Rotator Cuff: Evaluation with US and MR Imaging

Cameron J. Seibold, MD
Thomas A. Mallisee, MD
Scott J. Erickson, MD
Melbourne D. Boynton, MD
William G. Raasch, MD
Michael E. Timins, MD

From the Departments of Radiology (CJS, TAM, SJE, MET) and Orthopaedics (WGR), Froedert Memorial Lutheran, 9200 W. Wisconsin Ave., Milwaukee, WI; and Vermont Orthopaedic Clinic, Rutland (MDB). Recipient of a Cum Laude award for a scientific exhibit at the 1997 RSNA scientific assembly.

Revised May 13, 1998; revision requested June 5 and received August 13; accepted August 20.

Magnetic resonance (MR) and ultrasound (US) imaging are currently touted for assessment of rotator cuff disease. Optimum clinical imaging techniques include use of (a) a 1.5T MR imaging unit with small planar coils, proton-density-weighted and T2-weighted fast spin-echo sequences, and 10-12-cm fields of view (yielding 400-470 x 500-625-mm in-plane spatial resolution) and (b) a state-of-the-art commercial US unit with insonation frequencies of 9-13 MHz (yielding 200-400 mm axial and lateral resolution). Proper diagnosis requires familiarity with normal anatomic characteristics and imaging pitfalls. Care must be taken to avoid sonographic tendon anisotropy and MR imaging magic angle effects, which can be misinterpreted as rotator cuff tear. At MR imaging,a complete cuff tear typically appears as either a hyperintense defect or a tendinous avulsion that extends from the bursal to the articular side of the cuff; a partial cuff tear typically appears as a focal hyperintense region that contacts only one surface of the cuff. Complete and partial tears manifest with a wide spectrum of findings at US. MR imaging and US are effective for evaluating rotator cuff injuries, with high reported accuracies for detection of complete tears but more disparate results for detection of partial tears.