initials: R
authors.lastname: Houghton
authors.affiliation: Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. steven.corbett@gstt.nhs.uk.|Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK. steven.corbett@gstt.nhs.uk.
authors.forename: Steven
authors.initials: S
authors.lastname: Corbett
authors.affiliation: Department of Trauma and Orthopaedics, Guy's and St Thomas' Hospital, King's Health Partners, Great Maze Pond, London, SE1 9RT, UK. aajuied@doctors.org.uk.
authors.forename: Adil
authors.initials: A
authors.lastname: Ajuied
mesh_terms: D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000473:pathology*; D000070636:Rotator Cuff Injuries; D012680:Sensitivity and Specificity
keywords: 3-Tesla; Magnetic resonance; Rotator cuff; Sensitivity; Specificity; Subscapularis; Supraspinatus