Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.

Surgeon-Operated In-Office Ultrasonography for the Diagnosis of Rotator Cuff Tears: A Comparison with Magnetic Resonance Imaging

Objective: Few investigators have evaluated whether ultrasonography operated by a surgeon during a patient’s clinic visit is capable of obtaining a similar degree of accuracy as magnetic resonance imaging in regard to the diagnosis of rotator cuff tears and lesions of the biceps tendon. The purpose of this study was to clarify the accuracy of in-office ultrasonography for the diagnosis of rotator cuff tears in comparison to magnetic resonance imaging. Methods: One hundred and three patients (105 shoulders) with a clinical diagnosis of impingement and suspected rotator cuff tear, who subsequently underwent arthroscopic surgery were retrospectively enrolled in this study, including 7 males with 89 shoulders, and 33 females with 33 shoulders, and their mean age was 60.9 years (range, 30 to 83 years). The subjects were examined using ultrasonography and magnetic resonance imaging within three months pre-operatively per normal practice of the outpatient clinic. The two modalities were then compared to the reference standard, arthroscopic findings. Results: Intra-operatively, 79 full-thickness and 15 partial-thickness rotator cuff tears were found. The agreement between ultrasonography and magnetic resonance imaging for diagnosis of rotator cuff tears was statistically good;observed degree of agreement was 87% with Kappa coefficient of 0.73. Ultrasonography showed a sensitivity of 94% and a specificity of 100% for full-thickness tears, and a sensitivity of 80% and a specificity of 91% for partial-thickness tears. The agreement of the two modalities for diagnosis of lesions of the biceps tendon was also good;observed degree of agreement was 93% with Kappa coefficient of 0.76. In addition, ultrasonography showed comparable accuracy for classifying the size of rotator cuff tears to that of magnetic resonance imaging. Conclusion: Surgeon-operated in-office ultrasonography is an appropriate technique for the assessment of rotator cuff tears with a comparable sensitivity and specificity to that of magnetic resonance imaging.

Fusion Sign of Tendon-to-Bone Healing on X-Ray after Rotator Cuff Repair

Purpose: In clinical practice, increased radiolucency at the insertion site of a repaired tendon on the humerus on postoperative radiographs of patients following rotator cuff repair is often observed. Separately, magnetic resonance imaging (MRI) revealed tendon-to-bone healing in conjunction with this finding. Thus, we suspected that such radiographic changes are associated with tendon-to-bone healing, a phenomenon we labeled as the “fusion sign.” This study sought to investigate the diagnosis rate of the fusion sign in relation to tendon-to-bone healing after rotator cuff repair. Methods: Patients who underwent open rotator cuff repair (ORCR) or arthroscopic rotator cuff repair (ARCR) at two centers from 2010 to 2018 and who underwent MRI more than 6 months postoperatively were included in this study. The presence of radiolucency of the humeral footprint on a radiograph (the fusion sign) was investigated and checked for the concurrent presence of tendon-to-bone healing on MRI. Results: In total, 187 shoulders after ARCR and 55 shoulders after ORCR were included in this study. Among these, SH repair was performed in 202 shoulders and suture-bridging repair was performed in 40 shoulders. The fusion sign was positive in 67.8% of cases and negative in 32.3%. The positive predictive value (PPV) of the total population was 0.963 and did not differ according to the suture method used, reported as 0.964 in ARCR, 0.962 in ORCR, 0.966 in the surface-holding technique, and 0.938 in the suture-bridging technique. The intraobserver reliability was ĸ = 0.4478 (p < 0.001). The interobserver reliability for all observers was ĸ = 0.408 (p < 0.001). Conclusion: Postoperatively, the presence of the fusion sign at the footprint of the humerus strongly suggests that tendon-to-bone healing has occurred.

