Service d'imagerie Guilloz, hôpital central, centre hospitalier universitaire de Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
Service d'imagerie Guilloz, hôpital central, centre hospitalier universitaire de Nancy, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
Diagn Interv Imaging. 2019 Jul-Aug;100(7-8):437-444. doi: 10.1016/j.diii.2019.02.005. Epub 2019 Mar 8.
The purpose of this study was to determine the performance of CT arthrography for the diagnosis of intra-articular long head of biceps (LHB) tendon intrinsic lesions using arthroscopy findings as standard of reference.
CT arthrography studies of 98 patients (55 men, 43 women; mean age 54.8±12.7 [SD] years [range: 16-77 years]) were retrospectively evaluated by two radiologists independently. Per operative arthroscopic images and surgical reports were retrospectively reviewed by a shoulder-specialist surgeon. Based on the analysis of arthroscopic images and the surgical reports, the LHB tendon was classified as normal (continuous with uniform tendon thickness), tendinopathy/partial rupture (focal change in tendon thickness and contour irregularities) and total rupture (total loss in tendon continuity). Imaging results were compared to those of surgery that served as standard of reference. Interobserver agreement was assessed.
At arthroscopy, the LHB tendon was classified as normal in 38/98 (38.8%) patients, tendinopathic in 51/52 (52%) and totally ruptured in 9/98 (9.2%). The sensitivity and specificity of CT arthrography for the diagnosis of LHB tendinopathy were respectively 74% (95%CI: 60%-85%) and 93% (95%CI: 80%-99%) for reader 1 and 79% (95% CI: 67%-89%) and 95% (95% CI: 83%-99%) for reader 2. The sensitivity and specificity for the diagnosis of LHB tendon total ruptures were 100% (95%CI: 66%-100%) and 93% (95%CI: 86%-98%) for both readers. Interobserver agreements for the identification of the LHB tendon tendinopathy and total ruptures were excellent (kappa values of 0.94 and 0.96, respectively).
CT arthrography demonstrates good sensitivity and excellent specificity for the detection of intra-articular LHB tendinopathy and tear.
本研究旨在通过关节镜检查结果作为标准，评估 CT 关节造影术在诊断肩关节腔内长头腱（LHB）肌腱内在病变中的性能。
对 98 例患者（55 名男性，43 名女性；平均年龄 54.8±12.7[SD]岁[范围：16-77 岁]）的 CT 关节造影研究进行回顾性评估，由两位放射科医生独立进行。回顾性分析肩关节专科医生的手术关节镜图像和手术报告。根据关节镜图像和手术报告的分析，将 LHB 肌腱分为正常（连续且均匀的肌腱厚度）、腱病/部分撕裂（肌腱厚度和轮廓不规则的局灶性改变）和完全撕裂（肌腱连续性完全丧失）。将影像学结果与作为参考标准的手术结果进行比较。评估了观察者间的一致性。
关节镜检查时，LHB 肌腱在 38/98（38.8%）例患者中被归类为正常，51/52（52%）例患者为腱病，9/98（9.2%）例患者为完全撕裂。对于 LHB 腱病的诊断，CT 关节造影的敏感度和特异度分别为读者 1 的 74%（95%CI：60%-85%）和 93%（95%CI：80%-99%），以及读者 2 的 79%（95%CI：67%-89%）和 95%（95%CI：83%-99%）。对于 LHB 肌腱完全撕裂的诊断，敏感度和特异度分别为两位读者的 100%（95%CI：66%-100%）和 93%（95%CI：86%-98%）。观察者间对于 LHB 肌腱腱病和完全撕裂的识别具有极好的一致性（kappa 值分别为 0.94 和 0.96）。
CT 关节造影术在检测肩关节腔内 LHB 腱病和撕裂方面具有良好的敏感度和极好的特异性。
