上方盂唇前后向撕裂的肩关节MR造影评价

Superior labrum anterlor-posterior lesions on shoulder MR arthrography

目的 评价肩关节MR造影对上方盂唇前后向撕裂（SLAP损伤）的诊断价值.方法 由2名影像诊断医师独立回顾分析137例经肩关节镜证实的肩关节造影MR图像,判定有无SLAP损伤,并进行分型.SLAP损伤分4型：Ⅰ型为上盂唇毛糙,Ⅱ型为肱二头肌腱盂唇复合体从关节孟撕裂,Ⅲ型为上盂唇桶柄状撕裂,Ⅳ型为上盂唇桶柄状撕裂并同时累及肱二头肌长头腱.计算肩关节MR造影对SLAP损伤的敏感度、特异度和准确度,以及与肩关节镜分型的符合率.采用Kappa统计计算2名影像诊断医师评价的一致性.结果 137例患者中,肩关节镜证实SLAP损伤59例,包括SLAP损伤Ⅰ型6例（10.2%）、Ⅱ型50例（84.7%）、Ⅲ型3例（5.1%）.肩关节MR造影的敏感度、特异度和准确度医师甲分别为86.4%（51/59）、78.2%（61/78）和81.8%（112/137）,医师乙分别为88.1%（52/59）、84.6%（66/78）和86.1%（118/137）.2名影像诊断医师的评价一致性极好（K=0.796）.肩关节MR造影与肩关节镜的分型符合率医师甲为83.1%（49/59）,医师乙为79.7%（47/59）.结论 肩关节MR造影是评价SLAP损伤比较可靠的影像方法.

Objective To evaluate the diagnostic value of shoulder MR arthrography for superior labral anterior-posterior （SLAP） lesions.Methods A retrospective study was conducted in 137 cases of shoulder MR arthrography confirmed by subsequent shoulder arthroscopy.Two radiologists analyzed all MR examinations independently and the results were compared with those of arthrescopy.The superior labrum was described as normal or torn.In addition, each iabral tear was classified as type Ⅰ-Ⅳ.Type Ⅰ lesions were defined as marked fraying of the articulating surface of the superior labrum; type Ⅱ, avulsion of the labral-bicipital complex from the ghnoid; type Ⅲ, displaced bucket handle tear of the superior labrum; and type Ⅳ, bucket handle tear of the superior labrum with extension into the fibers of the biceps tendon.Sensitivity, specificity, and accuracy were calculated.Kappa values were calculated to quantify the level, of inter-observer agreement.Results SLAP lesions were arthroscopically diagnosed in 59 of the 137 patients.Six of the 59 lesions （ 10.2% ） were classified as type Ⅰ , 50 （84.7% ） as type Ⅱ, and 3 （5.1% ） as type Ⅲ.The overall sensitivity, specificity, and accuracy of MR arthrographic detection of SLAP lesions were 86.4% （51/59）, 78.2% （61/78）, and 81.8% （ 112/137）, respectively, for observer A, and 88.1% （52/59）, 84.6% （66/78）, and 86.1% （118/137）, respectively, for observer B.At inter-observer comparison, agreement was very good （Kappa values = 0.796 ）.The MR arthrographic classification showed correlation with the arthroscopic classification of SLAP lesions were 83.1% （49/59）and 79.7% （47/59） for two observers, respectively.Conclusion Shoulder MR arthrography is a reliable method for evaluating SLAP lesions.