Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan.
Am J Sports Med. 2012 Mar;40(3):624-30. doi: 10.1177/0363546511429258. Epub 2011 Dec 14.
Magnetic resonance imaging (MRI) has been widely used to characterize osteochondritis dissecans (OCD) lesions. However, the usefulness of MRI for predicting fragment stability in OCD of the humeral capitellum (capitellar OCD) remains unclear.
Preoperative MRI cannot accurately diagnose fragment instability of capitellar OCD in overhead athletes.
Cohort study (diagnosis); Level of evidence, 1.
Twenty-seven male overhead athletes who had undergone surgery for capitellar OCD were included in the study. A single senior musculoskeletal radiologist blindly reviewed preoperative MRI of these OCD lesions. The radiologist reported the presence or absence of each of the 4 MRI signs indicating fragment instability as described by De Smet et al. The lesions were also classified according to the MRI staging system of Dipaola et al for characterizing the lesions. Intraoperative assessment of fragment stability was used as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for fragment instability as assessed by MRI.
According to the MRI criteria by De Smet et al and the Dipaola et al staging system, 21 (78%) and 20 (74%) lesions were defined as unstable, respectively. The obtained results yielded a sensitivity of 89% and a specificity of 44% for diagnosing fragment instability using the De Smet et al MRI criteria and a sensitivity of 83% and a specificity of 44% using the Dipaola et al MRI staging system. The PPV and NPV for fragment instability were 76% and 67% using the De Smet et al criteria and 75% and 57% according to the Dipaola et al staging system, respectively. The overall correlation rate of Dipaola et al MRI and intraoperative stages was 41%.
Preoperative MRI cannot precisely diagnose fragment instability of capitellar OCD that requires operative treatments in overhead athletes. Especially, MRI indicating stable lesions is considered not to be useful in predicting intraoperative instability of capitellar OCD in this study population.
磁共振成像（MRI）已广泛用于骨软骨炎（OCD）病变的特征描述。然而，MRI 对于预测肱骨小头骨软骨炎（肱骨小头 OCD）中碎片稳定性的有用性尚不清楚。
术前 MRI 不能准确诊断 overhead 运动员中肱骨小头 OCD 碎片的不稳定性。
队列研究（诊断）；证据水平，1 级。
本研究纳入了 27 名因肱骨小头 OCD 而接受手术治疗的男性 overhead 运动员。一位资深的肌肉骨骼放射科医生对这些 OCD 病变的术前 MRI 进行了盲法评估。放射科医生报告了 De Smet 等人描述的 4 种 MRI 征象中每种征象的存在或缺失，这些征象提示碎片不稳定。病变还根据 Dipaola 等人的 MRI 分期系统进行分类，以描述病变。术中评估碎片稳定性作为金标准。确定了 MRI 评估的碎片不稳定性的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
根据 De Smet 等人的 MRI 标准和 Dipaola 等人的分期系统，21 个（78%）和 20 个（74%）病变分别被定义为不稳定。使用 De Smet 等人的 MRI 标准，获得的结果对诊断碎片不稳定性的敏感性为 89%，特异性为 44%，使用 Dipaola 等人的 MRI 分期系统的敏感性为 83%，特异性为 44%。使用 De Smet 等人的标准，碎片不稳定性的 PPV 和 NPV 分别为 76%和 67%，根据 Dipaola 等人的分期系统分别为 75%和 57%。Dipaola 等人的 MRI 与术中分期的总体相关率为 41%。
术前 MRI 不能准确诊断 overhead 运动员中需要手术治疗的肱骨小头 OCD 碎片的不稳定性。特别是，本研究人群中，MRI 显示稳定的病变被认为对预测术中肱骨小头 OCD 的不稳定性没有帮助。
