Adler Ronald S, Fealy Stephen, Rudzki Jonas R, Kadrmas Warren, Verma Nikhil N, Pearle Andrew, Lyman Stephen, Warren Russell F
Weill Medical College of Cornell University, New York, NY, USA.
Radiology. 2008 Sep;248(3):954-61. doi: 10.1148/radiol.2483071400. Epub 2008 Jul 22.
To test the hypothesis that regional variations in supraspinatus tendon vascularity exist and can be imaged and quantified in asymptomatic individuals by using contrast material-enhanced ultrasonography (US).
After institutional review board approval and informed consent were obtained, 31 volunteers aged 22-65 years (mean age, 41.5 years) underwent lipid microsphere contrast-enhanced shoulder US performed with an L8-4 transducer operating in contrast harmonic mode and a mechanical index of 0.07 in a HIPAA-compliant protocol. Images were obtained in the volunteers at rest and after exercise. Quantitative analysis was performed by using the time-enhancement postcontrast data derived from four regions of interest (ROIs): bursal medial, articular medial, bursal lateral, and articular lateral. Two 2-minute acquisitions were performed after each contrast material bolus. Baseline enhancement and peak enhancement for each ROI were estimated from these acquisitions. Baseline gray-scale and power Doppler US images of the supraspinatus tendon were obtained by using an L12-5 transducer. The Mann-Whitney nonparametric test was used to test for significant differences between ROIs in all volunteers.
In the volunteers at rest before exercise, significant variations in regional enhancement between the articular medial zone and both the bursal medial zone (P = .002) and the bursal lateral zone (P = .003) were observed. Differences in enhancement between the articular medial and articular lateral zones approached significance. Greater differentiation (P < .001) was observed after exercise, with a significant increase in apparent enhancement in each ROI in all volunteers.
This study revealed the spatial distribution of the blood supply to the supraspinatus tendon in asymptomatic individuals. The addition of exercise to the protocol resulted in a significantly increased level of enhancement compared with that at rest and enabled more sensitive assessment of intratendinous and peritendinous vascularity.
http://radiology.rsnajnls.org/cgi/content/full/2483071400/DC1.
验证如下假设，即存在冈上肌腱血管分布的区域差异，且可通过使用造影剂增强超声检查（US）对无症状个体进行成像及量化分析。
经机构审查委员会批准并获得知情同意后，31名年龄在22 - 65岁（平均年龄41.5岁）的志愿者按照符合健康保险流通与责任法案（HIPAA）的方案，使用L8 - 4探头以造影谐波模式及0.07的机械指数进行脂质微球造影增强肩部超声检查。在志愿者休息时及运动后获取图像。通过使用来自四个感兴趣区域（ROI）（滑囊内侧、关节内侧、滑囊外侧和关节外侧）的造影后时间增强数据进行定量分析。每次注射造影剂后进行两次2分钟的采集。从这些采集中估计每个ROI的基线增强和峰值增强。使用L12 - 5探头获取冈上肌腱的基线灰阶和功率多普勒超声图像。采用Mann - Whitney非参数检验来检测所有志愿者中各ROI之间的显著差异。
在运动前休息状态的志愿者中，观察到关节内侧区域与滑囊内侧区域（P = 0.002）及滑囊外侧区域（P = 0.003）之间的区域增强存在显著差异。关节内侧和关节外侧区域之间的增强差异接近显著水平。运动后观察到更大的差异（P < 0.001），所有志愿者每个ROI的表观增强均显著增加。
本研究揭示了无症状个体冈上肌腱血供的空间分布。与休息时相比，在检查方案中增加运动导致增强水平显著提高，并能够更敏感地评估肌腱内和肌腱周围的血管情况。
http://radiology.rsnajnls.org/cgi/content/full/2483071400/DC1
