肩袖损伤的影像学诊断方法

Rotator cuff diseases: a comparative study of X-arthrography, conventional MRI, and MRI arthrography

目的比较常规MRI、肩关节腔造影和MRI肩关节腔造影检查对肩袖撕裂伤的诊断价值。方法32例临床拟诊为肩袖损伤的患者,在接受肩关节镜探查前顺序进行常规MRI、肩关节腔造影和MRI肩关节腔造影检查,以肩关节镜作为标准诊断,计算三种影像学检查方法诊断肩袖损伤的敏感性、特异性和准确性。结果32例患者经肩关节镜检查诊断为肩袖全层撕裂14例、肩袖部分撕裂6例、肩袖无撕裂12例。对于判定有无肩袖撕裂,常规MRI的敏感性、特异性和准确性分别为80%16/20、83%10/12和81%26/32;肩关节腔造影分别为80%16/20、100%12/12和86%28/32;MRI肩关节腔造影为100%20/20、100%12/12和100%32/32。对于判定有无肩袖全层撕裂,常规MRI的敏感性、特异性和准确性分别为79%11/14、83%15/18和81%26/32;肩关节腔造影分别为93%13/14、94%17/18和94%30/34;MRI肩关节腔造影为100%14/14、94%17/18和97%31/32。结论MRI肩关节腔造影是诊断肩袖撕裂准确性较高的方法。

Objective To compare the diagnostic value of conventional MRI, X ray arthrography, and MRI arthrography in revealing rotator cuff injuries. Methods Thirty two patients with suspected rotator cuff tears were prospectively examined by conventional MRI, X ray arthrography, and MRI arthrography before the examination of shoulder arthroscope. Based on the results of the arthroscopy, the diagnostic sensitivity, specificity and accuracy of those three different methods were determined for rotator cuff tears. Results The arthroscopic findings included 14 full thickness tears, 6 partial thickness tears, and 12 without tears. For the diagnosis of rotator cuff tears,the sensitivity,specificity and accuracy were 80%(16/20), 83%(10/12), and 81%(26/32) for conventional MRI,respectively; the figures were 80%(16/20),100%(12/12), and 86%(28/32)for X ray arthrography,respectively; while the data were 100%(20/20),100%(12/12), 100%(32/32) for MRI arthrography,respectively. For the diagnosis of complete tears, the sensitivity, specificity and accuracy were 79%(11/14), 83%(15/18), and 81%(26/32) for conventional MRI, respectively; the figures were 93%(13/14),94%(17/18), and 94%(30/32) for X ray arthrography, respectively; while the parameters were 100%(14/14),94%(17/18), 97%(31/32) for MRI arthrography, respectively. Conclusion MRI arthrography is one of the best methods for the diagnoses of rotator cuff tears.