3.0T MR肩关节造影在前下盂唇变异型损伤诊断中的应用

Application of 3.0T MR arthrography in the diagnosis of anterior and inferior labrum variant injury

目的:探讨3.0T MR关节造影在肩关节前下盂唇变异型损伤诊断及分型价值。方法:搜集2016年1月-2019年12月疑似肩关节前下盂唇损伤患者79例,以关节镜或开放术后诊断为标准,回顾性对比分析其术前常规MR检查及MR关节造影检查资料,利用统计学计算两种检查术前诊断及分型的灵敏度、特异度、准确性。使用McNemar检验分析两种检查诊断阳性率差异,kappa检验分析其一致性。结果:79例患者术后确诊关节前下盂唇损伤64例,MR常规检查准确诊断分型29例,MR造影准确诊断分型52例,其中两者诊断分型经典Bankart损伤灵敏度、特异度及准确度分别为62.50%vs.95.83%、90.90%vs.98.18%和82.28%vs.97.47%;Perthes损伤45.45%vs.81.82%、89.71%vs.95.59%和83.54%vs.93.67%;ALPSA损伤43.75%vs.81.25%、93.65%vs.96.83%和83.54%vs.93.67%;GLAD损伤0.00%vs.50.00%、96.00%vs.98.67和93.51%vs.96.20%;kappa检验分析两种方法诊断分型一致性方面MRA明显优于常规MR检查,其中诊断Bankart损伤MR与MRA诊断结果一致性为中等、极好(K=0.599、K=0.940);Perthes损伤诊断结果一致性为一般、较好(K=0.339、K=0.746);ALPSA损伤诊断结果一致性为中等、较好(K=0.423、K=0.799);GLAD损伤诊断结果一致性为0、中等(K=0、K=0.552)。χ^2检验两种检查方法在前下盂唇诊断分型一致性差异有显著性意义(P<0.05)。结论:MR肩关节造影对肩关节前下盂唇损伤及分型的灵敏度、特异度及准确性均高于常规MR检查,能为术前评估、入路选择提供更为准确的信息。

Objective:To investigate the value of 3.0T MR arthrography(MRA)in the diagnosis and classification of variant injuries of the anterior inferior labrum of the shoulder.Methods:This was a retrospective study of 79 shoulder MR images and MRA obtained from January 2016-December 2019 that patients were suspected of shoulder joint injury of jar under lip,and completed examination in the fourth people's hospital of Guiyang.Arthroscopy or open operation served as the reference standard.Then,both preoperative diagnosis and classification of sensitivity,accuracy,specificity were calculated.McNemar test was used to analyze the difference of diagnostic positive rate between the two tests,and Kappa test was used to analyze the consistency.Results:64 cases of anterior inferior labrum injury were confirmed after surgery in 79 patients,29 cases were accurately diagnosed by MR routine examination,and 52 cases were accurately diagnosed by MR angiography.Among them,the sensitivity,specificity and accuracy of the diagnosis classification of classical Bankart injuries were 62.50%vs.95.83%,90.90%vs.98.18%and 82.28%vs.97.47%,respectively.Perthes lesions were 45.45%vs.81.82%,89.71%vs.95.59%,and 83.54%vs.93.67%.ALPSA was 43.75%vs.81.25%,93.65%vs.96.83%,and 83.54%vs.93.67%;The GLAD injury was 0.00%vs.50.00%,96.00%vs.98.67 and 93.51%vs.96.20%.Kappa test showed that MRA was significantly better than conventional MR test in terms of the consistency of the two diagnostic types.Among them,the consistency of MR and MRA diagnosis for Bankart injury was moderate and excellent(κ=0.599,κ=0.940).The diagnostic consistency of Perthes injury was normal and good(κ=0.339,κ=0.746).The diagnostic consistency of ALPSA injury was moderate and good(κ=0.423,κ=0.799).The diagnostic consistency of GLAD injury was consistent between 0 and moderate(κ=0,κ=0.552).Chi-square test Showed statistically significant difference between the two preoperative examination methods in the diagnostic classification of the anterior lower lip(P<0.05).Conclusion:The sensitivity,specificity and accuracy of MRA for anterior inferior labrum injury and classification are higher than those of conventional MR examination,which can provide more accurate information for preoperative evaluation and approach selection.