Comparative Evaluation of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Rotator Cuff Injury: A Cross-Sectional Observational Study
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Abstract
Background: Rotator cuff pathology is a leading cause of shoulder pain and disability worldwide, and magnetic resonance imaging (MRI) is regarded as the reference standard for its evaluation, although ultrasonography (USG) is increasingly used as an accessible first-line alternative, particularly in resource-constrained settings.
Objective: To determine the MRI findings, the USG findings, and the level of concordance between the two imaging modalities in patients with clinically suspected rotator cuff injury.
Methods: This cross-sectional observational study was conducted in the Department of Radio-diagnosis of a tertiary care teaching hospital over eighteen months. Thirty-two patients aged 18 to 75 years with clinical features suggestive of rotator cuff injury underwent both MRI and USG of the affected shoulder within 24 to 48 hours of each other. Tendon integrity, tear type, muscle atrophy, joint effusion, and associated structural abnormalities were recorded and compared descriptively, with MRI as the reference standard.
Results: The cohort showed a male predominance (59.4%) and peak involvement in the 45 to 60 year age group (34.4%). MRI identified supraspinatus tendon abnormality in 29 of 32 patients (90.6%), with full-thickness and partial-thickness tears each present in 11 patients (34.4%). USG identified supraspinatus abnormality in 25 of 32 patients (78.1%), most frequently partial tear (43.8%). Overall, 23 of 32 patients (71.9%) showed agreement in at least 7 of 10 assessed radiological parameters, while MRI detected more associated findings, such as posterior glenohumeral effusion and muscle atrophy, than USG.
Conclusion: USG showed substantial concordance with MRI for supraspinatus tendon abnormality, supporting its role as a practical first-line screening tool, although MRI remained superior for detailed tear characterization and for detecting associated structural findings..
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References
Lucas J, van Doorn P, Hegedus E, Lewis J, van der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskelet Disord. 2022;23:1073.
Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, et al. Rotator cuff tears. Nat Rev Dis Primers. 2024;10:8.
Lafrance S, Charron M, Roy JS, Dyer JO, Fremont P, Dionne CE, et al. Diagnosing, managing, and supporting return to work of adults with rotator cuff disorders: a clinical practice guideline. J Orthop Sports Phys Ther. 2022;52:647-64.
Pierce J, Anderson M. Update on diagnostic imaging of the rotator cuff. Clin Sports Med. 2023;42:25-52.
Hekmatnia F, Jamalipour Soufi G, Parviz Zarei A, Shafieioun S, Hekmatnia A, Sadraei N, et al. Diagnostic accuracy of ultrasound compared to magnetic resonance imaging for rotator cuff tears: a systematic review. Int J Burns Trauma. 2026;16:33-44.
Ganesh J, Patil SD, Muchchandi R, Naik S, Khatri R. Diagnostic comparison of ultrasound and magnetic resonance imaging in detecting rotator cuff tears: a study conducted in the population of Vijayapura. Cureus. 2024;16:e68302.
Nakashima Y, Sunagawa T, Shinomiya R, Kodama A, Adachi N. Point-of-care ultrasound in musculoskeletal field. J Med Ultrason. 2022;49:663-73.
Nasr AJ, Pierson CJ, Tzen YT, Khazzam M, Jain NB, Lin YS. Emerging role of quantitative ultrasound-based imaging techniques for characterizing rotator cuff tears: a scoping review. Diagnostics (Basel). 2023;13:2011.
Rampersad S, Morris K. Implementation of ultrasound-guided musculoskeletal injections in a South Trinidad medical practice: a perspective from a resource-limited setting. Cureus. 2026;18:e101245.
Nunna B Jr, Parihar P, Wanjari M, Shetty N, Bora N. High-resolution imaging insights into shoulder joint pain: a comprehensive review of ultrasound and magnetic resonance imaging (MRI). Cureus. 2023;15:e48974.
van der Kraats AM, Peeters NHC, Janssen ERC, Lambers Heerspink FO. Handheld ultrasound does not replace magnetic resonance imaging for diagnosis of rotator cuff tears. Arthrosc Sports Med Rehabil. 2023;5:e381-7.
Wang X, Zhang W, Dong J, Li L, Xiao Y, Liu F. Three-dimensional sonography has satisfied accuracy for detecting rotator cuff tears. Front Surg. 2024;11:1411816.
Riem L, Feng X, Cousins M, DuCharme O, Leitch EB, Werner BC, et al. A deep learning algorithm for automatic 3D segmentation of rotator cuff muscle and fat from clinical MRI scans. Radiol Artif Intell. 2023;5:e220132.
Yao J, Chepelev L, Nisha Y, Sathiadoss P, Rybicki FJ, Sheikh AM. Evaluation of a deep learning method for the automated detection of supraspinatus tears on MRI. Skeletal Radiol. 2022;51:1765-75.
Iio R, Ueda D, Matsumoto T, Manaka T, Nakazawa K, Ito Y, et al. Deep learning-based screening tool for rotator cuff tears on shoulder radiography. J Orthop Sci. 2024;29:828-34.
Velasquez Garcia A, Hsu KL, Marinakis K. Advancements in the diagnosis and management of rotator cuff tears: the role of artificial intelligence. J Orthop. 2023;47:87-93.
Longo UG, Bandini B, Mancini L, Merone M, Schena E, de Sire A, et al. Artificial intelligence in rotator cuff tear detection: a systematic review of MRI-based models. Diagnostics (Basel). 2025;15:1315.
Madhavi P, Patil P. Diagnostic accuracy of USG and MRI for the detection of rotator cuff injury. Cureus. 2024;16:e68199.
Toh Y. Ultrasound versus magnetic resonance imaging as first-line imaging strategies for rotator cuff pathologies: a comprehensive analysis of clinical practices, economic efficiency, and future perspectives. Cureus. 2024;16:e59231.
Bowen E, Waque A, Su F, Davies M, Ode G, Lansdown D, et al. Muscle health and fatty infiltration with advanced rotator cuff pathology. Curr Rev Musculoskelet Med. 2025;18:160-72.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453-7