Zhu Sizheng, Pu Darong, Li Jia, Wu Dandong, Huang Wei, Hu Ning, Chen Hong
Departments of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Arthroscopy. 2022 Feb;38(2):278-284. doi: 10.1016/j.arthro.2021.07.015. Epub 2021 Jul 24.
To evaluate the diagnostic reliability of ultrasonography (US) and magnetic resonance imaging (MRI) for subscapularis (SSC) tears with shoulder arthroscopy as the gold standard and to investigate the diagnostic value of 2 MRI signs (lesser tuberosity cysts and subcoracoid cysts) for SSC tears.
We consecutively enrolled 437 patients who were scheduled to undergo arthroscopic rotator cuff repair from January 2019 to December 2020. Patients with previous shoulder surgery or shoulder fracture, recurrent shoulder instability, and systemic inflammatory disease were excluded. Preoperative US and MRI of the shoulder were performed and interpreted with a standardized approach. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US and MRI were calculated using arthroscopic findings as the gold standard.
Of the 437 patients, 157 had SSC tears confirmed at the time of arthroscopy, 126 of whom had partial-thickness tears. US correctly diagnosed 122 of 157 patients with SSC tears, with an overall sensitivity of 77.7% (confidence interval [CI] 70.6%-83.5%), which was significantly greater than that of MRI (49.7%, CI 42.0%-57.4%, P < .001). For partial-thickness SSC tears, US correctly diagnosed 93 of 126 positive patients and 276 of 311 negative patients. This resulted in a sensitivity of 73.8% (CI 65.5%-80.7%), specificity of 88.7% (CI 84.8%-91.8%), and accuracy of 84.4% (CI 80.7%-87.5%). As with MRI, the sensitivity, specificity, and accuracy were 38.1% (CI 29.7%-47.2%), 86.5% (CI 82.3%-89.9%), and 72.5% (CI 68.2%-76.5%), respectively. Lesser tuberosity cysts and subcoracoid cysts were 2 MRI signs with high specificity (98.2% and 94.6%); however, their sensitivities were relatively low (19.8% and 33.8%).
US is a reliable and accurate diagnostic method for SSC tears, especially in easily missed partial-thickness tears. Lesser tuberosity cyst and subcoracoid cyst are highly specific but insensitive MRI signs for SSC tear.
Level I, diagnostic, testing of previously developed diagnostic criteria.
以肩关节镜检查为金标准，评估超声（US）和磁共振成像（MRI）诊断肩胛下肌（SSC）撕裂的可靠性，并探讨2种MRI征象（小结节囊肿和喙突下囊肿）对SSC撕裂的诊断价值。
我们连续纳入了2019年1月至2020年12月计划接受关节镜下肩袖修复术的437例患者。排除既往有肩部手术史或肩部骨折、复发性肩关节不稳及全身性炎症性疾病的患者。对肩部进行术前US和MRI检查，并采用标准化方法进行解读。以关节镜检查结果为金标准，计算US和MRI的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
437例患者中，157例在关节镜检查时确诊为SSC撕裂，其中126例为部分厚度撕裂。US正确诊断出157例SSC撕裂患者中的122例，总体敏感性为77.7%（置信区间[CI]70.6%-83.5%），显著高于MRI（49.7%，CI 42.0%-57.4%，P<.001）。对于部分厚度的SSC撕裂，US正确诊断出126例阳性患者中的93例和311例阴性患者中的276例。这导致敏感性为73.8%（CI 65.5%-80.7%），特异性为88.7%（CI 84.8%-91.8%），准确性为84.4%（CI 80.7%-87.5%）。与MRI一样，其敏感性、特异性和准确性分别为38.1%（CI 29.7%-47.2%）、86.5%（CI 82.3%-89.9%）和72.5%（CI 68.2%-76.5%）。小结节囊肿和喙突下囊肿是2种具有高特异性（分别为98.2%和94.6%）的MRI征象；然而，它们的敏感性相对较低（分别为19.8%和33.8%）。
US是诊断SSC撕裂的可靠且准确的方法，尤其是在容易漏诊的部分厚度撕裂中。小结节囊肿和喙突下囊肿是SSC撕裂的高特异性但不敏感的MRI征象。
I级，诊断性研究，对先前制定的诊断标准进行测试。
