磁共振成像影像指标与肩峰下撞击综合征的相关性研究

Correlation of Magnetic Resonance Imaging Quantitative Parameters and Subacromial Impingement Syndrome

目的:探讨磁共振成像影像指标与肩峰下撞击综合征的相关性。方法:回顾性收集宁夏医科大学总医院经肩关节镜及临床相关检查确诊肩峰下撞击综合征(subacromial impingement syndrome,SAIS)的患者57例(SAIS组),另筛选入组42名年龄相匹配的健康受试者(对照组)。所有受试者均行肩关节磁共振成像(magnetic resonance imaging,MRI)横断位、斜冠状位及斜矢状位检查,测量并记录两组研究对象的肩峰类型、最短肩肱间距(acromion humeral distance,AHD)、肩峰指数(acromion index,AI)、肩峰向下倾斜角(lateral acromion angle,LAA)、峰盂角(critical shoulder angle,CSA)及肩峰-大结节撞击指数(acromion–greater tuberosity impingement index,ATI)。以组内相关系数(intraclass correlation coefficient,ICC)评估观察者间测量各个指标的可重复性。两组研究对象的影像指标采用独立样本t检验进行比较,并利用受试者工作特征曲线(receiver operating characteristic curve,ROC)比较各影像指标对肩峰下撞击综合征的诊断效能。结果:峰盂角、肩峰向下倾斜角、肩峰大结节撞击指数、最短肩肱间距及肩峰指数的ICC均大于0.75,一致性较好。SAIS组与对照组的肩峰类型无明显差别(P>0.05),SAIS组及对照组均以Ⅱ型肩峰居多。SAIS组AHD平均值7.45±1.63 mm,低于对照组AHD平均值8.29±1.65mm,差异有统计学意义(P<0.05)。SAIS组CSA平均值(37.79±1.51)°、ATI平均值(0.93±0.06)及LAA平均值(79.36±3.73)°均高于对照组CSA(36.57±2.04)°、ATI(0.90±0.06)及LAA(75.29±1.84)°,差异均有统计学意义(P均<0.05)。SAIS组AI平均值为0.67±0.08,对照组AI平均值为0.66±0.07,SAIS组AI值较对照组稍高,差异无统计学意义(t=0.82,P=0.41)。最短肩肱间距、峰盂角、肩峰向下倾斜角及肩峰大结节撞击指数ROC曲线下面积分别为0.630、0.699、0.857、0.683。上述指标联合诊断SAIS的诊断效能明显高于单一指标的诊断效能,联合诊断的特异度为94.74%灵敏度为82.46%。结论:MRI影像指标(LAA、CSA、AHD及ATI)诊断肩峰下撞击综合征具有较高的敏感性和特异性,可作为肩峰下撞击综合征的诊断依据。

Objective To explore the correlation of magnetic resonance imaging(MRI) quantitative parameters and subacromial impingement syndrome(SAIS). Methods Fifty-seven patients with a diagnosis of subacromial impingement syndrome confirmed by shoulder arthroscopy and clinical examinations in the Ningxia Medical University General Hospital were retrospectively collected into the SAIS group,while another 42 age-matched healthy volunteers were selected into the control group. Both groups were performed magnetic resonance imagingin the axial, oblique coronal and oblique sagittal views,and the acromion type,acromion humeral distance(AHD),acromion index(AI),lateral acromion angle(LAA), critical shoulder angle(CSA) and acromion – greater tuberosity impingement index(ATI) of both groups were measured and recorded. Interclass correlation coefficient(ICC) was used to compared the consistency between observers. Paired T test was employed to compare the parameters of the two groups,and receiver operating characteristic curve(ROC) was used to compare the diagnostic efficacy of each parameters for subacromial impounding syndrome. Results The average ICCs of the CSA,LAA,ATI,AHD and AI were all greater than 0.75,with good agreement. There was no significant difference in the acromion type between the 2 groups(P>0.05),with both of the type-Ⅱ acromion.The mean AHD of SAIS group was 7.45 ± 1.63 mm,significantly lower than the control group(8.29± 1.65 mm)(P<0.05). The average CSA,ATI and LAA[(37.79 ± 1.51)°,(0.93 ± 0.06) and(79.36± 3.73)°] of SAIS group were significantly higher than the control group[(36.57 ± 2.04)°,(0.90 ±0.06) and(75.29 ± 1.84)°] (P<0.05 for all). The average AI value of SAIS group(0.67 ± 0.08) was higher than the control group(0.66 ± 0.07),but without significant differences(t=0.82,P=0.41). The areas under the ROC curve of the AHD,CSA,LAA and ATI for SAIS were 0.630,0.699,0.857and 0.683 respectively. The diagnostic efficacy of the above indexes combined was significantly higher than that of the single index,with the specificity and the sensitivity of 94.74% and 82.46% respectively. Conclusions MRI parameters(LAA, CSA, AHD and ATI)have high sensitivity and specificity in the diagnosis of SAIS,and can be used in the clinical practice.