Comparing shoulder maneuvers to magnetic resonance imaging and arthroscopic findings in patients with supraspinatus tears

BACKGROUND Shoulder maneuvers and magnetic resonance imaging(MRI)are performed to diagnose supraspinatus tendon tears regardless of arthroscopy exam.Although there are many studies on this subject,there is a lack of studies comparing the sensitivity(Se)and specificity(Sp)of shoulder maneuvers and MRI to arthroscopic findings(intact,partial,or full thickness supraspinatus tendon tear).AIM To compare the diagnostic values of shoulder maneuvers with MRI for supraspinatus tendon tears in patients undergoing shoulder arthroscopy.METHODS A total of 199 consecutive patients from four orthopedic centers met the eligibility criteria of shoulder pain persisting for at least four weeks.They were prospectively enrolled in this study from April 2017 to April 2019.Seven clinical tests(full can,empty can,drop arm,Hawkins’,painful arc,Neer’s sign and resisted external rotation)and MRI were performed,and all were compared with surgical findings.Full can,empty can and resisted external rotation tests were interpreted as positive in the case of pain and/or weakness.We assessed the Se,Sp,accuracy,positive predictive value(PPV)and negative predictive value(NPV),positive and negative likelihood ratio and diagnostic odds ratio for overall,partial and fullthickness supraspinatus tears.RESULTS MRI had the highest Se for overall(0.97),partial(0.91)and full-thickness(0.99)tears;moreover,MRI had the highest NPV:0.90,0.88 and 0.98 for overall,partial and full-thickness tears,respectively.For overall supraspinatus tears,the Se and PPV were:Painful arc(Se=0.85/PPV=0.91),empty can(pain)(Se=0.80/PPV=0.89),full can(pain)(Se=0.78/PPV=0.90),resisted external rotation(pain)(Se=0.48/PPV=0.87),drop arm(Se=0.19/PPV=0.97),Neer’s sign(Se=0.78/PPV=0.93)and Hawkins’(Se=0.80/PPV=0.88).MRI had the highest PPV(0.99).The Hawkin’s test had the highest false positive rate in patients with intact tendons(0.36).The Sp of the empty can and full can(both tests positive for pain and weakness),drop arm and MRI were:0.93,0.91,0.98 and 0.96,respectively.For partial and full-thickness tears,the empty can test(positive for pain and weakness)had a Sp of 0.93,and the drop arm and MRI had the same Sp(0.98).CONCLUSION Physical examination demonstrated good diagnostic value,the drop arm test had a Sp as good as MRI for supraspinatus tears;however,MRI was more accurate in ruling out tears.The Hawkins’test had high false-positive findings in patients with intact tendons.

Rotator cuff tears: An evidence based approach

Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

Magnetic Resonance Imaging and Biomechanical Analysis of Adipose-derived Stromal Vascular Fraction Applied on Rotator Cuff Repair in Rabbits

Background： Adipose-derived stromal vascular fraction （ADSVF） can be applied to repair tendon and ligament tears. ADSVF treatment has a better therapeutic potential than adipose stem cells alone in promoting the healing of connective tissue injury in rabbit models. Magnetic resonance imaging （MRI） and biomechanical testing were used in this study to evaluate the efficiency of SVF in the healing of tendon-bone interface of a rotator cuff injury after reattachment. Methods： A total of 36 rabbits were studied between March and June 2016, 18 rabbits received the SVF-fibrin glue （SVF-FG） treatment and the other 18 formed the control group. ADSVF was isolated from each rabbit. A bilateral amputation of the supraspinatus tendon and parallel reconstruction was also performed on all the 36 rabbits. Then, a mixture of SVF and FG was injected into the tendon-bone interface of the SVF-FG group, whereas the control group only received FG. Tile animals were randomly sacrificed at 4, 8, and 12 weeks after surgery （n = 6 per group）, respectively. The shoulders were prepared for MRI scanning and analysis of biomechanical properties. Analyses of variance were pertbrmed using SPSS 13.0. Results： MRI scanning showed that the signal-to-noise quotient of the SVF-FG group was not significantly higher than that of the control group at either 4 （20.1 ± 3.6 vs. 18.2 ± 3.4, F = 1.570, P = 0.232） or 8 weeks （20.7 ±3.3 vs. 18.0 ± 3.0, F = 2.162, P = 0.117） posttreatment, and only became significant after 12 weeks （27.5± 4.6 vs. 22.1 ± 1.9, F 4.968, P = 0.009）. Biomechanical properties such as the maximum load, maximum strength, and the stiffness for the SVF-FG group were significantly greater than that for the control group at 8 weeks＇ posttreatment （maximum load： 166.89 ± 11.62 N vs. 99.40 ± 5.70 N, P 〈 0.001： maximum strength： 8.22 ± 1.90 N/ram vs. 5.82 ±0.68 N/ram, P 〈 0.010： and the stiffness： 34.85±3.00 Pa vs. 24.57±5.72 Pa, P 〈 0.010）. Conclusion： Local application of ADSVF might lead to better tendon-bone healing in rabbit models.

