Strobel Klaus, Pfirrmann Christian W A, Zanetti Marco, Nagy Ladislav, Hodler Juerg
Department of Radiology, Orthopedic University Hospital, Balgrist, Forchstr. 340, Zurich CH-8008, Switzerland.
AJR Am J Roentgenol. 2003 Sep;181(3):755-60. doi: 10.2214/ajr.181.3.1810755.
Our objective was to evaluate the predictive value of various MRI findings in the acromioclavicular joint for pain relief after intraarticular injection.
The acromioclavicular joint of 50 patients (20 women, 30 men; mean age, 51 years; range, 25-75 years) was evaluated on MRIs of the shoulder. Osteophytes, subchondral cysts and irregularities, bone marrow edema, joint effusion, and joint capsule hypertrophy were assessed by two musculoskeletal radiologists in consensus. Local anesthetics were injected into the acromioclavicular joint with fluoroscopic guidance. Patients graded pain relief on a visual analogue scale (0-100%) after 15 min. The relationship between pain relief and MRI findings was assessed with the Mann-Whitney U test. Pain relief equal to or greater than 70% was rated as a positive response to the injection. This cutoff value was used to calculate sensitivity, specificity, accuracy, and predictive values of the various MRI findings in determining which acromioclavicular joints were responsive to joint injections.
Mean pain relief after injection was 38%. Pain relief was significantly related to capsular hypertrophy (p = 0.007) and was equal to or greater than 70% in 11 patients. The sensitivity in diagnosing a successful injection (range, 9-82%) was highest for caudal osteophytes (82%) and capsular hypertrophy (73%). The specificity (range, 51-97%) was highest for subchondral cysts (97%), subchondral bone marrow edema (95%), and joint effusion (92%).
Pain relief after intraarticular injection is significantly related to capsular hypertrophy diagnosed on MRI. MRI findings have a reasonable sensitivity and a high specificity in predicting relevant short-term pain relief after intraarticular injection.
我们的目的是评估肩锁关节各种MRI表现对关节内注射后疼痛缓解的预测价值。
对50例患者（20名女性，30名男性；平均年龄51岁；范围25 - 75岁）的肩锁关节进行肩部MRI检查。由两名肌肉骨骼放射科医生共同评估骨赘、软骨下囊肿及不平整、骨髓水肿、关节积液和关节囊肥厚情况。在透视引导下将局部麻醉剂注入肩锁关节。患者在15分钟后根据视觉模拟量表（0 - 100%）对疼痛缓解程度进行评分。采用Mann-Whitney U检验评估疼痛缓解与MRI表现之间的关系。疼痛缓解等于或大于70%被评为对注射的阳性反应。该临界值用于计算各种MRI表现对于确定哪些肩锁关节对关节注射有反应的敏感性、特异性、准确性和预测值。
注射后平均疼痛缓解率为38%。疼痛缓解与关节囊肥厚显著相关（p = 0.007），11例患者的疼痛缓解等于或大于70%。诊断注射成功的敏感性（范围9 - 82%）以尾侧骨赘（82%）和关节囊肥厚（73%）最高。特异性（范围51 - 97%）以软骨下囊肿（97%）、软骨下骨髓水肿（95%）和关节积液（92%）最高。
关节内注射后的疼痛缓解与MRI诊断的关节囊肥厚显著相关。MRI表现在预测关节内注射后相关短期疼痛缓解方面具有合理的敏感性和较高的特异性。
