Reliability of high-resolution ultrasound and magnetic resonance arthrography of the shoulder in patients with sports-related shoulder injuries

Autoři: Georg J. Wengert aff001;  Marc Schmutzer aff001;  Hubert Bickel aff001;  Mircea-Constantin Sora aff002;  Stephan H. Polanec aff001;  Micheal Weber aff001;  Claudia Schueller-Weidekamm aff001
Působiště autorů: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria aff001;  Morphology Centre, Medical Faculty, Sigmund Freund University, Vienna, Austria aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222783



The shoulder, a very complex joint, offers a wide range of pathologies. Intraarticular abnormalities and rotator cuff injuries are mainly assessed and diagnosed by magnetic resonance arthrography (MRA). In contrast to this well-established gold standard, high-resolution ultrasound (US) offers an additional easy and excellent modality to assess the shoulder joint. Therefore, the purpose of this study was to evaluate in which anatomic structures and pathologies comparable results of US and MRA could be achieved.

Materials and methods

In this IRB-approved prospective study 67 patients with clinically suspected labral lesions, rotator cuff rupture, or injury of the long head of the biceps (LHB) tendon were enrolled. Each participant was examined with high resolution US, and directly followed by MRA at 3 Tesla with a standard sequence protocol. To evaluate the agreement of the diagnostic performance between US and MRA a weighted kappa statistic was used.


Both of the investigated modalities yielded a moderate to almost perfect agreement in assessing a wide range of shoulder joint pathologies. For the rotator cuff, consistency was found in 71.64% for the supraspinatus tendon, in 95.52% for the infraspinatus tendon, in 83.58% for the subscapularis tendon, and in 98.51% for the teres minor tendon.

The diagnostic accuracy between both modalities was 80.60% for the LHB tendon, 77.61% for the posterior labroligamentous complex, 83.58% for the acromioclavicular joint, and 91.04% for the assessment of osseous irregularities and impaction fractures.


High resolution US is a reliable imaging modality for the rotator cuff, the LHB tendon, and the acromioclavicular joint, so for these structures we recommend a preference for US over MRA based on its diagnostic accuracy, comfortability, cost effectiveness, and availability. If the diagnosis remains elusive, for all other intraarticular structures we recommend MRA for further diagnostic assessment.

Klíčová slova:

Angiography – Lesions – Ligaments – Magnetic resonance imaging – Shoulders – Skeletal joints – Tendons – Rotator cuff muscles


1. Lugo R, Kung P, Ma CB. Shoulder biomechanics. European journal of radiology. 2008;68(1):16–24. doi: 10.1016/j.ejrad.2008.02.051 18511227.

2. Farrar NG, Malal JJ, Fischer J, Waseem M. An overview of shoulder instability and its management. Open Orthop J. 2013;7:338–46. doi: 10.2174/1874325001307010338 24082972; PubMed Central PMCID: PMC3785059.

3. Scutellari PN, Orzincolo C. Rheumatoid arthritis: sequences. European journal of radiology. 1998;27 Suppl 1:S31–8. doi: 10.1016/s0720-048x(98)00040-0 9652499.

4. Dinnes J, Loveman E, McIntyre L, Waugh N. The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review. Health Technol Assess. 2003;7(29):iii, 1–166. 14567906.

5. Naredo E, Aguado P, De Miguel E, Uson J, Mayordomo L, Gijon-Banos J, et al. Painful shoulder: comparison of physical examination and ultrasonographic findings. Annals of the rheumatic diseases. 2002;61(2):132–6. doi: 10.1136/ard.61.2.132 11796399; PubMed Central PMCID: PMC1754006.

6. Ottenheijm RP, Cals JW, Weijers R, Vanderdood K, de Bie RA, Dinant GJ. Ultrasound imaging for tailored treatment of patients with acute shoulder pain. Ann Fam Med. 2015;13(1):53–5. doi: 10.1370/afm.1734 25583893; PubMed Central PMCID: PMC4291266.

7. Pavic R, Margetic P, Bensic M, Brnadic RL. Diagnostic value of US, MR and MR arthrography in shoulder instability. Injury. 2013;44 Suppl 3:S26–32. doi: 10.1016/S0020-1383(13)70194-3 24060014.

8. Arirachakaran A, Boonard M, Chaijenkij K, Pituckanotai K, Prommahachai A, Kongtharvonskul J. A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II-VII. Skeletal Radiol. 2017;46(2):149–60. doi: 10.1007/s00256-016-2525-1 27826700.

