Comparative Analysis of Musculoskeletal Ultrasonography Versus MRI in Diagnosing Shoulder Injuries

Abstract

This study aimed to compare the diagnostic accuracy and cost-effectiveness of musculoskeletal ultrasonography (US) versus magnetic resonance imaging (MRI) in detecting shoulder injuries. Conducted at the Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, Bangladesh, from January to June 2024, the study included 120 patients with suspected shoulder pathologies. Patients were evaluated using both US and MRI, and findings for rotator cuff tears, labral injuries, and tendonitis were analyzed. MRI demonstrated higher diagnostic accuracy across all conditions, with sensitivity rates of 95%, 91%, and 92% for rotator cuff tears, labral injuries, and tendonitis, respectively, compared to 88%, 79%, and 86% for US. Inter-rater agreement between US and MRI was substantial, with Cohen's Kappa coefficients of 0.75 for rotator cuff tears, 0.70 for labral injuries, and 0.73 for tendonitis. Cost-effectiveness analysis revealed that US was significantly more affordable, with an average cost of 15,000 Tk per patient compared to 60,000 Tk for MRI. Additionally, the time to diagnosis was shorter for US (2 days) than for MRI (7 days). Although US required slightly more additional interventions (13.3% vs. 8.3%), this difference was not statistically significant. The findings suggest that while MRI is more accurate, US is a cost-effective and time-efficient alternative, particularly valuable in resource-limited settings.