Diagnostic accuracy of ultrasound in diagnosis of rotator cuff injuries keeping MRI as gold standard.

Abstract

Objective: To determine Diagnostic accuracy of ultrasonography in diagnosis of rotator cuff injuries keeping MRI as gold standard. Study Design: Cross-sectional Validation study. Setting: Department of Radiology, DHQ Hospital, Gujranwala. Period: September, 2025 to February, 2026. Methods: A total of 184 patients aged 18–60 years presenting with clinical suspicion of rotator cuff injury were enrolled through consecutive non-probability sampling. All patients underwent US examination using a high-frequency (7–12 MHz) linear probe followed by MRI on a 1.5 Tesla scanner. Ultrasonographic findings for full-thickness tear, partial-thickness tear, and tendinopathy were compared with MRI results considered as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Results: Among 184 participants, 55% were female and the mean age was 39 years (range 18–60 years). MRI detected full-thickness tear in 32.6%, partial-thickness tear in 27.2%, and tendinopathy in 21.7% of cases, while 18.5% had normal findings. Ultrasound identified full-thickness tears in 30.4%, partial-thickness tears in 25.0%, and tendinopathy in 19.6%. When compared with MRI, ultrasonography demonstrated a sensitivity of 90.2%, specificity of 89.5%, PPV of 91.1%, NPV of 88.3%, and an overall diagnostic accuracy of 90.0%. Conclusion: Ultrasonography is a highly accurate, accessible, and cost-effective imaging modality for evaluating rotator cuff pathology. Its strong concordance with MRI supports its use as a first-line diagnostic tool, particularly for full-thickness tears. MRI remains essential in equivocal cases or when detailed pre-operative assessment is required.