使用少量对比剂确认肩关节MR造影穿刺成功的X线征象分析

Analysis of X-ray signs to confirm the successful puncture in shoulder MR arthrography with low dose of contrast agent

目的探讨直接法肩关节MR造影过程中以注射少量对比剂后X线征象判断穿刺成功的价值。方法回顾性分析2016年1月至2018年8月于北京大学第三医院接受肩关节MR造影检查的669例患者资料,均采用前方入路穿刺,关节腔穿刺过程中向关节腔内注射1~2 ml对比剂后行X线投照,观察6个对比剂分布的X线征象,以MR肩关节造影所见为穿刺是否成功的金标准,采用Kappa检验评价两两X线征象的一致性,计算各征象判断穿刺成功的准确率,并两两组合寻找最佳诊断指标。结果669例患者均穿刺成功。注射少量对比剂后6种X线征象的出现率分别为:肱骨头重叠处不与针尖相连的对比剂66.8%(447/669)、腋隐窝内见对比剂64.7%(433/669)、盂肱关节间隙内见对比剂93.9%(628/669)、肩胛下滑囊内见对比剂69.8%(467/669)、肱二头肌长头腱腱鞘内见对比剂1.9%(13/669)、肱二头肌长头腱-冈上肌腱间见对比剂17.2%(115/669),两两征象间一致性均差(Kappa<0.2),其中“肱骨头重叠处见不与针尖相连的对比剂”与“盂肱关节间隙见对比剂”间一致性最差(Kappa=-0.115),将二者组合作为判断穿刺成功的标准,其准确率为100%(669/669)。结论在直接法前方入路肩关节MR造影过程中,注射少量对比剂后X线征象可作为判断穿刺成功的标准,联合使用“肱骨头重叠处见不与针尖相连的对比剂”和“盂肱关节间隙见对比剂”的准确率达100%。

Objective To explore the value of X-ray signs with applying low dose of contrast agent to confirm successful puncture in direct shoulder MR arthrography.Methods In total 669 patients who underwent shoulder MR arthrography in Peking University Third Hospital from January 2016 to August 2018 were retrospectively analyzed.All patients received the anterior approach puncture in shoulder arthrography.X-ray films were taken after 1-2 ml contrast agent was injected.Six X-ray signs of contrast agent distribution were recorded.MR arthrography findings were used to confirm whether the puncture was success.Kappa analysis was used to verify the consistency between each 2 signs.The accuracy rate of each X-ray sign to confirm the successful puncture was calculated.X-ray signs were paired to define the best diagnostic index of successful puncture.Results Successful puncture was performed in arthrographies for all 669 cases.The displaying rates of six signs were as follows.Contrast agent distribution at overlapping humeral head away from the needle was 66.8%(447/669),in axillary recess was 64.7%(433/669),in glenohumeral space was 93.9%(628/669),in subscapular bursa was 69.8%(467/669),in sheath of long head tendon of biceps brachii(LHBT)was 1.9%(13/669),between LHBT and supraspinatus tendon was 17.2%(115/669).Consistency of each 2 signs was poor(Kappa<0.2),in which the poorest consistency was found between contrast agent overlapping humeral head away from the needle and contrast agent in glenohumeral space(Kappa=-0.115).With combining the above 2 signs,the accuracy rate for defining successful puncture was 100%(669/669).Conclusion In direct shoulder arthrography by anterior approach,X-ray signs with low dose of contrast agent can be regard as the method to confirm successful puncture.The accuracy rate of the signs of contrast agent distribution at overlapping humeral head away from the needle or in glenohumeral space to define a successful puncture is 100%.