Schröder R-J, Bostanjoglo M, Kääb M, Herzog H, Hidajat N, Röttgen R, Mäurer J, Felix R
Klinik für Strahlenheilkunde, Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin.
Rofo. 2003 Jul;175(7):920-8. doi: 10.1055/s-2003-40431.
To determine the correlation of the extent of lesions of the supraspinatus tendon in MRI's of the shoulder with surgical or arthroscopic findings using the classification of Snyders and Batemann, respectively.
The preoperative MRI's of 80 patients (age: 16 - 76/47.4 +/- 14.0 years) which were performed due to various complaints of the shoulder were analyzed retrospectively by two experienced and blinded radiologists. We evaluated the incidence and the extent of partial or complete ruptures of the supraspinatus tendon. After MRI, an arthroscopic or open surgical intervention was performed (= gold standard). Various MR-scanners were used with a field strength of 1.0 T (17 cases), or 1.5 T (63 cases) and flexible or inflexible arthro coils. Additionally to plain MRI, 38 of 80 patients underwent contrast enhanced MRI. The MR and the surgical or arthroscopic findings were compared and statistically analyzed.
Neglecting the localization and the extent of discontinuity of the supraspinatus tendon, the sensitivity of the 80 MRI's was 0.93, the specificity 0.69, and the accuracy 0.85. The sensitivity increased to 0.96 with constant specificity and an accuracy of 0.83 excluding the lesions with an extent below 1 cm. Compared with non-enhanced examinations, the contrast enhanced MRI revealed higher sensitivity (+ 7 %, 0.89 vs. 0.96), higher specificity (+ 11 %, 0.64 vs. 0.75), and higher accuracy (+ 8 %, 0.81 vs. 0.89) in depicting lesions of the supraspinatus tendon at all. On T 1 -weighted images, the detection of lesions at all and the differentiation between partial and complete ruptures were improved significantly by contrast enhancement, especially in lesions with an extent below 1 cm. Diagnostic failures were seen in examinations without intravenous contrast application, artifacts, extent of the lesion below 1 cm, differentiating between degeneration and partial rupture of the tendon, differentiating between severely degenerated tendons with partial rupture and complete rupture, and covered ruptures.
The performance and consecutively the analysis of the widely used MRI of the shoulder is often not sufficiently reliable in its present routine form. To be able to compete with other imaging modalities such as sonography, standardized MR protocol, contrast enhancement as needed, avoiding the described source of failure, and an exact analysis should be applied.
分别采用斯奈德（Snyders）和贝特曼（Batemann）分类法，确定肩部磁共振成像（MRI）中冈上肌腱病变程度与手术或关节镜检查结果之间的相关性。
由两名经验丰富且不知情的放射科医生对80例患者（年龄：16 - 76/47.4±14.0岁）因肩部各种不适而进行的术前MRI进行回顾性分析。我们评估了冈上肌腱部分或完全断裂的发生率及程度。MRI检查后，进行了关节镜或开放手术干预（=金标准）。使用了各种场强为1.0T（17例）或1.5T（63例）的磁共振扫描仪以及柔性或刚性关节线圈。除了普通MRI外，80例患者中有38例接受了增强MRI检查。对MRI与手术或关节镜检查结果进行比较并进行统计学分析。
忽略冈上肌腱连续性中断的部位和程度，80例MRI的敏感性为0.93，特异性为0.69，准确性为0.85。排除长度小于1cm的病变后，敏感性提高到0.96，特异性不变，准确性为0.83。与未增强检查相比，增强MRI在显示冈上肌腱病变方面具有更高的敏感性（提高7%，0.89对0.96）、更高的特异性（提高11%，0.64对0.75）和更高的准确性（提高8%，0.81对0.89）。在T1加权图像上，增强造影显著改善了对所有病变的检测以及部分和完全断裂之间的区分，特别是在长度小于1cm的病变中。在未静脉注射造影剂的检查、伪影、病变长度小于1cm、区分肌腱退变与部分断裂、区分严重退变伴部分断裂的肌腱与完全断裂的肌腱以及隐匿性断裂中出现了诊断失败的情况。
目前常规形式的广泛使用的肩部MRI的性能及后续分析通常可靠性不足。为了能够与超声等其他成像模式竞争，应采用标准化的MR协议、按需进行增强造影、避免所述的失败原因并进行精确分析。
