The three-dimensional ultrasound of the rotator cuff: Histological versus sonomorphological evaluation.

Aim: Sonographic evaluation is a reliable method for the detection of rotat or cuff tears. However, the diagnostic value of the different echogenic pat terns of the rotator cuff, especially in elderly patients, has led to a con troversial discussion. The present study elucidates whether three-dimension al ultrasound can increase the diagnostic significance of different sonogra phic echogenicity patterns of tendons compared to histopathological tissue degeneration. Method: To evaluate the sonographic appearance of tendons in elderly patients, the sonographic echogenicity of 33 rotator cuff specimens with macroscopic absence of rotator cuff lesions was classified in three g roups and compared with the histopathological morphology. Results: The sono graphic appearance of the degenerated rotator cuff in elder patients correl ates with a reduced sonographic echogenicity. The two-dimensional ultrasoun d evaluation of the rotator cuff led to a sensitivity of 84.0%, a specifici ty of 42.9%, a positive predictive value of 63.6%, a negative predictive va lue of 69.2%, and an accuracy of 65.2%. The three-dimensional ultrasouund e valuation of the rotator cuff led to a sensitivity of 91.6%, a specificity of 50.0%, a positive predictive value of 66.6%, a negative predictive Value of 84.6% and an accuracy of 71.%, respectively. Conclusion: As a high inci dence of false positive results has to be taken into consideration, neither the two-dimensional, nor the three-dimensional ultrasound evaluation seems to lead to a reliable correlation.