Comparison with Surgical Findings for the Accuracy of Routine MRI in Rotator Cuff Tears

Objective: To evaluate the diagnostic efficacy of magnetic resonance imaging (MRI) for the detection of partial-thickness rotator cuff tears (PTT) and full-thickness rotator cuff tears(FTT) by comparing its findings with surgical findings as the gold standard and to improve the previous MRI accuracy in diagnosing rotator cuff tears (RCT) considering more variables. Methods: In 45 months, 804 patients underwent MRI shoulder joint. Among them, only 95 cases had undergone both MRI imaging and surgery accordingly. The patient records were evaluated retrospectively if MRI and surgery were performed within 40 days of MRI. MRI findings were categorized into PTT, FTT and no tears which were further divided into different types according to four main nominal data as variables viz. site, size, shape and muscle involvement in RCT and were correlated with surgical findings for statistical calculation by using Kappa coefficient and McNemar Bowker test. Results: 81 patients (86 RCTs) underwent surgery within 40 days. On the basis of site as variable, MRI correctly depicted 100% of full thickness tears(FTT), 85% of bursal partial thickness tears(PTT), 80.4% of articular partial thickness tears(PTT). The consistency in diagnosis of RCT between MRI and surgery was moderate (Kappa coefficient 0.645). Overall sensitivity, specificity and accuracy of MRI for diagnosing PTT was 87.3%, 53.3% and 81.3%;and that for FTT was 100%, 98.7% and 98.8% respectively. Likewise on the basis of size, shape and muscles involved, the consistency between MRI and surgery was poor for size and shape and moderate for muscles involved;and the difference in diagnosing RCT by MRI and surgery was significant for shape (P = 0.002) only, but not significant for size (P = 0.16) and for muscles involved (P = 0.206) respectively. The agreement between MRI and surgery in diagnosing calcific tendinitis and shoulder joint hematoma with Kappa coefficient is (0.577) and (0.556) respectively. Conclusion: MRI has better accuracy for detecting FTT and has high sensitivity and positive predictive value in diagnosing both PTT and FTT. Combining more others variables in addition to RCT, MRI offers a great value in diagnosing RCT.

MRI诊断肩袖损伤及撕裂程度的临床应用观察

目的:探究MRI在肩袖损伤诊断及撕裂程度的评估中的应用效果。方法:回顾性分析我院183例肩部损伤患者资料,所有患者均行核磁共振成像(MRI)检查,以关节镜检查为金标准,探究MRI对肩袖损伤的诊断价值,对肩袖不同肌腱损伤及撕裂程度的检出情况,分析MRI与关节镜测量肩袖全层撕裂肌腱撕裂尺寸偏差情况。结果:经关节镜检查,183例患者肩袖损伤阳性136例,阴性47例,MRI检查134例阳性,49例阴性,诊断敏感度95.59%(130/136),特异度91.49%(43/47),准确度为94.54%(173/183),阳性预测值为97.01%(130/134),阴性预测值87.76%(43/49),Kappa值为0.859。183例患者关节镜共诊断373处损伤,其中冈上肌腱136处,冈下肌腱122处,肩胛下肌腱115处。MRI对冈上肌腱、冈下肌腱、肩胛下肌腱的检出率显著低于关节镜检查(P<0.05);136例肩袖损伤患者中全层撕裂45例,部分撕裂91例,MRI诊断全层撕裂准确率为93.33%(42/45),部分撕裂为94.51%(86/91),总准确率为94.12%(128/136),显著低于关节镜检查(P<0.05);MRI测量全层撕裂肌腱断端回缩度、撕裂跨度的准确率分别为86.67%(39/45)、82.22%(37/45)。结论:MRI对肩袖损伤及肌腱撕裂程度均具有较高的诊断价值,可为肩袖损伤提供可靠的术前诊断依据,值得在临床推广应用。

