Matsushita Ryosuke, Yokoya Shin, Negi Hiroshi, Matsubara Norimasa, Akiyama Yuji, Adachi Nobuo
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Clinical Radiology, Hiroshima University Hospital, Hiroshima, Japan.
JSES Int. 2021 Sep 28;6(1):97-103. doi: 10.1016/j.jseint.2021.08.005. eCollection 2022 Jan.
Magnetic resonance imaging (MRI) is widely used to diagnose subscapularis tendon tears; however, it is difficult to assess the anterosuperior aspect of these tears. Radial-sequence MRI can reveal the fiber components of the anterosuperior aspect, from perpendicular, by overcoming the partial volume effect. We aimed to classify the insertion of subscapularis tendon tears on radial-sequence MRI and determine the effectiveness of radial-sequence MRI for subscapularis tendon tear assessments.
We retrospectively investigated 196 patients (mean age, 66.7 ± 9.0 years; 118 men, 78 women) who underwent 1.5 T MRI before arthroscopic rotator cuff repair. Radial-sequence MRI findings of the anterosuperior aspect insertion of the subscapularis tendon were classified into five grades, and intraoperative findings compared with preoperative conventional MRI and radial-sequence MRI. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values. Interobserver and intraobserver reliability for radial-sequence MRI classification was calculated using kappa (κ).
Conventional MRI sensitivity of subscapularis tendon tears was 45.3%; specificity, 95.8%; accuracy, 82.1%; positive predictive value, 80.0%; and negative predictive value, 82.5%. Radial-sequence MRI sensitivity was 92.5%; specificity, 88.1%; accuracy, 89.3%; positive predictive value, 74.2%; and negative predictive value, 96.9%. Sensitivity ( < .001), accuracy ( = .04), specificity ( = .02), and negative predictive values ( < .001) in radial-sequence MRI were significantly higher than those in conventional MRI. Intraobserver and interobserver reliabilities for radial-sequence MRI classification were κ = 0.78 and 0.65, respectively, corresponding to high reproducibility, and defined as good.
We provide evidence that radial-sequence MRI is an effective tool to evaluate subscapularis tendon tears, especially before surgery.
磁共振成像（MRI）被广泛用于诊断肩胛下肌腱撕裂；然而，评估这些撕裂的前上方部分存在困难。通过克服部分容积效应，径向序列MRI能够从垂直方向显示前上方部分的纤维成分。我们旨在对径向序列MRI上肩胛下肌腱撕裂的附着点进行分类，并确定径向序列MRI在评估肩胛下肌腱撕裂方面的有效性。
我们回顾性研究了196例患者（平均年龄66.7±9.0岁；男性118例，女性78例），这些患者在关节镜下肩袖修复术前接受了1.5T MRI检查。将肩胛下肌腱前上方附着点的径向序列MRI表现分为五个等级，并将术中发现与术前传统MRI和径向序列MRI进行比较。我们计算了敏感性、特异性、准确性以及阳性和阴性预测值。使用kappa（κ）计算径向序列MRI分类的观察者间和观察者内可靠性。
肩胛下肌腱撕裂的传统MRI敏感性为45.3%；特异性为95.8%；准确性为82.1%；阳性预测值为80.0%；阴性预测值为82.5%。径向序列MRI敏感性为92.5%；特异性为88.1%；准确性为89.3%；阳性预测值为74.2%；阴性预测值为96.9%。径向序列MRI的敏感性（<0.001）、准确性（=0.04）、特异性（=0.02）和阴性预测值（<0.001）显著高于传统MRI。径向序列MRI分类的观察者内和观察者间可靠性分别为κ=0.78和0.65，对应高重现性，定义为良好。
我们提供的证据表明，径向序列MRI是评估肩胛下肌腱撕裂的有效工具，尤其是在手术前。
