Martin‐Hervas 2001.

Clinical features and settings	Inclusion criteria: Patients with shoulder pain and limited movement Exclusion criteria: Patients with claustrophobia, metallic implants, and pacemaker Duration of symptoms: Not reported Previous treatments: Not reported Care setting: Not reported
Participants	Place of study: Madrid, Spain Period of study: During 1998 Number of participants eligible: 140 shoulders Number of participants enrolled IT and RS: ‐ MRI and arthroscopy or open surgery: 61 shoulders ‐ US and arthroscopy or open surgery: 72 shoulders Data available for analyses: ‐ MRI and arthroscopy or open surgery: 61 shoulders ‐ US and arthroscopy or open surgery: 61 shoulders Age: Not reported Male/Female: 25/36 Dominant arm: Not reported Nature of onset: Not reported
Study design	Primary objective: To compare the accuracy of US and MRI in the diagnosis of rotator cuff injuries (focusing on supraspinatus tears) using arthroscopy or open surgery findings as the gold standard Study design: Prospective accuracy cohort study with fully paired direct comparison between US and MRI Unclear whether consecutive recruitment Language: English
Target condition and reference standard(s)	Target conditions: Presence of any rotator cuff tears, full thickness tears and partial thickness tears Reference standard(s): Shoulder arthroscopy or open surgery ‐ Description of technique: Not reported ‐ Criteria for a positive result: Not reported
Index and comparator tests	Index test(s): MRI and US ‐ Description of technique: MRI MRI unit: 0.5 T superconducting magnet Sequences: Spin echo T1‐weighted sequences for coronal and oblique plane images and gradient echo T2*‐weighted sequences for axial and oblique coronal images; when the supraspinatus tendon showed a suggestive increased signal intensity, spin echo T2‐weighted sequences were performed Planes: Axial, oblique coronal and oblique sagittal images Patient position: Patient in a supine position and the arm in a neutral position US Scanner: 7.5 MHz high‐resolution linear electronic transducer Technique and Patient position: Images were obtained in transverse and longitudinal plane scans on the anterior plane of a shoulder with a neutrally rotated humerus to visualise bicipital and subscapularis bursae and axilla Next, sections of the shoulder were performed with internal humeral rotation, and the transducer was moved laterally to visualise the supraspinatus tendon and subacromial bursa The last images were obtained in the posterior plane with the humerus in a neutral position to visualise the infraspinatus and teres minor tendons ‐ Criteria for a positive result: MRI: Full thickness tears: hypersignal on the T1‐ and T2‐weighted images or any irregularity in the borders of the entire thickness of the tendon Partial thickness tears: any irregularity within the tendon or at the bursal or joint surfaces US: Full thickness tears: complete absence of the tendon, focal atrophy, a concave border, liquid‐filled hypoechoic bands, and/or lineal hyperechoic bands Partial thickness tears: heterogeneous tendon with hypoechoic areas (> 3 mm) that do not reach both sides of the tear and an irregular or indented border ‐ Time from symptoms to index test: Not reported ‐ Time from MRI and US: Not reported ‐ Time from index test to reference standard: Less than 6 months
Follow‐up	Adverse events due to index test(s): Not reported Adverse events due to reference standard test(s): Not reported
Notes	The rotator cuff tears were focused on only supraspinatus tendon tears No two‐by‐two table of the ITs and RS was given, but it was possible to back‐calculate this from the reported summary data
Table of Methodological Quality
Item	Authors' judgement	Description
Representative spectrum? All tests	Unclear	Tertiary or secondary care, participants with suspected of having any rotator cuff tears The study was prospective It was unclear whether consecutive recruitment
Acceptable reference standard? All tests	Unclear	The reference standard was arthroscopy or open surgery and the target conditions were presence of any rotator cuff tears, full thickness tears and partial thickness tears
Acceptable delay between tests? All tests	Unclear	The interval between tests was not clearly reported
Partial verification avoided? All tests	No	Not all the patients who received the index test underwent a reference standard to verify their true disease status
Differential verification avoided? All tests	Unclear	Insufficient information was given to permit judgement
Incorporation avoided? All tests	Yes	The index test did not form part of the reference standard
Index test results blinded? All tests	Yes	The study was prospective and the results of the index tests were interpreted before the reference standard
Reference standard results blinded? All tests	Unclear	Insufficient information was given to permit judgement
Relevant clinical information? All tests	Unclear	Not reported
Uninterpretable results reported? All tests	Unclear	Insufficient information was given to permit judgement
Withdrawals explained? All tests	No	Some of the eligible patients who entered the study did not complete it and these patients were not accounted for
Learning curve / training reported of index test? All tests	Unclear	The interpreter of index test was a musculoskeletal radiologist Experience was not reported
Learning curve / training reported of reference standard? All tests	Unclear	Insufficient information was given to permit judgement
Index test criteria for a positive test result reported? All tests	Yes	The study reported the definition of a positive index test result