肩袖损伤的MRI诊断比较研究

MR Imaging of Rotator Cuff Tears:A Comparative Study of Conventional MR Imaging and MR Indirect Arthrography

目的：比较常规MRI和MRI间接关节造影检查对肩袖撕裂伤的诊断价值。方法：搜集2002年11月～2006年8月共40例肩袖损伤病例，20例行常规MRI检查，20例行MRI间接关节造影检查。以肩关节镜作为诊断标准，比较两种影像学方法诊断肩袖损伤的敏感性和特异性。结果：肩袖完全撕裂中，常规MRI检查的敏感度为45．5％，特异度为66．7％，准确度为55％；MRI间接关节造影的敏感度为92．3％，特异度为85．7％，准确度为90％。肩袖不全撕裂中，常规MRI检查敏感度为57．1％，特异度为53．8％，准确度为55％；而间接关节造影敏感度为83．3％，特异度为92．8％，准确度则为90％。经Fisher确切概率统计法统计，MRI间接关节造影诊断肩袖全层撕裂敏感性及准确性明显高于常规MRI（P〈0．05），在诊断肩袖部分撕裂时，MRI间接关节造影的特异性及准确性明显高于MRI（P〈0．05）。结论：MRI间接关节造影较常规MRI诊断肩袖撕裂准确性较高。同时对盂唇等其它病变诊断有帮助。

Objective：To compare the diagnostic value of conventional MRI and MR indirect arthrography in revealing rotator cuff injuries. Methods：A retrospective study was undertaken in 40 patients with rotator cuff tears with whom MR examinations were performed during the time period from Nov 2002 to Aug 2006. In these 40 patients, 20 of them were scanned with conventional MRI and the other 20 patients examined with MR indirect arthrography. Based on the arthroscopic findings and results, MR diagnostic sensitivity and specificity in the diagnosis of rotator cuff tears with the two differ- ent techniques were correlatively evaluated. Results： In the demonstration of full-thickness tears, the conventional MRI presented a sensitivity rate of 45.5 %, specificity rate of 66.7 % and accuracy rate of 55 %, while the MR indirect arthrography showed a sensitivity rate of 92.3% ,specificity rate of 85.7% and accuracy rate of 90%. In revealing partial-thickness rotator cuff tears, the conventional MRI presented low rates of sensitivity,specificity and accuracy of 57.1%, 53.8 % and 55 % respectively;while MR indirect arthrography showed higher rates of sensitivity, specificity and accuracy of 83.3 %, 92.8 % and 90% respectively. The difference in diagnostic sensitivity and accuracy between MR indirect arthrography and conventional MRI in the diagnosis of full-thickness tears was statistically significant （P〈0.05）. The specificity and accuracy rates of MR indirect arthrography in the diagnosis of partial-thickness rotator cuff tears were higher than those of conventional MRI （statistically, P〈0.05）. Conclusion： MR indirect arthrography was a better MR technique with a higher diagnostic accuracy rate in comparison with that with MR conventional one in the diagnosis of rotator cuff tears. Moreover,MR indirect arthrography was helpful in the diagnosis of diseases of glenoid lips and others as well.