肩关节损伤MRI与关节镜的对比分析

Comparison of MRI and arthroscopy in diagnosis of shoulder joint injury

目的探讨常规MRI对肩关节损伤的诊断价值。方法回顾性分析因肩关节损伤行常规MRI和关节镜检查的55例病人资料,MRI观察指标包括肩袖、盂唇形态及信号,有否肩峰下撞击及骨性损伤。以肩关节镜为诊断金标准,统计MRI对不同类型肩关节损伤的诊断结果,并分别计算MRI的诊断敏感度、特异度和准确度。采用Kappa检验分析MRI与肩关节镜诊断结果的一致性。结果肩关节损伤的MRI征象中分别有25%部分肩袖撕裂、13.3%Bankart’s损伤、20%盂唇上部前后方向(SLAP)损伤和11.6%肩峰下撞击漏诊。MRI诊断损伤性病变的特异度及肩袖全层撕裂(100%)、骨性损伤(100%)、肩峰下撞击(88%)和Bankart’s损伤(87%)的敏感度较高,诊断SLAP损伤(75%)和肩袖部分撕裂(75%)的敏感度较低;诊断肩袖全层撕裂(100%)和骨性损伤(100%)的准确度最高,其次是Bankart’s损伤(96%),诊断SLAP损伤(89%)的准确度较低。MRI和关节镜诊断肩袖全层撕裂、骨性损伤的κ值为1,结果完全一致,诊断Bankart’s损伤的κ值为0.904,一致性较好,诊断肩袖部分撕裂、SLAP损伤和肩峰下撞击的κ值虽稍低,但均>0.75,一致性也较好,P均<0.05。结论 MRI是有效诊断肩关节损伤的影像方法,但对SLAP损伤和肩袖部分撕裂的诊断准确度有待提高。

Objective To investigate the performance of conventional MRI in the diagnosis of shoulder joint injury. Methods Retrospective analysis was performed on data from 55 patients with shoulder joint injury who had undergone conventional MRI and arthroscopy. The MRI indicators included the abnormal morphology and signal of rotator cuff and labrum, the impingement of the subacromion, and the bony injury. Using arthroscopy results as the golden standard, the sensitivity, specificity, and accuracy of MRI diagnosis were calculated. Kappa test was performed to test agreement between findings on conventional MRI and arthroscopy. Results On MRI, there were 25%showing partial rotator cuff tear, 13.3%Bankart＆#39;s damage, 20% SLAP damage and 11.6% undetected subacromial impingement. The specificity of MRI for the diagnosis of traumatic lesions and the sensitivity of full-thickness rotator cuff tear （100%）, bone injury （100%）, subacromial impingement （88%） and Bankart＆#39;s damage （87%） were high, but the sensitivity of SLAP injury （75%） and partial rotator cuff tear （75%） were low. The accuracy of MRI was highest in diagnosing full-thickness rotator cuff tear （100%） and bone injury （100%）, followed by Bankart＆#39;s damage （96%）, accuracy was least in diagnosing SLAP lesion （89%）. The results were completely consistent between MRI and arthroscopy in diagnosing full-thickness rotator cuff tear and bone injury with kappa score 1, and showed good consistency for Bankart＆#39;s tear with kappa score 0.904. The kappa scores were relatively lower in diagnosis of partial rotator cuff tear, SLAP lesion and subacromial impingement, but all〉0.75,the consistency was also good, respectively （P〈0.05, respectively）. Conclusion MRI is an effective imaging method for the diagnosis of shoulder joint injury, but the diagnostic accuracy of SLAP lesion and partial rotator cuff tear needs to be improved.