3T MRI半定量冈上肌脂肪浸润程度与慢性肩袖撕裂的相关性分析

目的 探讨3T MRI半定量冈上肌脂肪浸润程度与慢性肩袖损伤的相关性。方法 选取经手术或关节镜证实的95例慢性肩袖损伤患者,所有患者均行3T MRI检查。MRI冠状位测量肱-肩距离、斜矢状位记录肩峰形态以及采用Goutallier分类改良方法评估冈上肌脂肪浸润程度分级。所有患者依据冈上肌腱损伤程度分为退变组,部分撕裂组和完全撕裂组。结果 1)冈上肌腱退变组、部分性撕裂组及完全性撕裂组与冈上肌脂肪浸润有显著相关性(P<0.01)。2)冈上肌腱退变组、部分性撕裂组及完全性撕裂组性别、年龄、肩峰下间隙及肩峰形态差异无统计学意义(P>0.05)。3)进一步两两比较显示,冈上肌腱退变组冈上肌脂肪浸润程度分级小于部分性撕裂组及完全性撕裂组,差异具有统计学意义(P<0.05);部分性撕裂组小于完全性撕裂组,差异有统计学意义(P<0.05)。结论 3T MRI可半定量评估冈上肌脂肪浸润程度,冈上肌脂肪浸润程度与其损伤呈正相关。

IDEAL-IQ序列在冈上肌腱损伤后肩袖肌群脂肪浸润定量评估中的应用

目的采用非对称采集与迭代最小二乘估算法迭代水脂分离(iteraterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation,IDEAL-IQ)方法定量评估冈上肌腱损伤的严重程度与肩袖肌群脂肪浸润程度及受试者特征之间的关系。材料与方法回顾性分析2022年8月至2024年6月本院经肩关节镜证实的33例冈上肌腱部分撕裂患者及89例完全撕裂患者,均进行了常规MRI扫描及IDEAL-IQ序列扫描。由两名放射科医生分别对所有受试者的MRI图像进行独立评估,根据常规MRI图像的冈上肌腱损伤表现,将完全撕裂组的冈上肌腱按照Patte分型分为Patte 1型(Ⅱ级)、Patte 2型(Ⅲ级)、Patte 3型(Ⅳ级),将部分撕裂组定义为Ⅰ级。同时在斜矢状位上进行Goutallier分级及Thomazeau萎缩分级,并通过GE ADW 4.7工作站后处理软件在IDEAL-IQ序列生成的脂肪分数图像上测量冈上肌、冈下肌、肩胛下肌及小圆肌脂肪分数(fat fraction,FF)。用组内相关系数(intra-class correlation coefficient,ICC)及Kappa一致性检验评估观察者间及观察者内的一致性。采用Kruskal-Wallis H检验、单因素ANOVA检验分析FF值在不同分组之间的差异,组间两两比较用Bonferroni检验。采用Pear_(s)on相关性分析肩袖肌肉FF值与年龄、症状持续时间的相关性(相关系数r),Spearman相关性分析冈上肌腱损伤分级与肩袖肌群FF值、Goutallier分级及Thomazeau萎缩分级之间的相关性(相关系数r_(s))。结果(1)冈上肌、冈下肌、肩胛下肌的FF值在冈上肌腱损伤Ⅳ级中显著高于Ⅲ级,高于Ⅱ级和Ⅰ级,差异有统计学意义(P值分别为<0.001、<0.001、0.005);小圆肌的FF值在不同分级之间差异无统计学意义(P=0.073)。组内比较Ⅰ级和Ⅱ级的冈上肌、冈下肌、肩胛下肌、小圆肌FF值差异无统计学意义(P值分别为0.026、0.102);Ⅲ级和Ⅳ级的FF值差异有统计学意义(P<0.001)。(2)冈上肌、冈下肌、小圆肌的FF值与年龄呈中等相关(r值分别为0.381、0.339、0.349,P均<0.001),肩胛下肌的FF值与年龄呈弱相关(r=0.216,P=0.017);冈上肌、冈下肌、肩胛下肌FF值与症状持续时间呈中等程度相关(r分别为0.442、0.412、0.314,P均<0.001),小圆肌的FF值与症状持续时间呈弱相关(r=0.277,P=0.002);冈上肌腱损伤程度与冈上肌FF值呈显著相关(r_(s)=0.740,P<0.001),与冈下肌的FF值呈强相关性(r_(s)=0.596,P<0.001),与肩胛下肌、小圆肌的FF值呈弱相关(r_(s)分别为0.257、0.212,P值分别为0.004、0.019);冈上肌损伤程度分级与Goutallier分级、Thomazeau分级之间呈显著正相关(r_(s)分别为0.757、0.737,P均<0.001),且冈上肌FF值在Goutallier和Thomazeau的分级中差异具有统计学意义(P均<0.001)。结论3.0 T MR IDEAL-IQ序列能量化和客观评估肩袖肌群脂肪浸润程度,肩袖肌群脂肪浸润程度与冈上肌腱损伤分级呈正相关,与年龄、症状持续时间呈正相关。

