Jeong Seonji, Choi Ja-Young, Kang Yu Suhn, Yoo Hye Jin, Kim Sae Hoon, Hong Sung Hwan, Kang Heung Sik
1 Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
2 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Acta Radiol. 2018 Sep;59(9):1102-1109. doi: 10.1177/0284185117744589. Epub 2017 Nov 28.
Background Deep, high-grade bursal-sided supraspinatus tendon tears are sometimes preoperatively misinterpreted as full-thickness tears on shoulder magnetic resonance imaging (MRI). Purpose To determine the usefulness of disproportionate fluid sign for differentiating high-grade bursal-sided partial-thickness tears from full-thickness tears on conventional MRI. Material and Methods Preoperative MRIs of 198 patients with arthroscopically confirmed high-grade bursal-sided partial-thickness tears and full-thickness tears were independently reviewed by two readers on two occasions. The presence of high-grade bursal-sided partial-thickness tears with a confidence level using a five-point grading scale was assessed based on tear depth alone and also in combination with disproportionate fluid sign, defined as a prominent subdeltoid or subacromial-subdeltoid bursal fluid distension with a relative paucity of effusion in the glenohumeral joint. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated, as well as inter-observer reliability. Results The disproportionate fluid sign was identified in 60/74 (81.2%) bursal-sided partial-thickness tears and 9/124 (7.5%) full-thickness tears. The sensitivity and accuracy of the diagnosis of bursal-sided tear were higher when disproportionate fluid sign was used in conjunction with the tear depth, compared with tear depth alone ( P < 0.001). There was excellent inter-observer agreement for disproportionate fluid sign and deep bursal-sided tear. The AUCs were significantly higher in combination with disproportionate fluid sign. Conclusion The disproportionate fluid sign indicates the presence of a deep, high-grade bursal-sided partial-thickness tear, which can be misinterpreted as a full-thickness tear. Thus, it can provide greater diagnostic assistance to less-experienced radiologists and clinicians.
背景 深部、高级别滑囊侧冈上肌腱撕裂在肩关节磁共振成像（MRI）上有时术前会被误诊为全层撕裂。目的 确定不成比例的液体征在传统MRI上鉴别高级别滑囊侧部分厚度撕裂与全层撕裂的有用性。材料与方法 198例经关节镜证实为高级别滑囊侧部分厚度撕裂和全层撕裂患者的术前MRI由两位阅片者分两次独立进行评估。仅根据撕裂深度以及结合不成比例的液体征（定义为三角肌下或肩峰下-三角肌下滑囊明显积液，而肩关节内积液相对较少），使用五点分级量表评估高级别滑囊侧部分厚度撕裂的存在及其置信度。计算敏感性、特异性、准确性和受试者操作特征曲线下面积（AUC），以及观察者间可靠性。结果 在74例滑囊侧部分厚度撕裂中有60例（81.2%）发现不成比例的液体征，在124例全层撕裂中有9例（7.5%）发现该征象。与仅使用撕裂深度相比，将不成比例的液体征与撕裂深度结合使用时，滑囊侧撕裂诊断的敏感性和准确性更高（P < 0.001）。对于不成比例的液体征和深部滑囊侧撕裂，观察者间一致性良好。结合不成比例的液体征时AUC显著更高。结论 不成比例的液体征提示存在深部、高级别滑囊侧部分厚度撕裂，这种撕裂可能被误诊为全层撕裂。因此，它可为经验较少的放射科医生和临床医生提供更大的诊断帮助。
