超声在肩胛下肌腱异常中的诊断准确性及操作者经验的重要性。
Diagnostic accuracy of ultrasound in subscapularis tendon abnormalities and the importance of operator experience.
机构信息
Department of Radiology, Eskişehir Osmangazi University, School of Medicine, Eskişehir, Turkey.
Clinic of Radiology, Denizli State Hospital, Denizli, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Jul;54(4):423-429. doi: 10.5152/j.aott.2020.20146.
OBJECTIVE
This study aimed to investigate the reasons behind the compliance, diagnostic success, and failure of ultrasound (US) examinations of two radiologists with reference to magnetic resonance imaging (MRI) in the abnormalities of subscapularis (SSC) tendon, including tendinosis.
METHODS
One less experienced radiologist (operator-1) and one senior radiologist, experienced in the musculoskeletal US (operator-2), performed the shoulder US on 78 patients (mean age: 53.18 ± 10.89 [22-73] years), who had undergone MRI for routine reasons except malignancy, within 1-4 weeks of MRI. Tendinopathy, partial (PT), or full-thickness (FT) tears were recorded in the subscapularis. The thickness of the anterior and lateral soft tissues in the shoulder girdle was measured by MRI. The inter-operator agreement on the US results, the US-MRI compliance for each operator, and the relationship between the US-MRI compliance and tissue thickness were investigated.
RESULTS
The inter-operator agreement on the US findings was moderate. The US-MRI compliance was fair for operator-1, but substantial for operator-2. The circumferential soft tissue thickness and US-MRI compliance were not correlated (p>0.05). The interobserver agreement in US was moderate (K: 0.415). The US-MRI compliance was fair for operator-1 (K: 0.344) and substantial for operator-2 (K: 0.616). The accuracy rates for the differentiation of normal tendon, tendinosis, PT, and FT were 59%, 75%, 72%, and 100%, respectively, for operator-1 and 87%, 83%, 85%, and 100%, respectively, for operator-2. However, the respective sensitivity of operator-1 was 46%, 19%, 44%, and 100%; and operator-2 was 91%, 67%, 82%, and 100%. The diagnostic performance of operator-1 was lower, except for FT.
CONCLUSION
The thickness of the surrounding tissue does not affect the US results. The differentiation between tendinosis and PT tear is difficult (more prominent in less experienced user); however, because this would not change the treatment choice, shoulder US is recommended after basic training in subscapularis pathologies.
LEVEL OF EVIDENCE
Level II, Diagnostic.
目的
本研究旨在探讨两位放射科医生在肩胛下肌腱（SSC）病变包括肌腱病的超声（US）检查中与磁共振成像（MRI）参考的符合率、诊断成功率和失败率的原因。
方法
一位经验较少的放射科医生（操作员 1）和一位经验丰富的肌肉骨骼超声医生（操作员 2）对 78 名因常规原因而非恶性肿瘤而接受 MRI 检查的患者（平均年龄：53.18±10.89[22-73]岁）进行了肩部 US 检查，这些患者在 MRI 检查后 1-4 周内进行。肩胛下肌腱记录为肌腱病、部分（PT）或全层（FT）撕裂。通过 MRI 测量肩带的前侧和外侧软组织厚度。研究了操作员之间 US 结果的一致性、每位操作员的 US-MRI 符合率以及 US-MRI 符合率与组织厚度之间的关系。
结果
US 检查结果的操作员间一致性为中度。操作员 1 的 US-MRI 符合率为尚可，操作员 2 的 US-MRI 符合率为良好。环形软组织厚度与 US-MRI 符合率无相关性（p>0.05）。US 检查的观察者间一致性为中度（K：0.415）。操作员 1 的 US-MRI 符合率为尚可（K：0.344），操作员 2 的 US-MRI 符合率为良好（K：0.616）。操作员 1 对正常肌腱、肌腱病、PT 和 FT 的区分准确率分别为 59%、75%、72%和 100%，操作员 2 分别为 87%、83%、85%和 100%。然而，操作员 1 的相应敏感性分别为 46%、19%、44%和 100%；操作员 2 为 91%、67%、82%和 100%。操作员 1 的诊断性能较低，除了 FT。
结论
周围组织的厚度不会影响 US 结果。肌腱病和 PT 撕裂的鉴别困难（在经验较少的使用者中更为突出）；然而，由于这不会改变治疗选择，建议在肩胛下肌腱病变的基础培训后进行肩部 US 检查。
证据水平
II 级，诊断。
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