Can Shoulder Ultrasonography Review Replace Magnetic Resonance Imaging?

Objective: Magnetic resonance imaging (MRI) is the gold standard examination in the evaluation of shoulder pathologies, but it is a static method, expensive and examination time is long. Ultrasonography (US) is a fast, easy-to-apply, cheap and common imaging method, but it is more subjective and dependent on experience. In this study, we aimed to compare the diagnostic accuracy of US with MRI in the diagnosis of shoulder joint pathologies, with increasing experience. Methods: A radiologist without sufficient shoulder US experience read the literature on shoulder US. Then, for 2 weeks, US was performed for training in 100 patients whose MRI findings were known. Subsequently, for 5 weeks, firstly US, then MRI were performed a total of 250 patients, including 50 patients every week. With increased US experience, it was investigated whether the consistency between US and MRI findings increased. Results: One hundred and sixty (64%) of the patients were female and 90 (36%) were male. The mean age of the patients was 54±11.7. Each week, patients were evaluated as a separate group, with a total of 5 groups. Sensitivity, specificity, positive and negative predictive values were calculated which were achieved with increasing US experience. Conclusion: When sufficient experience is gained in shoulder pathologies, diagnostic accuracy increases significantly in US. The success of US in partial tears is behind MRI. US lags behind MRI in showing joint effusion. The sensitivity and specificities in the subacromial-subdeltoid effusion are close to MRI. The rates of US to detect total tears, biceps tenosynovitis and acromioclavicular joint degeneration are similar to MRI. US is successful than MRI in showing calcific tendinitis, biceps subluxation-dislocation and impingement.