双能量CT对肩腱袖撕裂的诊断及分级价值

Value of Dual-energy CT in The Diagnosis and Grading of Rotator Cuff Tears

目的探讨双能量CT对肩腱袖撕裂的诊断及分级价值。方法对2022年1月至2022年6月我院收治的110例肩袖损伤患者行双能量CT检查,以肩关节镜检查结果为“金标准”,分析双能量CT对肩腱袖撕裂的诊断及分级价值。结果110例患者,经肩关节镜证实肩袖完全撕裂51例(46.36%)、部分撕裂48例(43.64%),无撕裂11例(10.00%);共有54条肌腱撕裂;双能CT诊断完全撕裂与肩关节镜诊断符合率为88.24%(45/51);部分撕裂符合率为79.17%(38/48);无撕裂诊断符合率为81.82%(9/11);以关节镜为金标准,双能CT诊断肩腱袖撕裂的敏感度为83.84%、特异性为81.82%、准确率为83.64%、阳性预测值为97.65%、阴性预测值为36.00%。51例完全撕裂患者肩关节镜证实共有54条肌腱撕裂,其中冈上肌肌腱撕裂36条,冈下肌肌腱撕裂4条,肩胛下肌肌腱撕裂14条;双能CT检出与关节镜相符的撕裂肌腱39条,诊断符合率为72.22%(39/54),其中,冈上肌肌腱撕裂正确检出29条(80.56%),冈下肌肌腱撕裂正确检出2条(50.00%),肩胛下肌肌腱撕裂正确检出8条(57.14%)。完全撕裂及部分撕裂肌腱止点、边缘外形轮廓、总体显示评分均低于无撕裂肌腱(P<0.05);完全撕裂肌腱边缘外形轮廓显示评分低于部分撕裂肌腱(P<0.05),完全撕裂肌腱与部分撕裂肌腱止点及总体显示评分对比,差异无统计学意义(P>0.05)。受试者工作特征曲线(ROC)结果显示,肌腱止点评分为1.57分时,诊断完全撕裂的曲线下面积为0.734,敏感性72.55%,特异性69.49%;边缘轮廓评分为1.38分时,诊断完全撕裂的曲线下面积为为0.770,敏感性74.51%,特异性79.66%;肌腱总体评分为1.62分时,诊断完全撕裂的曲线下面积为0.742,敏感性78.43%,特异性74.58%。结论双能量CT对肩腱袖撕裂具有较高的诊断价值,可无创性明确撕裂部位及撕裂程度,对临床诊疗有一定借鉴意义。

ObjectiveTo explore the value of dual-energy CT in the diagnosis and grading of rotator cuff tears.Methods110 patients with rotator cuff tears who were treated in the hospital from January 2022 to June 2022 were examined by dual-energy CT.The results of shoulder arthroscopy were used as the"gold standard"to analyze the value of dual-energy CT in the diagnosis and grading of rotator cuff tears.ResultsAmong 110 patients,51 cases(46.36%)of complete rotator cuff tears,48 cases(43.64%)of partial rotator cuff tears and 11 cases(10.00%)without rotator cuff tears were confirmed by shoulder arthroscopy,and there were 54 tendon tears.The coincidence rate of dual-energy CT in the diagnosis of complete tears,partial tears and no tears with shoulder arthroscopy were 88.24%(45/51),79.17%(38/48)and 81.82%(9/11)respectively.Taking arthroscopy as the gold standard,the sensitivity,spec ificity,accuracy rate,positive predictive value and negative predictive value of dual-energy CT in the diagnosis of rotator cuff tears were 83.84%,81.82%,83.64%,97.65%and 36.00%respectively.54 tendon tears were confirmed by shoulder arthroscopy among 51 patients with complete tears,including 36 supraspinatus tendon tears,4 infraspinatus tendon tears and 14 subscapularis tendon tears.Dual-energy CT detected 39 torn tendons that were consistent with arthroscopy,with the diagnostic coincidence rate of 72.22%(39/54).29(80.56%)supraspinatus tendon tears,2(50.00%)infraspinatus tendon tears and 8(57.14%)subscapularis tendon tears were correctly detected.The scores of attachment,edge contour and overall display of completely torn and partially torn tendons were lower than those of non-torn tendons(P<0.05).The score of edge contour display of completely torn tendon was lower than that of partially torn tendon(P<0.05),but there were no statistical differences in the scores of attachment and overall display between completely torn tendon and partially torn tendon(P>0.05).Receiver operating characteristic curve(ROC)showed that the area under the curve,sensitivity and specificity in the diagnosis of complete tears were 0.734,72.55%and 69.49%when the score of tendon attachment was 1.57 points,were 0.770,74.51%and 79.66%when the edge contour score was 1.38 points,and were 0.742,78.43%and 74.58%when the total tendon score was 1.62.ConclusionDual-energy CT has high diagnostic value on rotator cuff tears,and it can determine the location and degree of tear non-invasively and has certain reference significance for clinical diagnosis and treatment.