肌骨超声与磁共振成像诊断肩袖撕裂的对比分析

目的 比较分析肌骨超声和磁共振成像在诊断肩袖撕裂中的作用。方法收集2021年2月至2022年2月在东莞市人民医院收治的43例怀疑肩袖撕裂患者。结果超声、MRI和联合检查在不同类型肩袖撕裂的诊断中均存在显著差异性。超声、MRI和联合检查对冈上肌腱部分或全层撕裂、肱二头肌长头腱病变、盂肱关节腔积液或滑膜增生、肩峰下-三角肌下滑囊炎及肩峰下撞击综合征阳性的诊断准确度分别为62.79%、86.04%、65.12%、53.49%、90.7%、67.44%,37.21%、72.09%、84.21%、94.74%、89.47%、50%和60.46%、86.04%、81.4%、83.7%、100%、72.1%。绘制ROC曲线,超声、MRI及联合检查显示冈上肌腱部分和全层撕裂的AUC分别为0.613、0.687、0.596和0.842、0.684、0.842。结论对于怀疑冈上肌腱全层撕裂的患者,可采用超声为首选影像学方法。联合检查可以提升肩峰下-三角肌下滑囊炎和肩峰下撞击综合征阳性的诊断能力。

肩袖间隙结构的MR平扫和关节造影最佳显示方位探究

目的探讨肩袖间隙(RI)结构的磁共振(MR)平扫和关节造影最佳显示方位。方法选取2021年1月至2023年3月于红河州第一人民医院行MR平扫及关节造影的患者80例,均经肩关节镜手术证实RI正常。统计MR平扫及关节造影检查横轴位、斜矢状位及斜冠状位显示RI及上盂肱韧带(SGHL)、肱二头肌长头腱(LHBT)、喙肱韧带(CHL)的情况。结果MR斜矢状位平扫对RI结构的显示率17.50%高于横轴位0.00%、斜冠状位5.00%(4/80)(χ^(2)=18.739,P<0.001);MR斜矢状位平扫对RI内SGHL、LHBT、CHL的显示情况优于横轴位、斜冠状位(χ^(2)=26.036,P<0.001);MR斜矢状位关节造影对RI结构的显示率57.50%高于横轴位5.00%、斜冠状位17.50%(χ^(2)=61.534,P<0.001);MR斜矢状位关节造影对RI内SGHL、LHBT、CHL结构的显示情况优于横轴位、斜冠状位(χ^(2)=64.569,P<0.001);MR斜矢状位关节造影对RI结构的完全显示率57.50%明显高于MR斜矢状位平扫17.50%(χ^(2)=27.307,P<0.05)。结论斜矢状位是MR平扫及关节造影显示RI结构的最优显示方位,其中斜矢状位MR关节造影可作为RI结构的最佳检查方法。

肩关节冈上肌出口位与MRI在肩袖损伤诊断中的应用价值对比

目的比较肩袖损伤诊断中肩关节冈上肌出口位数字化X射线摄影(DR)与磁共振成像(MRI)的临床价值。方法选取2022年1月至2024年3月于医院就诊的疑似肩袖损伤的患者80例,均行肩关节冈上肌出口位DR与MRI诊断。以肩关节镜检查结果为“金标准”,比较肩关节冈上肌出口位DR与MRI诊断肩袖损伤的价值。结果肩关节冈上肌出口位DR显示,65例患者肩峰形态为Ⅲ型(钩状,肩峰下方有骨赘形成,肩峰尖端部位处呈现出钩形);52例患者肩峰-肱骨头间隙明显狭窄,肩峰下方有骨赘形成;肌腱不同程度的钙化,钙化在X射线上表现为亮点或斑片状密度增高影;关节间隙狭窄或关节面存在骨质增生;肱骨大结节出现囊性变、硬化及反应性增生等改变。肱骨头或冈上肌起点有骨刺形成。MRI显示,62例患者肩袖肌腱信号增强,T2WI受损肌腱常呈现高信号,T1WI上信号无显著变化;肌腱形态发生改变,43例患者肩袖肌腱变薄,30例增厚,7例不规则;在斜冠状位和斜矢状位上显示肩袖部分或全层撕裂;肌肉横截面积减少和脂肪侵润,考虑存在肌肉萎缩;肩峰下组织增厚或骨赘形成,导致肩袖受压;肩峰下滑囊炎在MRI上表现为滑囊增大,信号增强。MRI诊断肩袖损伤的阳性率高于肩关节冈上肌出口位DR(χ^(2)=4.514,P=0.034)。MRI诊断肩袖损伤的灵敏度、准确度及曲线下面积(AUC)均高于肩关节冈上肌出口位DR。结论MRI诊断肩袖损伤的临床价值高于肩关节冈上肌出口位DR。

