非增强MRI液性高信号在冻结肩鉴别诊断中的应用

Application of non-contrast MRI edema signals in the differential diagnosis of frozen shoulder

目的探讨非增强MRI液性高信号在鉴别冻结肩与继发性肩关节僵硬中的临床价值。方法选取2013年1月至2019年6月于我院住院治疗的86例原发性冻结肩和继发性肩关节僵硬患者作为研究对象。将患者随机编码后由2位专科医师共同评估患者的术前MRI征象,根据患者术后诊断结果将其分为冻结肩组和继发性肩关节僵硬组,分析2组患者MRI表现的差异。分别以联合喙突下滑囊、腋囊及肱二头肌腱长头腱鞘的非增强MRI液性高信号、喙肱韧带厚度> 2 mm以及腋囊厚度> 4 mm作为影像学诊断指标进行诊断试验,比较3种指标的诊断价值。结果与继发性肩关节僵硬组相比,冻结肩组喙突下滑囊、腋囊以及肱二头肌腱长头腱鞘同时出现液性高信号更常见,差异具有极显著性统计学意义(P=0.000)。联合喙突下滑囊、腋囊以及肱二头肌腱长头腱鞘处的液性高信号作为诊断指标的敏感性、特异性、阳性似然比、阴性似然比以及受试者曲线下面积(AUC)分别为52.9%、94.3%、9.3、0.5、0.736;以喙肱韧带厚度> 2 mm作为诊断指标的对应结果分别为62.8%、54.3%、1.4、0.7、0.585;以腋囊厚度> 4 mm作为诊断指标的对应结果分别为80.4%、40.0%、1.3、0.5、0.602。一致性分析结果提示,以联合喙突下滑囊、腋囊以及肱二头肌腱长头腱鞘处液性高信号作为诊断指标的Kappa值为0.802,喙肱韧带厚度> 2 mm的ICC=0.761,腋囊厚度> 4 mm的ICC=0.909。结论联合喙突下滑囊、腋囊以及肱二头肌腱长头腱鞘3个部位非增强MRI液性高信号诊断原发性冻结肩具有较高特异性和准确性,有助于与继发性肩关节僵硬进行鉴别诊断,降低临床误诊率。

Objective To evaluate the clinical value of non-contrast MRI edema signals in the differential diagnosis of frozen shoulder and secondary stiff shoulder. Methods A total of 123 patients with frozen shoulder and secondary stiff shoulder who were admitted into our hospital from January 2013 to June 2019 were included. The patients were randomly coded and their preoperative MRI signs were jointly evaluated by two specialist physicians. The patients were divided into frozen shoulder group and secondary stiff shoulder group according to the postoperative diagnosis results,and the differences in MRI manifestations of the two groups were analyzed. The non-enhanced MRI edema signals,the thickness of the coracobrachial ligament > 2 mm and the thickness of the axillary sac > 4 mm at the subcoracoid bursa,axillary sac,and biceps tendon sheath were used as imaging diagnostic indicators to evaluate the diagnostic value of the three indicators. Results Compared with the secondary stiff shoulder group,it was more common for the simultaneous occurrence of hyperintensity signals at the the subcoracoid bursa,axillary sac,and biceps tendon sheath in the frozen shoulder group,and the difference was extremly significant( P = 0. 000). The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and area under the curve( AUC) of the simultaneous occurrence of hyperintensity signals at the the subcoracoid bursa,axillary sac,and biceps tendon sheath,which were regarded as the diagnostic indicators,were 52. 9%,94. 3%,9. 3,0. 5,0. 736,respectively. The corresponding results were 62. 8%,54. 3%,1. 4,0. 7 and0. 585 respectively,with the thickness of the coracobrachial ligament > 2 mm as the diagnostic indicator. The corresponding results were80. 4%,40. 0%,1. 3,0. 5 and 0. 602 respectively,with the thickness of the axillary sac > 4 mm as the diagnostic indicator. Consistency analysis results showed that the Kappa value of simultaneous occurrence of hyperintensity signals at the the subcoracoid bursa,axillary sac,and biceps tendon sheath was 0. 802. The ICC value of the coracobrachial ligament > 2 mm was 0. 761,while the ICC value of the thickness of the axillary sac > 4 mm was 0. 909. Conclusion Non-contrast MRI hyperintensity signals of simultaneous occurrence at the the subcoracoid bursa,axillary sac,and biceps tendon sheath as a diagnostic indicator have relatively high specificity and accuracy for diagnosing frozen shoulder,which is helpful to differentiate it from secondary stiff shoulder and reduce the rate of clinical misdiagnosis.