Esposito A, Souto S C L, Catalano O A, Doria A S, Trigo P B S, Resnick D
Department of Radiology, I.R.C.C.S. Maggiore Policlinico Hospital, Milan, Italy.
Skeletal Radiol. 2006 Nov;35(11):847-56. doi: 10.1007/s00256-006-0134-0. Epub 2006 May 25.
To develop a schematic segmentation of the proximal ulna in order to detect, assess the frequency, and characterize the bony outgrowths arising from the trochlea and from the radial notch of the ulna, to enable differentiation of osteophytes from enthesophytes.
Eighty well-preserved ulna specimens from the collection of the San Diego Museum of Man were analyzed by two musculoskeletal radiologists. The trochlea and the radial notch of the ulna simulate the shape of a clock quadrant. The proximal ulna was divided into 24 anatomic areas. The relationships of the joint capsule and insertions of tendons and ligaments onto these area were assessed by the two readers, and the resulting appearances of bony outgrowths were compared at visual inspection and on Radiographs.
The interobserver visual comparison was good in 17 areas out of 24, but poor correlation was found in 7 areas. In one case, difficulties in differentiating osteophytes originating from the brachialis muscle/ tendon (area 9) from an enthesophyte originating from the capsule insertion on the coronoid process (areas 2 or 3) occurredand between two different enthesophytes in a further case. Five cases had difficulties in defining differences in the grading system of the outgrowths. The percentage of outgrowths observed in each of the areas was globally high, especially in areas 9 and 10. On radiographs it was possible to observe irregularities in ten areas; in eight at a threshold of height of 2 mm (areas 1-4, 9, 10, 11, 14) and in two at a threshold of height of 3 mm (areas 5, 6). The two readers had the same difficulties in differentiating enthesophytes from osteophytes at radiographic and visual examination.
Our segmentation scheme is reproducible and objective, and permitted the differentiation of the bony outgrowths arising from the proximal ulna into osteophytes and enthesophytes, which may be particularly useful for the in vivo assessment of abnormalities seen in elbow overuse syndromes.
制定尺骨近端的示意图分割方法，以检测、评估尺骨滑车和桡切迹处骨赘的发生频率并对其特征进行描述，从而能够区分骨赘和附着点骨疣。
两名肌肉骨骼放射科医生对圣地亚哥人类博物馆收藏的80个保存完好的尺骨标本进行了分析。尺骨的滑车和桡切迹模拟钟面象限的形状。将尺骨近端分为24个解剖区域。两名阅片者评估关节囊以及肌腱和韧带在这些区域的附着情况，并在目视检查和X线片上比较骨赘的表现。
24个区域中有17个区域的观察者间视觉比较良好，但7个区域的相关性较差。在1例中，难以区分源自肱肌/肌腱的骨赘（区域9）和源自冠状突上关节囊附着处的附着点骨疣（区域2或3），在另1例中，难以区分两种不同的附着点骨疣。5例在确定骨赘分级系统的差异方面存在困难。在各个区域观察到的骨赘百分比总体较高，尤其是在区域9和10。在X线片上，可以在10个区域观察到不规则情况；8个区域在高度阈值为2 mm时（区域1 - 4、9、10、11、14），2个区域在高度阈值为3 mm时（区域5、6）。两名阅片者在X线片和目视检查中区分附着点骨疣和骨赘时遇到了相同的困难。
我们的分割方案具有可重复性和客观性，能够将尺骨近端出现的骨赘区分为骨赘和附着点骨疣，这对于体内评估肘部过度使用综合征中出现的异常情况可能特别有用。