9. Roy JS, Braen C, Leblond J, Desmeules F, Dionne CE, MacDermid JC, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49(20):1316–28. doi: 10.1136/bjsports-2014-094148 25677796; PubMed Central PMCID: PMC4621376.

10. Beggs Ian BS, Bueno Angel, Cohen Michel, Court-Payen Michel, Grainger Andrew, Kainberger Franz, Klauser Andrea, Martinoli Carlo, McNally Eugene, O'Connor Philip J, Peetrons Philippe, Reijnierse Monique, Remplik Philipp, Silvestri Enzo. Musculoskeletal ultrasound technical guidelines.2014. Available from:

11. Ottenheijm RP, van't Klooster IG, Starmans LM, Vanderdood K, de Bie RA, Dinant GJ, et al. Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study. BMC Fam Pract. 2014;15:115. doi: 10.1186/1471-2296-15-115 24916105; PubMed Central PMCID: PMC4057656.

12. Ferri M, Finlay K, Popowich T, Stamp G, Schuringa P, Friedman L. Sonography of full-thickness supraspinatus tears: comparison of patient positioning technique with surgical correlation. AJR American journal of roentgenology. 2005;184(1):180–4. Epub 2004/12/24. doi: 10.2214/ajr.184.1.01840180 15615971.

13. Tian CY, Cui GQ, Zheng ZZ, Ren AH. The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. European journal of radiology. 2013;82(4):651–7. doi: 10.1016/j.ejrad.2012.11.038 23287711.

14. Nakata W, Katou S, Fujita A, Nakata M, Lefor AT, Sugimoto H. Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics: a review publication of the Radiological Society of North America, Inc. 2011;31(3):791–810. Epub 2011/05/17. doi: 10.1148/rg.313105507 21571657.

15. Kompel AJ, Li X, Guermazi A, Murakami AM. Radiographic Evaluation of Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017;10(4):425–33. Epub 2017/10/02. doi: 10.1007/s12178-017-9433-4 28965317; PubMed Central PMCID: PMC5685955.

16. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Family medicine. 2005;37(5):360–3. 15883903.

17. Elbinoune I, Amine B, Wabi M, Rkain H, Aktaou S, Hajjaj-Hassouni N. Rheumatoid shoulder assessed by ultrasonography: prevalence of abnormalities and associated factors. Pan Afr Med J. 2016;24:235. doi: 10.11604/pamj.2016.24.235.9068 27800090; PubMed Central PMCID: PMC5075465.

18. Chauhan NS, Ahluwalia A, Sharma YP, Thakur L. A Prospective Comparative Study of High Resolution Ultrasound and MRI in the Diagnosis of Rotator Cuff Tears in a Tertiary Hospital of North India. Pol J Radiol. 2016;81:491–7. doi: 10.12659/PJR.897830 27800039; PubMed Central PMCID: PMC5074798.

19. Ottenheijm RP, Jansen MJ, Staal JB, van den Bruel A, Weijers RE, de Bie RA, et al. Accuracy of diagnostic ultrasound in patients with suspected subacromial disorders: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2010;91(10):1616–25. doi: 10.1016/j.apmr.2010.07.017 20875523.

20. Zanetti M, Jost B, Lustenberger A, Hodler J. Clinical impact of MR arthrography of the shoulder. Acta Radiol. 1999;40(3):296–302. 10335968.

21. Modi CS, Karthikeyan S, Marks A, Saithna A, Smith CD, Rai SB, et al. Accuracy of abduction-external rotation MRA versus standard MRA in the diagnosis of intra-articular shoulder pathology. Orthopedics. 2013;36(3):e337–42. doi: 10.3928/01477447-20130222-23 23464954.

22. Loh B, Lim JB, Tan AH. Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging? Ann Transl Med. 2016;4(21):419. doi: 10.21037/atm.2016.11.22 27942510; PubMed Central PMCID: PMC5124608.

23. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F. Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013;(9):CD009020. doi: 10.1002/14651858.CD009020.pub2 24065456.

24. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR American journal of roentgenology. 2009;192(6):1701–7. doi: 10.2214/AJR.08.1241 19457838.

25. Jonas SC, Walton MJ, Sarangi PP. Is MRA an unnecessary expense in the management of a clinically unstable shoulder? A comparison of MRA and arthroscopic findings in 90 patients. Acta Orthop. 2012;83(3):267–70. doi: 10.3109/17453674.2012.672090 22401678; PubMed Central PMCID: PMC3369153.

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