超声检查在肩袖肌肉脂肪变性中的诊断性能和可靠性。
Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles.
机构信息
Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA.
出版信息
J Bone Joint Surg Am. 2012 Jun 20;94(12):e83. doi: 10.2106/JBJS.J.01899.
BACKGROUND
Diagnostic evaluation of rotator cuff muscle quality is important to determine indications for potential operative repair. Ultrasonography has developed into an accepted and useful tool for evaluating rotator cuff tendon tears; however, its use for evaluating rotator muscle quality has not been well established. The purpose of this study was to investigate the diagnostic performance and observer reliability of ultrasonography in grading fatty degeneration of the posterior and superior rotator cuff muscles.
METHODS
The supraspinatus, infraspinatus, and teres minor muscles were prospectively evaluated with magnetic resonance imaging (MRI) and ultrasonography in eighty patients with shoulder pain. The degree of fatty degeneration on MRI was graded by four independent raters on the basis of the modified Goutallier grading system. Ultrasonographic evaluation of fatty degeneration was performed by one of three radiologists with use of a three-point scale. The two scoring systems were compared to determine the diagnostic performance of ultrasonography. The interobserver and intraobserver reliability of MRI grading by the four raters were determined. The interobserver reliability of ultrasonography among the three radiologists was determined in a separate group of thirty study subjects. The weighted Cohen kappa, percentage agreement, sensitivity, and specificity were calculated.
RESULTS
The accuracy of ultrasonography for the detection of fatty degeneration, as assessed on the basis of the percentage agreement with MRI, was 92.5% for the supraspinatus and infraspinatus muscles and 87.5% for the teres minor. The sensitivity was 84.6% for the supraspinatus, 95.6% for the infraspinatus, and 87.5% for the teres minor. The specificity was 96.3% for the supraspinatus, 91.2% for the infraspinatus, and 87.5% for the teres minor. The agreement between MRI and ultrasonography was substantial for the supraspinatus and infraspinatus (kappa = 0.78 and 0.71, respectively) and moderate for the teres minor (kappa = 0.47). The interobserver reliability for MRI was substantial for the supraspinatus and infraspinatus (kappa = 0.76 and 0.77, respectively) and moderate for the teres minor (kappa = 0.59). For ultrasonography, the interobserver reliability was substantial for all three muscles (kappa = 0.71 for the supraspinatus, 0.65 for the infraspinatus, and 0.72 for the teres minor).
CONCLUSIONS
The diagnostic performance of ultrasonography in identifying and grading fatty degeneration of the rotator cuff muscles was comparable with that of MRI. Ultrasonography can be used as the primary diagnostic imaging modality for fatty changes in rotator cuff muscles.
背景
评估肩袖肌肉质量对于确定潜在手术修复的适应证非常重要。超声检查已成为评估肩袖肌腱撕裂的一种公认且有用的工具；然而，其在评估肩袖肌肉质量方面的应用尚未得到充分确立。本研究旨在探讨超声检查在后上肩袖肌肉脂肪变性分级中的诊断性能和观察者可靠性。
方法
前瞻性评估 80 例肩部疼痛患者的磁共振成像（MRI）和超声检查。四名独立的观察者根据改良的 Goutallier 分级系统对 MRI 上的脂肪变性程度进行分级。三名放射科医生使用三分制对超声检查的脂肪变性进行评估。比较两种评分系统以确定超声检查的诊断性能。通过四名观察者确定 MRI 分级的观察者间可靠性。在另一组 30 名研究对象中确定三位放射科医生之间的超声检查观察者间可靠性。计算加权 Cohen kappa、百分比一致性、敏感性和特异性。
结果
基于与 MRI 的百分比一致性，超声检查对肩袖肌肉脂肪变性的检测准确性分别为：肩胛下肌和冈下肌为 92.5%，小圆肌为 87.5%。肩胛下肌的敏感性为 84.6%，冈下肌为 95.6%，小圆肌为 87.5%。肩胛下肌的特异性为 96.3%，冈下肌为 91.2%，小圆肌为 87.5%。肩胛下肌和冈下肌的 MRI 和超声检查之间的一致性较高（kappa = 0.78 和 0.71），小圆肌的一致性中等（kappa = 0.47）。MRI 的观察者间可靠性为肩胛下肌和冈下肌高（kappa = 0.76 和 0.77），小圆肌中等（kappa = 0.59）。对于超声检查，所有三个肌肉的观察者间可靠性均较高（肩胛下肌 kappa = 0.71，冈下肌 kappa = 0.65，小圆肌 kappa = 0.72）。
结论
超声检查在识别和分级肩袖肌肉脂肪变性方面的诊断性能与 MRI 相当。超声检查可作为评估肩袖肌肉脂肪变化的主要诊断影像学方法。
Zotero 插件