Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA, USA.
J Shoulder Elbow Surg. 2018 Aug;27(8):1451-1455. doi: 10.1016/j.jse.2018.02.034. Epub 2018 Mar 21.
Computed tomography (CT) is the standard assessment of glenoid morphology before shoulder arthroplasty and is commonly used to evaluate rotator cuff pathology in patients with glenohumeral osteoarthritis (GHOA). Magnetic resonance imaging (MRI) is not routinely used in this setting but has higher sensitivity in diagnosing full-thickness rotator cuff tears (RCT) and is considered the gold standard. The purpose of this study was to determine the sensitivity and specificity of CT in diagnosing full-thickness RCTs and compare the evaluation of fatty infiltration and muscle atrophy on CT vs. MRI in the setting of GHOA.
In this retrospective case-controlled study, we identified 49 patients from a prospectively maintained 2-surgeon registry who received preoperative CT and MRI scans for the evaluation of GHOA between 2011 and 2016. Three fellowship-trained shoulder surgeons assessed rotator cuff integrity, fatty infiltration, and muscle atrophy in the CT and MRI scans.
CT sensitivity and specificity were 20% and 95.5%, respectively. Fatty infiltration was significantly lower on CT for the supraspinatus (P = .003), infraspinatus (P < .001), and subscapularis (P = .0182), whereas muscle atrophy was significantly lower on CT for only the supraspinatus (P = .0023).
Our results suggest that CT underestimates the frequency of full-thickness RCTs and the severity of fatty infiltration and muscle atrophy in the setting of GHOA before total shoulder arthroplasty.
在肩关节置换术前，计算机断层扫描（CT）是评估肩盂形态的标准方法，常用于评估肩峰下关节炎（GHOA）患者的肩袖病变。磁共振成像（MRI）在这种情况下不常规使用，但在诊断全层肩袖撕裂（RCT）方面具有更高的灵敏度，被认为是金标准。本研究旨在确定 CT 诊断全层 RCT 的灵敏度和特异性，并比较 GHOA 中 CT 与 MRI 评估脂肪浸润和肌肉萎缩的效果。
这是一项回顾性病例对照研究，我们从 2011 年至 2016 年期间，从一个由两位外科医生维护的前瞻性注册处中确定了 49 名接受术前 CT 和 MRI 扫描以评估 GHOA 的患者。三位接受过肩部专业培训的外科医生评估了 CT 和 MRI 扫描中的肩袖完整性、脂肪浸润和肌肉萎缩。
CT 的灵敏度和特异性分别为 20%和 95.5%。对于冈上肌（P = .003）、冈下肌（P < .001）和肩胛下肌（P = .0182），CT 上的脂肪浸润明显更低，而对于冈上肌（P = .0023），CT 上的肌肉萎缩明显更低。
我们的结果表明，在全肩关节置换术前 GHOA 中，CT 低估了全层 RCT 的频率以及脂肪浸润和肌肉萎缩的严重程度。
