磁共振关节造影评估青少年部分肩袖撕裂的诊断缺陷
Diagnostic shortcomings of magnetic resonance arthrography to evaluate partial rotator cuff tears in adolescents.
作者信息
Edmonds Eric W, Eisner Eric A, Kruk Peter G, Roocroft Joanna H, Dwek Jerry D
机构信息
Departments of *Orthopedic Surgery §Radiology, Rady Children's Hospital †Department of Orthopedic Surgery, University of California, San Diego, San Diego, CA ‡Department of Orthopedics, Joe DiMaggio Children's Hospital, Hollywood, FL.
出版信息
J Pediatr Orthop. 2015 Jun;35(4):407-11. doi: 10.1097/BPO.0000000000000283.
BACKGROUND
Recent evidence suggests an increase in the incidence of partial articular-sided rotator cuff tears in adolescent athletes, but the accuracy of diagnostic studies has not been previously assessed in this cohort. This study was performed to assess the ability of magnetic resonance imaging with arthrography (MRIa) to diagnose partial rotator cuff (PRC) pathology in the adolescent age group.
METHODS
All patients under the age of 19 years who underwent shoulder arthroscopy, between August 2008 and August 2010, were grouped based on the presence of a PRC tear diagnosed by either MRIa or arthroscopy. The control cohort included children without evidence of an intraoperative PRC. Surgical findings were then correlated with the preoperative MRIa findings and the accuracy of MRIa reading. Interclass coefficient was then determined for the MRIa reviewers.
RESULTS
Thirty-one of 89 adolescents (mean age, 15.9 y; 36% girls and 64% boys) who underwent arthroscopic shoulder surgery were found to have radiographic or arthroscopic evidence of a PRC injury. There were 17 boys and 14 girls in the PRC group, with a mean age of 15.6 years. The PRC injuries involved either the supraspinatus tendon, infraspinatus tendon, or both. MRIa was 44% sensitive and 87% specific, with a positive predictive value of 64% and a negative predictive value of 74% with arthroscopic findings used as the gold standard. The ICC between reviewers was κ=0.57, with an absolute agreement of 84%.
CONCLUSIONS
The overall diagnostic accuracy of the MRIa with regard to adolescent PRC injuries was 72%. MRIa was found to be specific, but not sensitive for the diagnosis of this pathology. The high false-negative rate seen in this adolescent cohort indicates that a PRC injury may be present even with a negative MRIa. Therefore, if clinical suspicion indicates a PRC injury, then the treating physician should consider management for rotator cuff pathology despite negative MRIa findings.
LEVEL OF EVIDENCE
Level III--retrospective cohort study.
背景
最近的证据表明青少年运动员中部分关节侧肩袖撕裂的发生率有所增加，但此前尚未对该队列中诊断性研究的准确性进行评估。本研究旨在评估磁共振关节造影（MRIa）诊断青少年组部分肩袖（PRC）病变的能力。
方法
2008年8月至2010年8月期间接受肩关节镜检查的所有19岁以下患者，根据MRIa或关节镜检查诊断的PRC撕裂情况进行分组。对照组包括术中未发现PRC证据的儿童。然后将手术结果与术前MRIa结果及MRIa阅片的准确性进行关联。随后确定MRIa阅片者之间的组内相关系数。
结果
89例接受肩关节镜手术的青少年（平均年龄15.9岁；女孩36%，男孩64%）中，有31例有PRC损伤的影像学或关节镜证据。PRC组有17名男孩和14名女孩，平均年龄15.6岁。PRC损伤累及冈上肌腱、冈下肌腱或两者。以关节镜检查结果为金标准，MRIa的敏感性为44%，特异性为87%，阳性预测值为64%，阴性预测值为74%。阅片者之间的组内相关系数κ=0.57，绝对一致性为84%。
结论
MRIa对青少年PRC损伤的总体诊断准确性为72%。发现MRIa具有特异性，但对该病变的诊断不敏感。在这个青少年队列中看到的高假阴性率表明，即使MRIa为阴性，也可能存在PRC损伤。因此，如果临床怀疑有PRC损伤，那么治疗医生即使MRIa结果为阴性，也应考虑对肩袖病变进行处理。
证据水平
III级——回顾性队列研究。
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