Won Kyoung Sook, Kim Du Hwan, Sung Duk Hyun, Song Bong-Il, Kim Hae Won, Song Kwang-Soon, Lee Si-Wook, Cho Chul-Hyun
Department of Nuclear Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea.
Department of Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, 56 Dalseong-ro, Jung-gu, Daegu, 700-712, South Korea.
Ann Nucl Med. 2017 Apr;31(3):211-217. doi: 10.1007/s12149-016-1147-y. Epub 2017 Feb 6.
Because positron emission tomography/computed tomography (PET/CT) using fluorine-18-fluorodeoxyglucose (F-FDG) can be used to visualize inflammation of the musculoskeletal system, it may help elucidate the pathophysiology of frozen shoulder (FS). The purpose of this study was to characterize the uptake pattern on F-FDG PET/CT in patients with idiopathic FS and to determine if there is a correlation between its metabolic parameters and clinical findings.
F-FDG PET/CT was conducted to 35 patients with unilateral idiopathic FS. Clinical data including pain, functional scores, and passive range of motion (ROM) were collected. Maximum standardized uptake values (SUVmax) were measured at the four regions of interest (ROIs): rotator interval (RI), anterior joint capsule (AJC), axillary recess (AR), and posterior joint capsule (PJC) from the attenuation-corrected axial images.
Mean SUVmax values for four ROIs of the affected shoulder were significantly higher than those of the unaffected shoulder. Mean SUVmax values of RI and AR were significantly higher than those of AJC and PJC and mean SUVmax of AJC was significantly higher than that of PJC in the affected side. Three recognizable patterns of increased uptake were noted: (1) AR dominant type (15 patients); (2) RI dominant type (9 patients); (3) both RI and AR dominant type (11 patients). The SUVmax of AR showed negative correlation with abduction and forward flexion. The SUVmax of RI showed negative correlation with external rotation and internal rotation. The SUVmax of AJC showed negative correlation with all ROMs. However, there was no significant correlation between the SUVmax of PJC and any ROM.
Our study demonstrates that the anterior-inferior capsular portion, including RI and AR, is the main pathologic site of idiopathic FS and reveals significant correlations between ROM and metabolic parameters on F-FDG PET/CT. These results imply that AR and RI lesions are related to elevational limitations and rotational limitations, respectively.
由于使用氟 - 18 - 氟脱氧葡萄糖（F - FDG）的正电子发射断层扫描/计算机断层扫描（PET/CT）可用于显示肌肉骨骼系统的炎症，它可能有助于阐明肩周炎（FS）的病理生理学。本研究的目的是描述特发性FS患者F - FDG PET/CT上的摄取模式，并确定其代谢参数与临床发现之间是否存在相关性。
对35例单侧特发性FS患者进行F - FDG PET/CT检查。收集包括疼痛、功能评分和被动活动范围（ROM）在内的临床数据。从衰减校正后的轴向图像中，在四个感兴趣区域（ROI）测量最大标准化摄取值（SUVmax）：回旋间隙（RI）、前关节囊（AJC）、腋窝隐窝（AR）和后关节囊（PJC）。
患侧肩部四个ROI的平均SUVmax值显著高于未患侧肩部。患侧RI和AR的平均SUVmax值显著高于AJC和PJC，且AJC的平均SUVmax值显著高于PJC。观察到三种可识别的摄取增加模式：（1）AR主导型（15例患者）；（2）RI主导型（9例患者）；（3）RI和AR均主导型（11例患者）。AR的SUVmax与外展和前屈呈负相关。RI的SUVmax与外旋和内旋呈负相关。AJC的SUVmax与所有ROM均呈负相关。然而，PJC的SUVmax与任何ROM之间均无显著相关性。
我们的研究表明，包括RI和AR在内的前下关节囊部分是特发性FS的主要病理部位，并揭示了ROM与F - FDG PET/CT上的代谢参数之间存在显著相关性。这些结果意味着AR和RI病变分别与抬高受限和旋转受限有关。