高频超声及磁共振成像对肩袖损伤的诊断效果分析

目的采用高频超声和磁共振(MRI)诊断肩袖损伤,并对两者的诊断效能进行比较,以寻找到能高效诊断肩袖损伤的方法。方法选择2020年8月至2023年5月期间于焦作市中医院超声科就诊的96例疑似肩袖损伤患者作为观察对象,均行高频超声、MRI检查,并以关节镜检查作为金标准,对2种检查方法的诊断效果进行比较。结果关节镜检查出88例有肩袖损伤,其中62例有冈上肌腱损伤、12例有冈下肌腱损伤、27例有肩胛下肌腱损伤。高频超声检查出79例有肩袖损伤,其中54例有冈上肌腱损伤、11例有冈下肌腱损伤、23例有肩胛下肌腱损伤。MRI检查出86例有肩袖损伤,其中59例有冈上肌腱损伤、12例有冈下肌腱损伤、24例有肩胛下肌腱损伤。2种方法对肩袖各肌腱损伤的检出率差异无统计学意义(P>0.05)。高频超声的诊断灵敏度为86.4%、特异度为62.5%、准确性为84.4%,MRI的诊断灵敏度为95.5%、特异度为75.0%、准确性为93.8%,两者的灵敏度、准确性相比差异有统计学意义(P<0.05)。结论高频超声、MRI对肩袖损伤具有相似的诊断效果,MRI的灵敏度和准确性较高,但高频超声价格便宜,可双侧对比,实时观察,可重复性强。因此建议将高频超声作为肩袖损伤的首选诊断方法。

磁共振关节造影诊断肩袖损伤的价值分析

目的探讨磁共振(magnetic resonance,MR)关节造影诊断肩袖损伤的价值。方法选取2021年10月—2023年9月单县中医医院收治的100例肩关节损伤患者为研究对象,所有患者均接受常规磁共振成像(magnetic resonance imaging,MRI)及MR关节造影检查,以关节镜为金标准,分析MRI和MR关节造影的诊断价值。结果MRI关节造影诊断肩袖损伤的灵敏度为97.30%(72/74)、特异度为96.15%(25/26)、准确度为97.00%(97/100),高于常规MRI的89.19%(66/74)、76.92%(20/26)、86.00%(86/100),差异有统计学意义(χ^(2)=3.861、4.127、7.779,P均<0.05)。MR关节造影的阳性预测值、阴性预测值高于常规MRI,差异有统计学意义(P均<0.05)。结论MR关节造影检查诊断肩袖损伤的价值较高,可用于肩袖损伤的早期诊断。

MSCT重建与MRI检查诊断肩袖损伤的价值研究

目的探究多层螺旋CT(MSCT)重建与磁共振成像(MRI)检查用于肩袖损伤患者中的诊断价值。方法选取以肩部慢性疼痛或者外伤史为主诉且拟行关节镜诊疗的128例患者,以关节镜检查结果为“金标准”,对所有患者实施MSCT重建与MRI检查,判断两种方法的诊断效能。结果MRI与肩关节镜检查结果的一致性中等(Kappa=0.59,P<0.05);MSCT重建与肩关节镜检查结果的一致性中等(Kappa=0.53,P<0.05);两者联合诊断与肩关节镜检查结果的一致性高(Kappa=0.96,P<0.05)。联合诊断准确率高于MRI检验,亦高于MSCT重建(χ^(2)分别=14.94、19.41,P均<0.05),MRI诊断准确率与MSCT重建相比,差异无统计学意义(χ^(2)=0.39,P>0.05)。结论MRI与MSCT重建两者联合可提高诊断效能,与肩关节镜诊断具有较高一致性。

