Which imaging modality is most sensitive for detecting soft tissue tears of the rotator cuff?

• A. Ultrasound
• B. X-ray
• C. CT
• D. MRI

Answer: (D)

Rotator cuff tears are soft tissue injuries, so imaging with the strongest soft tissue contrast is most effective. MRI provides high-resolution cross-sectional images that clearly differentiate tendon tissue from fluid and adjacent muscle, making it easy to see both partial- and full-thickness tears and to assess associated muscle atrophy or fatty degeneration. Using fat-suppressed T2-weighted sequences highlights edema and fluid within a tear, and MR arthrography can further increase sensitivity for subtle or partial-thickness tears. While ultrasound can detect many tears and is useful in experienced hands, it is more operator-dependent and may miss smaller or more complex tears. X-ray and CT don’t visualize soft tissue tears well and are used mainly for bone assessment or chronic cuff changes. Therefore, MRI offers the highest sensitivity for rotator cuff soft tissue tears.