Department of Radiology, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
Radiologic Associates of Fredericksburg, Main Street Radiology, 10401 Spotsylvania Ave., Suite 200, Fredericksburg, VA, 22408, USA.
Skeletal Radiol. 2021 Sep;50(9):1873-1880. doi: 10.1007/s00256-021-03759-y. Epub 2021 Mar 17.
To study the diagnostic utility of the "smoke sign" to detect unsuspected acute pectoralis major tendon injury on routine shoulder MRI.
Retrospective study of 52 shoulder MRI in patients with (38) and without (14) acute pectoralis major injury confirmed on imaging. Two readers independently reviewed shoulder MRI for the presence of the "smoke sign"-feathery soft tissue edema lateral or anterior to short head biceps/coracobrachialis on fluid-sensitive coronal-oblique and sagittal-oblique images, respectively.
The smoke sign was present on shoulder MRI in 24/24 (100%) humeral avulsions, 4/4 (100%) tendon tears, 4/8 (50%) of myotendinous junction injuries, and 0/2 (0%) intramuscular injuries. The smoke sign was present in 0/14 examinations without acute pectoralis major injury.
While dedicated pectoralis MRI remains the preferred method for imaging pectoralis injury, the "smoke sign" can serve as an easy to recognize finding on routine shoulder MRI that can raise the suspicion of an acute pectoralis major tendon injury. Its detection should prompt evaluation of the pectoralis major tendon and recommendation for dedicated imaging to confirm and evaluate the full extent of injury.
研究“烟雾征”在常规肩部 MRI 中检测隐匿性急性胸大肌肌腱损伤的诊断效用。
对 52 例肩部 MRI 进行回顾性研究，其中（38 例）和（14 例）患者有和无影像学证实的急性胸大肌损伤。两名读者分别独立评估肩 MRI 上是否存在“烟雾征”——短头肱二头肌/喙肱肌外侧或前的羽毛状软组织水肿，分别在液体敏感冠状斜位和矢状斜位图像上。
烟雾征在 24/24 例（100%）肱骨头撕脱伤、4/4 例（100%）肌腱撕裂、4/8 例（50%）肌肌腱交界处损伤和 0/2 例（0%）肌内损伤的肩部 MRI 上存在。在 14 例无急性胸大肌损伤的检查中，烟雾征均不存在。
虽然专门的胸大肌 MRI 仍然是成像胸大肌损伤的首选方法，但“烟雾征”可以作为常规肩部 MRI 上易于识别的发现，提示存在急性胸大肌肌腱损伤。其检测应提示评估胸大肌肌腱，并建议进行专门成像以确认和评估损伤的全部范围。
