1 Department of Radiology, New York-Presbyterian Hospital-Columbia University Medical Center, 622 W 168th St, MC-28, New York, NY 10032.
2 Present address: NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
AJR Am J Roentgenol. 2019 Apr;212(4):867-873. doi: 10.2214/AJR.18.20474. Epub 2019 Jan 30.
The purpose of this study was to determine whether ulnar collateral ligament (UCL) insertion below the articular margin (so-called T sign) exists in the pediatric population and whether MRI features can be used to identify insertional UCL injuries in overhead athletes that are symptomatic or require surgery.
Retrospective review of elbow MR images of patients younger than 21 years from 2011 to 2017 yielded 26 control subjects who were not overhead athletes and 97 overhead athletes. According to the clinical diagnosis, 50 of the overhead athletes had symptoms. Two radiologists evaluated the UCL for thickness, abnormal insertional signal intensity, insertion distance, and adjacent marrow or soft-tissue edema. Insertion distance was defined as the coronal length of any T sign measured from the articular margin.
Mean insertion distance was greater in overhead athletes than in control subjects (1.42 vs 0.23 mm, p = 0.001) but not significantly different in athletes with symptoms compared with those without symptoms or in those who underwent operative treatment compared with those who did not. Mean UCL thickness was greater in overhead athletes than in control subjects (2.64 vs 1.74 mm, p < 0.0001), athletes with than those without symptoms (2.84 vs 2.41 mm, p = 0.005), and athletes who did versus those who did not undergo operative treatment (3.40 vs 2.73 mm, p = 0.011). Marrow (p = 0.002) and soft-tissue (p = 0.016) edema were found more frequently in athletes with symptoms. ROC analysis of UCL thickness and insertion distance as predictors of symptoms showed AUCs of 0.69 and 0.49, respectively.
The T sign is likely not an anatomic variation but is a poor predictor of symptoms and need for surgery. Soft-tissue and marrow edema are more frequently seen in overhead athletes with symptomatic injuries and can aid in the diagnosis of clinically relevant injury.
本研究旨在确定尺侧副韧带（UCL）在关节缘下方的插入（即所谓的 T 征）是否存在于儿科人群中，以及 MRI 特征是否可用于识别有症状或需要手术的过头运动员的 UCL 插入损伤。
对 2011 年至 2017 年期间年龄小于 21 岁的患者肘部 MRI 图像进行回顾性分析，共纳入 26 名非过头运动员对照者和 97 名过头运动员。根据临床诊断，50 名过头运动员有症状。两名放射科医生评估 UCL 的厚度、异常插入信号强度、插入距离以及相邻骨髓或软组织水肿。插入距离定义为从关节缘测量的任何 T 征的冠状长度。
与对照组相比，过头运动员的平均插入距离更大（1.42 对 0.23mm，p = 0.001），但有症状的运动员与无症状的运动员之间、接受手术治疗的运动员与未接受手术治疗的运动员之间差异无统计学意义。与对照组相比，过头运动员的 UCL 平均厚度更大（2.64 对 1.74mm，p<0.0001），有症状的运动员比无症状的运动员更大（2.84 对 2.41mm，p = 0.005），接受手术治疗的运动员比未接受手术治疗的运动员更大（3.40 对 2.73mm，p = 0.011）。有症状的运动员更常出现骨髓（p = 0.002）和软组织（p = 0.016）水肿。UCL 厚度和插入距离作为症状预测因子的 ROC 分析显示 AUC 分别为 0.69 和 0.49。
T 征可能不是解剖变异，而是症状和手术需求的不良预测因子。有症状损伤的过头运动员中更常出现软组织和骨髓水肿，有助于临床相关损伤的诊断。
