常规MRI预测关节镜术中肩胛下肌撕裂Yoo分型和Lafosse分型的价值

Predictive value of conventional MRI for detection and grading of subscapularis tear according to Yoo classification and Lafosse classification system

目的基于肩胛下肌足印区不同的解剖面,评估常规MRI预测关节镜术中肩胛下肌撕裂Yoo分型和Lafosse分型的准确性。方法回顾性分析自2019-10—2022-06完成的171例关节镜下肩袖修补术,术中确认98例肩胛下肌正常,73例肩胛下肌不同程度损伤。以关节镜下分型为金标准,分析常规MRI预测关节镜术中Yoo分型和Lafosse分型的敏感性、特异性、准确性以及观察者间一致性。结果关节镜下肩胛下肌撕裂Yoo分型:Ⅰ型9例,ⅡA型18例,ⅡB型20例,Ⅲ型14例,Ⅳ型11例,Ⅴ型1例。常规MRI诊断YooⅡA型以上撕裂的敏感性为85.9%,特异性为80.4%,准确性为82.5%;诊断需要手术修复的YooⅡB型以上撕裂的敏感性为89.1%,特异性为88.0%,准确性为88.3%。关节镜下肩胛下肌撕裂Lafosse分型:Ⅰ型27例,Ⅱ型18例,Ⅲ型16例,Ⅳ型10例,Ⅴ型2例。常规MRI诊断LafosseⅠ型以上撕裂的敏感性为86.3%,特异性为76.5%,准确性为80.7%;诊断需要手术修复的LafosseⅡ型以上撕裂的敏感性为89.1%,特异性为91.1%,准确性为90.5%。常规MRI预测Yoo分型和Lafosse分型的观察者间一致性较好,加权Kappa值分别为0.809、0.816。结论常规MRI图像可以区分肩胛下肌不同的足印区面,据此可以准确预测关节镜术中Yoo分型和Lafosse分型,对需要手术修复的肩胛下肌撕裂诊断敏感性和准确性较高。

Objective To assess the predictive accuracy of conventional MRI for detecting anatomy of facets of subscapularis and grading subscapularis tears with Yoo classification and Lafosse classification.Methods One hundred and seventy-one patients who underwent arthroscopic rotator cuff surgery from October 2019 to June 2022 were retrospectively analyzed.Among these patients,arthroscopy confirmed 98 cases with normal subscapularis and 73 cases with varying degrees of subscapularis tears.Using arthroscopic findings as the gold standard,the sensitivity,specificity,accuracy,and interobserver agreement for conventional MRI detecting intraoperative subscapularis Yoo classification and Lafosse classification were analyzed.Results Arthroscopy confirmed that the numbers of Yoo type Ⅰ,ⅡA,ⅡB,Ⅱ,Ⅳ,and Ⅴ tears were 9,18,20,14,11,and 1,respectively.The sensitivity,specificity,and accuracy for the detection of tears(type Ⅱ A or higher)by conventional MRI were 85.9%,80.4%,and 82.5%,respectively,and those for the detection of surgical candidates(type ⅡB or higher)were 89.1%,88.0%,and 88.3%,respectively.Arthroscopy confirmed that the numbers of Lafosse type Ⅰ,Ⅱ,Ⅱ,Ⅳ,and Ⅴ tears were 27,18,16,10,and 2,respectively.The sensitivity,specificity,and accuracy for the detection of tears(typeⅠ or higher)by conventional MRI were 86.3%,76.5%,and 80.7%,respectively,and those for the detection of surgical candidates(type Ⅱ or higher)were 89.1%,91.1%,and 90.5%,respectively.The interobserver agreements for grading subscapularis tears by conventional MRI according to the Yoo classification and Lafosse classification were excellent(weighted Kappa=0.809 and 0.816,respectively).Conclusion Preoperative conventional MRI is capable of identifying distinct footprints of subscapularis,accurately oredicting the intraoperative Yoo classification and Lafosse classification,with high sensitivity and accuracy in detecting surgial candidates of subscapularis tears.