Hasegawa Shoichi, Yoshimura Hideya, Mochizuki Tomoyuki, Arai Ryuzo, Akita Keiichi, Nimura Akimoto
Department of Orthopaedic Surgery, Kawaguchi Kogyo General Hospital, 1-18-15 Aoki, Kawaguchi-shi, Saitama, 332-0031, Japan.
Department of Orthopaedic Surgery, Tokyo-Kita Medical Centre, 4-17-56 Akabanedai, Kita-ku, Tokyo, 115-0053, Japan.
Surg Radiol Anat. 2023 Jan;45(1):17-24. doi: 10.1007/s00276-022-03059-7. Epub 2022 Dec 12.
This study aimed to test the hypothesis that identifying the exact location of the most superior portion of the subscapularis tendon using magnetic resonance imaging (MRI) provides high diagnostic accuracy in detecting subscapularis tendon tears.
This study included 157 patients who underwent primary arthroscopic rotator cuff repair between 2014 and 2017. All patients underwent conventional 1.5-T MRI in our hospital, within 3 months before surgery. We retrospectively compared the diagnosis of subscapularis tendon tears using MRI based on an anatomical concept focusing on the superior-most insertion point of the subscapularis tendon with intraoperative arthroscopic findings.
Subscapularis tendon tears were detected in 80 (51.0%) of the 157 patients during arthroscopic evaluation. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the MRI examination were 90, 83, 85, 89, and 87%, respectively. With a kappa score of 0.83, the concordance rate between the two raters was almost perfect (95% confidence interval, 0.75-0.92). The sensitivities of the oblique-sagittal and axial sequences were 84 and 79%, respectively.
Preoperative MRI evaluation focusing on the most superior portion of the subscapularis tendon demonstrated high diagnostic accuracy in detecting subscapularis tendon tears. To find the most superior portion of the subscapularis tendon tears, it was essential to check the slice at the level of the lesser tubercle tip and its adjacent slice. In addition, the combined observation of oblique-sagittal and axial sequences helped to detect subscapularis tendon tears with higher sensitivity.
本研究旨在验证以下假设，即通过磁共振成像（MRI）确定肩胛下肌腱最上部分的确切位置，在检测肩胛下肌腱撕裂方面具有较高的诊断准确性。
本研究纳入了2014年至2017年间接受初次关节镜下肩袖修补术的157例患者。所有患者在我院术前3个月内接受了常规1.5-T MRI检查。我们回顾性地比较了基于聚焦肩胛下肌腱最上附着点的解剖学概念的MRI对肩胛下肌腱撕裂的诊断与术中关节镜检查结果。
在关节镜评估中，157例患者中有80例（51.0%）检测到肩胛下肌腱撕裂。MRI检查的总体敏感性、特异性、阳性预测值、阴性预测值和准确性分别为90%、83%、85%、89%和87%。两名评估者之间的一致性率几乎完美（kappa评分为0.83，95%置信区间为0.75-0.92）。斜矢状位和轴位序列的敏感性分别为84%和79%。
术前聚焦于肩胛下肌腱最上部分的MRI评估在检测肩胛下肌腱撕裂方面显示出较高的诊断准确性。为了找到肩胛下肌腱撕裂的最上部分，检查小结节尖端水平的切片及其相邻切片至关重要。此外，斜矢状位和轴位序列的联合观察有助于以更高的敏感性检测肩胛下肌腱撕裂。
