Department of Radiology, Technische Universität München, Munich, Germany.
Radiology. 2012 Aug;264(2):504-13. doi: 10.1148/radiol.12112007. Epub 2012 Jun 12.
To retrospectively determine the diagnostic accuracy of magnetic resonance (MR) arthrography of the shoulder in the evaluation of lesions of the biceps pulley and to evaluate previously described and new diagnostic signs.
Institutional review board approval was obtained; the requirement for informed consent was waived. MR arthrograms of 80 consecutive patients (mean age, 34.2 years; 53 male, 27 female) with arthroscopically proved intact or torn pulley systems were assessed for the presence of a pulley lesion by three radiologists who were blinded to arthroscopic results. Criteria evaluated were displacement of the long head of the biceps tendon (LHBT) relative to the subscapularis tendon on oblique sagittal images (displacement sign), medial subluxation of the LHBT on transverse images, nonvisibility or discontinuity of the superior glenohumeral ligament (SGHL), presence of biceps tendinopathy, and rotator cuff tears adjacent to the rotator interval.
There were 28 pulley lesions noted at arthroscopy. For observers 1, 2, and 3, respectively: MR arthrography showed a sensitivity of 89%, 86%, and 82% and a specificity of 96%, 98%, and 87% in the detection of pulley lesions. Nonvisibility or discontinuity of the SGHL was sensitive (79%, 89%, and 79%) and specific (83%, 79%, and 75%). With the displacement sign, sensitivity was 86%, 82%, and 75% and specificity was 96%, 98%, 90%. Tendinopathy of the LHBT on oblique sagittal images showed a sensitivity of 93%, 82%, 64%; specificity was 81%, 96%, and 85%. Subluxation of the LHBT was insensitive (36%, 50%, and 64%) but specific (100%, 98%, and 96%).
MR arthrography is accurate in the detection of pulley lesions; the displacement sign, nonvisibility or discontinuity of the SGHL, and tendinopathy of the LHBT on oblique sagittal images are the most accurate criteria for the detection of pulley lesions.
回顾性分析磁共振（MR）关节造影术在评估肱二头肌滑囊病变中的诊断准确性，并评估先前描述和新的诊断征象。
本研究获得机构审查委员会批准，豁免了知情同意书的要求。对 80 例连续接受关节镜检查证实肱二头肌滑囊系统完整或撕裂的患者的 MR 关节造影进行评估，3 名放射科医生在不知道关节镜检查结果的情况下评估滑囊病变的存在。评估的标准包括斜矢状图像上长头肱二头肌肌腱（LHBT）相对于肩胛下肌腱的移位（移位征象）、横断图像上 LHBT 的内侧半脱位、上盂肱韧带（SGHL）的不可见或不连续、肱二头肌肌腱病和肩袖撕裂相邻的旋转间隔。
关节镜下发现 28 例滑囊病变。观察者 1、2 和 3 分别为：MR 关节造影术检测滑囊病变的敏感性分别为 89%、86%和 82%，特异性分别为 96%、98%和 87%。SGHL 的不可见或不连续具有较高的敏感性（79%、89%和 79%）和特异性（83%、79%和 75%）。在存在移位征象时，敏感性分别为 86%、82%和 75%，特异性分别为 96%、98%和 90%。斜矢状图像上 LHBT 的肌腱病显示出 93%、82%、64%的敏感性，81%、96%和 85%的特异性。LHBT 的半脱位不敏感（36%、50%和 64%），但特异性高（100%、98%和 96%）。
MR 关节造影术在检测滑囊病变方面是准确的；移位征象、SGHL 的不可见或不连续以及斜矢状图像上 LHBT 的肌腱病是检测滑囊病变最准确的标准。
