Shahabpour M, Kichouh M, Laridon E, Gielen J L, De Mey J
Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.
Eur J Radiol. 2008 Feb;65(2):194-200. doi: 10.1016/j.ejrad.2007.11.012.
There are no clear guidelines for diagnostic imaging of articular and soft tissue pathologies of the shoulder and elbow. Several methods are used, including magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US). Their cost-effectiveness is still unclear. We performed a meta-analysis of the relevant literature and discussed the role of MR imaging of the shoulder and elbow compared with other diagnostic imaging modalities. For the shoulder impingement syndrome and rotator cuff tears, MRI and US have a comparable accuracy for detection of full-thickness rotator cuff tears. MRA and US might be more accurate for the detection of partial-thickness tears than MRI. Given the large difference in cost of MR and US, ultrasound may be the most cost-effective diagnostic method for identification of full-thickness tears in a specialist hospital setting (Evidence level 3). Both MRA and CT arthrography (CTA) are effective methods for the detection of labrum tears. More recently, multidetector CTA has offered the advantages of thinner slices than with MRA in a shorter examination time. Still, MRA has the advantage towards CTA to directly visualize the affected structures with a better evaluation of extent and location and to detect associated capsuloligamentous injuries. For the elbow pathologies, plain MRI or MRA have the advantage towards CTA to detect occult bone injuries. CTA is better for the assessment of the thin cartilage of the elbow. Both US and MRI are reliable methods to detect chronic epicondylitis; US is more available and far more cost-effective (Evidence level 2). MRA can differentiate complete from partial tears of the medial collateral ligament. US or MRI can detect partial and complete biceps tendon tears and/or bursitis. MRI can provide important diagnostic information in lesions of the ulnar, radial, or median nerve.
目前尚无针对肩部和肘部关节及软组织病变的诊断性影像学检查的明确指南。常用的检查方法有多种，包括磁共振成像（MRI）、磁共振关节造影（MRA）和超声（US）。它们的成本效益仍不明确。我们对相关文献进行了荟萃分析，并讨论了肩部和肘部磁共振成像与其他诊断性影像学检查方法相比的作用。对于肩部撞击综合征和肩袖撕裂，MRI和US在检测全层肩袖撕裂方面具有相当的准确性。MRA和US在检测部分厚度撕裂方面可能比MRI更准确。鉴于MR和US的成本差异巨大，在专科医院环境中，超声可能是识别全层撕裂最具成本效益的诊断方法（证据级别3）。MRA和CT关节造影（CTA）都是检测盂唇撕裂的有效方法。最近，多排CTA在更短的检查时间内提供了比MRA更薄的切片优势。尽管如此，MRA相对于CTA仍具有优势，能够直接可视化受影响的结构，更好地评估范围和位置，并检测相关的关节囊韧带损伤。对于肘部病变，普通MRI或MRA在检测隐匿性骨损伤方面比CTA更具优势。CTA在评估肘部薄软骨方面更好。US和MRI都是检测慢性肱骨外上髁炎的可靠方法；US更易于获得且成本效益更高（证据级别2）。MRA可以区分内侧副韧带的完全撕裂和部分撕裂。US或MRI可以检测肱二头肌肌腱的部分和完全撕裂及/或滑囊炎。MRI可以为尺神经、桡神经或正中神经的病变提供重要的诊断信息。
