Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
BMC Musculoskelet Disord. 2019 Jun 1;20(1):270. doi: 10.1186/s12891-019-2654-5.
It is difficult to diagnose the pathology of the long head of the biceps tendon (LHBT) clinically. This study aimed to determine the diagnostic value of standard non-enhancing magnetic resonance imaging (MRI) for detecting LHBT pathology and identify the most useful diagnostic signs on MRI.
A total of 554 patients with preoperative 3-Tesla (3 T) MRI who underwent arthroscopic surgery for rotator cuff tears were retrospectively enrolled. Abnormal signs of LHBT on MRI included diameter change, contour irregularity, and alteration of signal intensity. Arthroscopic findings were classified according to tear progress and used as a reference standard: Type I, normal tendon; Type II, hourglass-shaped hypertrophic tendon with fraying extending into the bicipital groove; Type III, partial tear involving less than 50% of tendon width at the intraarticular region without fraying in the bicipital groove; Type IV, partial tear involving more than 50% of tendon width and extending into the bicipital groove; and Type V, complete tear (cutoff) of the tendon. Using receiver operating characteristic, prediction accuracies of MRI findings were assessed compared to those of arthroscopic findings.
Arthroscopic findings showed LHBT pathology in 124 (22.4%) cases. High diagnostic efficacy was achieved when 'at least 2 abnormal signs' was set as diagnostic criteria (sensitivity: 77.9%; specificity: 93.7%; positive predictive value: 76.3%). Types II and III lesions showed the highest sensitivities (36.8 and 66.7%, respectively) in abnormal alteration of signal intensity in the parasagittal view while Type IV showed the highest sensitivity (82.3%) in diameter change in axial view. Interobserver agreements were substantial to almost perfect, with kappa value of 0.69-0.81.
The standard non-enhancing 3 T MRI had a high diagnostic value in preoperative detection of LHBT pathology. Its accuracy was increased when diagnostic criterion was set as '2 or more abnormal signs (diameter change, contour irregularity, and alteration of signal intensity)'. The single diagnostic sign with the highest sensitivity was alteration of signal intensity in the parasagittal view.
临床上难以诊断长头肱二头肌肌腱（LHBT）的病理。本研究旨在确定标准非增强磁共振成像（MRI）对检测 LHBT 病变的诊断价值，并确定 MRI 上最有用的诊断征象。
回顾性纳入 554 例术前 3T MRI 行关节镜手术治疗肩袖撕裂患者。MRI 上 LHBT 异常征象包括直径改变、轮廓不规则和信号强度改变。关节镜检查结果根据撕裂进展进行分类，并作为参考标准：Ⅰ型，正常肌腱；Ⅱ型，沙漏形肥大肌腱，伴有在肱二头肌沟内延伸的磨损；Ⅲ型，部分撕裂，关节内区域小于 50%的肌腱宽度，肱二头肌沟内无磨损；Ⅳ型，部分撕裂，涉及超过 50%的肌腱宽度并延伸至肱二头肌沟；Ⅴ型，肌腱完全撕裂（切断）。使用受试者工作特征，评估 MRI 发现与关节镜发现的预测准确性。
关节镜检查发现 124 例（22.4%）LHBT 病变。当将“至少 2 个异常征象”设定为诊断标准时，诊断效能较高（敏感性：77.9%；特异性：93.7%；阳性预测值：76.3%）。在矢状位异常信号强度改变方面，Ⅱ型和Ⅲ型病变的敏感性最高（分别为 36.8%和 66.7%），而在轴位直径改变方面，Ⅳ型病变的敏感性最高（82.3%）。观察者间一致性为高度至几乎完美，kappa 值为 0.69-0.81。
标准非增强 3T MRI 在术前检测 LHBT 病变方面具有较高的诊断价值。当诊断标准设定为“2 个或更多异常征象（直径改变、轮廓不规则和信号强度改变）”时，准确性增加。具有最高敏感性的单一诊断征象是矢状位信号强度改变。
