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

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

Answer: (B)

MRI provides the most sensitive assessment of rotator cuff soft tissue because it offers superb soft tissue contrast and multiplanar visualization of tendons, muscle, and marrow. It can detect even small or partial-thickness tears, show tendon retraction, and identify associated signs such as muscle atrophy or fatty infiltration—factors that influence prognosis and treatment. Ultrasound is operator-dependent and excels at many full-thickness tears but is less reliable for subtle partial-thickness tears and deeper structures. X-ray cannot visualize soft tissue at all, only bony and secondary changes. CT arthrography adds contrast-enhanced detail but is invasive and involves radiation, not offering the same overall soft tissue sensitivity as MRI. Thus MRI is the best choice for detecting soft tissue rotator cuff tears.