Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
J Ultrasound Med. 2011 Aug;30(8):1103-9. doi: 10.7863/jum.2011.30.8.1103.
To characterize the distribution of vascularity of the postoperative rotator cuff tendon using a maximum intensity projection technique after contrast-enhanced sonography.
We retrospectively evaluated image data on 23 patients (11 male and 12 female) with intact rotator cuff repairs who had previously undergone contrast-enhanced sonography of their shoulders using lipid microspheres before and after a standardized exercise protocol. The patients were on average 3 months out from their surgery. Using offline image analysis software, a maximum intensity projection image was obtained for each patient, reflecting the regional vascular distribution within the repair and adjacent soft tissue. Subjective analysis was performed in 4 regions of interest: peribursal, articular medial, articular lateral, and suture anchor, independently by 2 musculoskeletal radiologists using a semiquantitative scale ranging from 0 to 4 for each region (0, no enhancement; 1, 1%-25% enhancement; 2, 26%-50%; 3, 51%-75%; and 4, 76%-100%). A combined vascularity score (0-8) was produced for each region and formed the basis for the subjective analysis.
Using a Mann-Whitney nonparametric test, the data showed significantly higher regional enhancement in the peribursal and suture anchor regions compared to the tendon (P < .001). Exercise resulted in a statistically significant increase in the extent of enhancement in all regions (P < .002). Inter-rater reliability analysis using a weighted κ statistic showed strong agreement (0.63-0.64) for the suture anchor site and moderate agreement for the others (peribursal, 0.35-0.39; articular medial, 0.45-0.55; and articular lateral 0.32-0.33).
The maximum intensity projection technique after contrast-enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone-tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.
使用对比增强超声后的最大强度投影技术描绘术后肩袖肌腱的血管分布特征。
我们回顾性评估了 23 例肩袖完整修复患者的图像数据，这些患者在标准运动方案前后均使用脂质微球进行了肩部对比增强超声检查。这些患者平均在手术后 3 个月。使用离线图像分析软件，为每位患者获得最大强度投影图像，反映修复部位和相邻软组织的区域血管分布。2 位肌肉骨骼放射科医生分别在 4 个感兴趣区域（关节内内侧、关节内外侧、关节外和缝线锚定处）进行主观分析，使用 0 到 4 的半定量评分对每个区域进行评分（0，无增强；1，1%-25%增强；2，26%-50%；3，51%-75%；4，76%-100%）。为每个区域生成一个组合血管评分（0-8），作为主观分析的基础。
使用 Mann-Whitney 非参数检验，数据显示关节外和缝线锚定区域的局部增强明显高于肌腱（P<.001）。运动后，所有区域的增强程度均有统计学显著增加（P<.002）。使用加权κ统计的组内相关分析显示，缝线锚定部位的一致性较强（0.63-0.64），其他部位的一致性为中度（关节外，0.35-0.39；关节内内侧，0.45-0.55；关节内外侧，0.32-0.33）。
对比增强超声后的最大强度投影技术提供了肩袖血管分布的地形图；后者被认为是促进骨腱愈合的重要因素。肩袖修复后约 3 个月，缝线锚定部位和关节外部位显示出最强的血管生成能力。最大强度投影成像进一步证实，运动后修复部位的血管反应有整体增加。
