CT与MRI评估肩袖脂肪浸润的一致性研究

Reliability of Fatty Degeneration in Rotator Cuff by CT and MRI

目的:比较CT与MRI评估肩袖脂肪浸润程度的一致性以及不同层面评估肩袖脂肪浸润程度的一致性。方法:选取24例肩袖撕裂患者的CT与MRI,采用Goutallier分型评估肩袖脂肪浸润情况。三位骨科医师分别从三个层面进行评估。评估层面包括:斜矢状位标准层面以及标准层面偏外1个层面、偏外2个层面。采用加权κ比较不同检查的一致性。结果:CT评估脂肪浸润的观察者内一致性为0.45~0.74,观察者间一致性为0.50~0.65。MRI评估脂肪浸润的观察者内一致性为0.81~0.91,观察者间一致性为0.67~0.71。MRI与CT的一致性为0.32~0.34。标准层面与标准层面向外一个层面的一致性为0.73~0.77,标准层面与标准层面向外两个层面的一致性为0.45~0.53。结论:MRI评估肩袖脂肪浸润的一致性优于CT,MRI与CT评估结果相关性较差。应尽可能选择标准层面评估肩袖脂肪浸润,如选取层面过于偏外,会与真实情况产生显著差异。

Objective To compare the interobserver and intraobserver agreement of fat infiltration assessed by CT and MRI and to evaluate the reliability of fatty degeneration of the rotator cuff muscle at different sites.Methods Twenty-four MRI and CT examinations of patients with rotator cuff tears were assessed by 3 orthopedists.The evaluators graded the fatty infiltration of the rotator cuff using Goutallier classification at three different sites:the Y-shaped view and the next 2 consecutive lateral images from the Y-shaped view.The intraobserver and interobserver reliabilities were evaluated using the weighed kappa.Results For CT examinations,the intraobserver and interobserver agreement was0.45~0.74 and 0.50~0.65 respectively.For MRI examinations,the intraobserver and interobserver agreement was 0.81~0.91 and 0.67~0.71 among 3 orthopedists.The agreement of CT and MRI was 0.32~0.34.The reliability of the Y-shaped view and next 2 consecutive lateral images was 0.73~0.77 and0.67~0.71 respectively.Conclusions MRI shows better reliability than CT and the agreement of MRI and CT is poor.It is essential to evaluate fat infiltration on standard Y-view.Fat infiltration of the rotator cuff might be overestimated when the evaluation is performed on images lateral from Y-view.