Kim Mee Jeong, Sung Mi Sook, Jeong Chang Hoon, Park Hae-Il
Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ultrasonography. 2022 Jul;41(3):553-565. doi: 10.14366/usg.21232. Epub 2022 Feb 17.
The aim of this study was to analyze the imaging findings and clinical characteristics of extratendinous migration of calcific tendinitis of the shoulder with temporal changes.
Seventy-six patients with extratendinous calcific tendinitis of the shoulder diagnosed by ultrasonography (US) or magnetic resonance imaging (MRI) were enrolled in this retrospective study. Clinical symptoms and imaging findings (on radiography, US, and MRI) of extratendinous calcific tendinitis during an acute painful attack were analyzed. Temporal changes were analyzed in 28 patients before an acute attack and 40 patients after an acute attack. For comparison, 65 patients with intratendinous calcific tendinitis were included.
Patients with extratendinous calcific tendinitis had a significantly higher average visual analogue scale (VAS) score (8.8±1.6) than the intratendinous group (6.4±2.2) (P<0.001). The fragmented type (80.5%) was the most common shape on US; sonographic black hole appearance (14.6%) and echogenic fluid (9.8%) were characteristic findings of intrabursal calcifications. In 28 patients with previous radiographs, radiographic type III (78.6%) was dominant and the location of calcific deposits changed (82.1%) during the acute painful attack, which was also perceivable in 12 patients with previous US or MRI. In follow-up radiographs of 40 patients, calcifications shrunk by more than 50% or became invisible in 82.5% of patients, with symptom improvement (VAS score, 8.9±1.5 to 1.9±1.2). Follow-up US and MRI of 16 patients also showed decreased size (56.3%) or disappearance (43.7%) of calcific deposits.
Extratendinous calcific tendinitis has distinctive imaging features, the temporal changes of which correlate well with clinical symptoms.
本研究旨在分析肩峰下钙化性肌腱炎肌腱外移行的影像学表现及临床特征随时间的变化。
本回顾性研究纳入了76例经超声（US）或磁共振成像（MRI）诊断为肩峰下钙化性肌腱炎的患者。分析急性疼痛发作期肩峰下钙化性肌腱炎的临床症状及影像学表现（X线、US和MRI）。对28例急性发作前及40例急性发作后的患者进行了时间变化分析。作为对照，纳入了65例肌腱内钙化性肌腱炎患者。
肩峰下钙化性肌腱炎患者的平均视觉模拟评分（VAS）显著高于肌腱内钙化组（8.8±1.6 vs 6.4±2.2）（P<0.001）。碎块型（80.5%）是US上最常见的形态；超声黑洞征（14.6%）和强回声液性区（9.8%）是滑囊内钙化的特征性表现。在28例有既往X线片的患者中，X线Ⅲ型（78.6%）占主导，钙化沉积部位在急性疼痛发作期发生改变（82.1%），这在12例有既往US或MRI检查的患者中也可观察到。在40例患者的随访X线片中，82.5%的患者钙化缩小超过50%或消失，症状改善（VAS评分从8.9±1.5降至1.9±1.2）。16例患者的随访US和MRI也显示钙化沉积大小减小（56.3%）或消失（43.7%）。
肩峰下钙化性肌腱炎具有独特的影像学特征，其随时间的变化与临床症状密切相关。
