Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
Radiologisches Zentrum München, Pippinger Str. 25, 81245, Munich, Germany.
Skeletal Radiol. 2022 Sep;51(9):1807-1815. doi: 10.1007/s00256-022-03994-x. Epub 2022 Feb 28.
Correct identification of adhesive capsulitis of the shoulder (ACS) has an important impact on adequate therapy. The aim of our study was to investigate the influence of intravenous contrast administration and of reader's experience on sensitivity and specificity of MRI in diagnosing ACS.
A total of 180 patients were included in a retrospective study: 60 subjects with at least 4 of 5 clinical signs of adhesive capsulitis of the shoulder and 120 patients with other shoulder diseases who underwent contrast-enhanced MRI. In a first session, only non-enhanced images and in a second session also contrast-enhanced (CE) series were independently evaluated by three radiologists with various levels of professional experience. Readers were blinded to all clinical information and had to rate the shoulder MRIs for absence or presence of adhesive capsulitis. Data analysis included McNemar's test, t test, and U test (p < .05).
Using non-enhanced MRI, readers achieved a mean sensitivity of 63.9% and a mean specificity of 86.4%. By additional use of CE sequences, the mean sensitivity (85.5%) and the sensitivity for each reader increased significantly (p = .046, p < .01, p < .001, p = .045) while the improvement in mean specificity was not significant. Reader's experience had a positive effect on sensitivity and specificity, which was in part but not consistently significant.
The addition of CE sequences can significantly increase the sensitivity of MRI in the diagnosis of ACS. Reader's experience has shown to be another important factor for the diagnostic outcome.
正确识别肩关节粘连性囊炎（ACS）对充分治疗具有重要影响。我们的研究目的是调查静脉内对比剂给药和读者经验对 MRI 诊断 ACS 的敏感性和特异性的影响。
共纳入 180 例患者进行回顾性研究：60 例患者至少有 5 个肩关节粘连性囊炎的临床体征中的 4 个，120 例患者患有其他肩部疾病，均接受了对比增强 MRI 检查。在第一次评估中，仅评估未增强的图像，在第二次评估中，还评估了三位放射科医生具有不同专业经验的增强（CE）系列。读者对所有临床信息均不知情，并对肩部 MRI 评估有无粘连性囊炎。数据分析包括 McNemar 检验、t 检验和 U 检验（p<.05）。
使用未增强 MRI，读者的平均敏感性为 63.9%，特异性为 86.4%。通过额外使用 CE 序列，平均敏感性（85.5%）和每位读者的敏感性均显著增加（p=.046，p<.01，p<.001，p=.045），而平均特异性的改善则不显著。读者的经验对敏感性和特异性有积极影响，但部分影响并不一致。
CE 序列的添加可以显著提高 MRI 诊断 ACS 的敏感性。读者的经验也是诊断结果的另一个重要因素。