MRI不同序列对肩袖损伤诊断价值的比较

目的分析肩袖损伤在MRI不同序列上表现的病理基础,比较各种序列对肩袖损伤的检出效果。方法24例患者,采用1.5TMR机,肩关节线圈,常规斜矢状位T1WI,横轴位T2WI,斜冠状位PDFS,SPGR和STIR;层厚4mm,层距0.1mm。判断标准依据肩袖的形态、信号,确定肿胀、断裂、萎缩。根据信号特征区分水肿、出血、纤维化、钙质沉积的病理基础。依据图像质量和显示的解剖细节确定不同序列的检出率,分为优、良、差三级。结果冈上肌腱损伤18例次,水肿4例次;冈下肌腱损伤5例次;肩胛下肌腱损伤4例次;小圆肌腱损伤2例次;肱二头长头肌腱损伤4例次;腱鞘炎1例次;肩关节积液4例次;肩峰下滑囊肿胀3例次;肱骨大结节撕脱骨折3例次;大结节骨折1例次。经卡方检验,各序列之间检出率差别显著(χ2=17.134,P<0.05),PDFS序列对肩袖损伤的显示最佳。结论MRI是诊断肩袖损伤的重要手段,信号的差异可反映不同的病理特征,建议肩袖损伤应首选PDFS序列。

3.0T MRI肩撞击综合征影像征象分析

目的探讨3.0TMRI对肩关节撞击综合征的诊断价值,并分析其影像征象及损伤机制。方法回顾性分析30例肩撞击综合征患者的MRI表现及临床症状。结果①直接征象:30例MRI均显示冈上肌肌腱信号和形态的改变,其中6例冈上肌肌腱完全撕裂;13例冈上肌肌腱的部分撕裂;11例表现冈上肌肌腱表面的信号异常、混杂;②间接征象:9例肩峰下滑囊增厚、肩峰下-三角肌下囊积液及15例关节囊积液;③继发征象:5例关节盂唇撕脱,于关节造影时显示较好,5例冈上肌萎缩、2例三角肌萎缩、4例Bankart病变;④病因征象:本组患者肩峰形态分别为平直型(4/30)、弧形(7/30)、钩型(19/30);肩峰下通道(AHI)7例<5mm,23例为5～10mm之间。结论高场强3.0TMRI能够有效显示肩撞击综合征的影像特征,有助于临床诊治。

3.0T MR肩关节造影对肩袖损伤的诊断价值分析

目的探讨3. 0T MR肩关节造影在肩袖损伤诊断中的价值。方法回顾性分析2014年3月～2017年3月期间,经关节镜检查证实的111例肩袖损伤的肩关节术前常规MRI和MR关节造影资料。结果 111例肩关节中,肩袖完全撕裂15例,常规MRI和MR关节造影正确诊断率均为100%;肩袖部分撕裂96例,其中滑囊面型27例、肌腱内型26例、关节面型43例,常规MRI对以上三种类型的肩袖部分撕裂正确诊断率分别为85. 2%、88. 5%和76. 7%,MR关节造影对其正确诊断率分别为85. 2%、80. 8%和93. 0%;两种检查方法对滑囊面型和肌腱内型肩袖部分撕裂的诊断无明显差异,而对关节面型肩袖部分撕裂的诊断,MR关节造影优于常规MRI,差异有统计学意义(P <0. 05)。结论 MR关节造影对肩袖损伤的诊断具有较高的价值,但在关节滑囊型和肌腱内型两种类型的肩袖部分撕裂的诊断中仍存在一定的局限性。

高频超声对肩袖撕裂诊断的应用价值

目的：对比分析高频超声检查对肩袖撕裂的诊断价值.方法：回顾性分析临床怀疑肩袖撕裂并分别行超声、MRI检查及关节镜治疗的患者37例37肩,男21例,女16例;年龄51～75岁,平均64岁.通过超声检查对肩袖损伤进行分型,并与MRI及关节镜结果行对比分析.结果：超声检查诊断肩袖损伤32肩,诊断正常肩袖5肩;MRI诊断肩袖损伤29肩,正常8肩;手术诊断肩袖损伤33肩,诊断正常肩袖4肩.超声诊断肩袖损伤的敏感性为93.4%（31/33）,特异性为75.0%（3/4）;MRI诊断肩袖损伤的敏感性为87.5%（28/32）,特异性为80.0%（4/5）.结论：超声检查在诊断肩袖损伤方面具有较高灵敏度及特异性,可以作为诊断肩袖损伤的常规检查方法.