超声与MRI在肩袖损伤中的临床应用价值

Clinical application value of ultrasound and MRI in rotator cuff injury

目的探讨超声(US)和磁共振成像(MRI)在肩袖损伤的临床应用价值。方法收集2016年1月~2018年2月川北医学院附属医院肩关节镜确诊为肩袖损伤的患者38例,术前均同时行US和MRI检查。以肩关节镜为金标准,将US与MRI对肩袖撕裂的检查结果进行McNemer检验,并采用Kappa检验评价US与MRI对肩袖损伤及并发症诊断的一致性。结果关节镜显示26根全层撕裂肌腱,23根部分撕裂肌腱。US对全层撕裂诊断的敏感度、特异性、准确性分别为92.31%、100.00%、98.24%,而MRI分别为96.15%、100.00%、99.12%,US对部分撕裂诊断的敏感度、特异性、准确性分别为78.26%、97.80%、93.85%,而MRI分别为86.96%、96.70%、94.74%。两种检测方法诊断肩袖全层撕裂和部分撕裂比较,差异无统计学意义(P>0.05),且超声与MRI对肩袖全层撕裂和部分撕裂的诊断均具有很好的一致性(κ=0.922、0.811),但对肩袖撕裂后并发症显示的一致性较差(κ=-0.068)。结论US可以作为临床肩袖损伤的初筛诊断及常规随访的首选检查方法,当肩关节US诊断不明确或外科手术前需要更详细的并发症信息时需进一步行MRI检查。

Objective To evaluate the clinical value of ultrasound(US)and magnetic resonance imaging(MRI)in rotator cuff injury.Methods From January 2016 to February 2018,38 cases of rotator cuff injury who confirmed by arthroscopy were collected in Affiliated Hospital of North Sichuan Medical College.US and MRI were performed before operation.Shoulder arthroscopy was the gold standard.McNemer test was performed on US and MRI results of rotator cuff injury and Kappa test were used to evaluate the consistency of US and MRI in the diagnosis of rotator cuff injury and common complications.Results Arthroscopic examination showed that there were 26 full-thickness tears and 23 partial-thickness tears.The sensitivity,specificity,and accuracy of US in diagnosis of full-thickness tear were 92.31%,100.00%and 98.24%respectively,while MRI was 96.15%,100.00%,and 99.12%respectively.The sensitivity,specificity,and accuracy in US of the diagnosis of partial-thickness tear were 78.26%,97.80%and 93.85%respectively,while 86.96%,96.70%and 94.74%respectively in MRI.There was no statistically significant difference between the two methods in the diagnosis of rotator full-thickness tear and partial-thickness tear(P>0.05).There was a good consistency between US and MRI in the diagnosis of rotator cuff full-thickness tears and partial-thickness tears(κ=0.922,0.811),but the consistency of US and MRI in the diagnosis of complications after rotator cuff tears was poor(κ=-0.068).Conclusion US can be used as the first screening diagnosis of clinical rotator cuff injury and the first choice for routine follow-up.When the diagnosis of rotator cuff injury is not clear or more detailed complications information is needed before surgery,MRI can be further performed.