磁共振肩关节造影在肩袖损伤的临床应用

The Clinical Application of MR Shoulder Arthrography in Rotator Cuff Injury

目的:探讨MRA检查对肩袖损伤的诊断价值。材料与方法:回顾性分析127例肩袖损伤MRA及MRI表现,与肩关节镜手术结果对照。结果:127例肩袖损伤病例,MRI诊断肩袖完全撕裂的敏感度、特异度及准确度分别是79.25%、82.43%和81.10%;诊断部分撕裂的敏感度、特异度及准确度分别是73.33%、67.31%和70.87%;其一致性较好(Kappa=0.708),差异均有统计学意义(p<0.05)。MRA诊断Ⅰ型8例(6.30%)、Ⅱ型21例(16.54%)、Ⅳ型32例(25.20%),其敏感度分别为100%、95.24%、96.88%;特异度分别为100%、99.06%、98.95%;准确度分别为100%、98.43%、98.43%;明显高于常规MRI诊断;与关节镜结果对比,其一致性极佳(Kappa=0.944),差异均有统计学意义(p<0.05);而对于Ⅲ型、Ⅴ型和Ⅵ型肩袖损伤,MRA均不能显示其损伤部位及程度,无法对其进行诊断。结论:MRA能准确判断Ⅰ型、Ⅱ型和Ⅳ型肩袖撕裂范围及程度,是MRI诊断肩袖损伤的有效补充,为临床诊断和治疗能提供更准确的依据。

Purpose： To investigate the value of MR arthrography （MRA） in diagnosis of rotator cuff injury. Materi- als and Methods： Retrospectively analysed MRA and MRI performanceof 127 cases with rotator cuff injury, and contrasted it with the results of arthroscopy. Resuhs Among all 127 cases, diagnosed as complete rotator cuff injury by MRI, the sensitivi- ty was79.25% , the specificity was82. 43%, and the accuracy was81.10% ; diagnosed as partial rotator cuff injury, the sensi- tivity was73.33%, the specificity was67.31%, and the accuracy was70. 87% ; the diagnostic results was the same to that by arthroscopy（ Kappa =0. 708 ）, and thedifference had statistical significance（ p 〈0. 05）. Used MRA to diagnose type Ⅰ 8 cases （6. 30% ）, type Ⅱ 21cases （ 16. 54% ）, type Ⅳ 32 cases （25.20%）, and the sensitivity was respectively 100%, 95.24%, 96. 88%; the specificity was respectivelyl00%, 99.06%, 98.95%; the accuracy was respectivelyl00%, 98.43%, 98.43%. The diagnostic results was same to that by arthroscopy（ Kappa = 0. 944）, and thedifference had statistical signifi- cance（ p 〈 0. 05）. and its accuracy was obviously higherthan conventional MRI diagnostic. However, for type Ⅲ, Ⅴ and Ⅵ rotator cuff injury, MRA weren＇ t able to diagnose and show the damage location and degree. Conclusion MRA, an effective complement of MRI in the diagnosis of rotator cuff injury, can accurately determine the scope and degree of type Ⅰ , Ⅱ and Ⅳ rotator cuff tear, and it can provide more accuratebasis for clinical diagnosis and treatment.