MD. Attending Orthopedic Surgeon, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
MD, PhD. Attending Musculoskeletal Radiologist, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; Attending Musculoskeletal Radiologist, Imaging Department, Musculoskeletal Radiology Division, Hospital Israelita Albert Einstein (HIAE), São Paulo, Brazil.
Sao Paulo Med J. 2020 Jul-Aug;138(4):310-316. doi: 10.1590/1516-3180.2020.014605062020.
The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies.
To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears.
Diagnostic test study performed in a tertiary care hospital.
We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated.
MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%.
The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.
磁共振成像（MRI）在诊断肩胛下肌撕裂中的准确性在文献中差异很大，且前瞻性研究较少。
比较 MRI 和关节镜检查诊断肩胛下肌撕裂的结果。
在一家三级保健医院进行的诊断性试验研究。
我们纳入了接受关节镜肩袖修复且首先进行无对比高磁场 MRI 的患者。由一名肩部外科医生和两名肌肉骨骼放射科医生独立评估图像。计算了敏感性、特异性、阳性和阴性预测值、准确性以及观察者间和观察者内的一致性。
评估了 200 个肩膀的 MRI。肩胛下肌撕裂的发生率为 69.5%（部分撕裂 41.5%，全层撕裂 28.0%）。检测肩胛下肌撕裂的观察者间和观察者内的一致性为中度。肩部外科医生的敏感性为 51.1%至 59.0%，特异性为 91.7%至 94.4%。放射科医生的敏感性为 83.5%至 87.1%，特异性为 41%至 45.9%。准确性范围为 60.5%至 73.0%。
无对比 1.5-T MRI 对肩胛下肌撕裂的平均敏感性为 70.2%，平均特异性为 61.9%。放射科医生的敏感性更高，而肩部外科医生的特异性更高。平均准确性为 67.6%，低于整个肩袖撕裂的准确性。
