Ni Y B, Tian Z R, Yang J P, Wang Y Q, Tian B, Gong R, Zhao W, Wang Z J
Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan 750001, China.
Basic Medical College of Ningxia Medical University, Yinchuan 750001, China.
Zhonghua Yi Xue Za Zhi. 2023 Jun 6;103(21):1603-1610. doi: 10.3760/cma.j.cn112137-20220926-02029.
To investigate the diagnostic value of quantitative parameters of synthetic magnetic resonance imaging (SyMRI) in the grade of supraspinatus tendon injury. Ninety-seven patients with clinical definite of supraspinatus tendon injury from July 2021 to July 2022 in General Hospital of Ningxia Medical University were prospectively collected (case group), including 54 males and 43 females, with an age of 29 to 56 (37.4±9.6) years. According to the results of shoulder arthroscopy, the case group were divided into three subgroups included tendinopathy group (37 cases, grade Ⅱ), partial tear group (34 cases, grade Ⅲ) and complete tear group (26 cases, grade Ⅳ). During the same period, 28 normal rotator cuff volunteers without supraspinatus tendon injury were recruited (control group), including 16 males and 12 females, aged 23 to 49 (36.1±7.2) years, and marked as grade Ⅰ. All the subjects underwent MRI scan of articulatio humeri included T-weighted imaging(TWI) fast spin echo(FSE) sequences in axial view, T-weighted imaging(TWI) fat suppression(FS) sequences in axial view, TWI FS sequences in oblique coronal view, proton density-weighted (PDW) imaging in oblique sagittal view and SyMRI in oblique coronal view. The supraspinatus tendon was divided into lateral, medial and middle subregions according to its shape in oblique coronal TWI view, two radiologists measured the T, T and PD values of the supraspinatus tendon. The interclass correlation coefficient (ICC) were used to compare the consistency between and within observers. One-way analysis of variance or Kruskal-Wallis test were used to compare the differences of quantitative parameters in different grades, the multivariate logistic regression model was used to analyze the risk factors of supraspinatus tendon injury grade, and the receiver operating characteristic (ROC) curves and area under curve (AUC) was drawn and calculated to evaluate the diagnostic efficacy. The Spearman correlation was used to analyze the correlation between the quantitative values and grades of supraspinatus tendon injury. The ICC values of T, T and PD values for the three subregions of the supraspinatus tendon were greater than 0. 700. The differences of T values in the lateral subregion, T values in the lateral and middle subregions were statistically significant in the overall comparison across different grades (all <0. 001).The differences of T values in the middle and medial subregions, T values in the medial subregion and PD values in the lateral, middle and medial subregions were not statistically significant in the overall comparison of different grades (all 0. 05). Multiple logistic regression model analysis showed that T values in the lateral and middle subregions were related factors for the grade of supraspinatus tendon injury[ (95%):1.123 (1.037-1.216), 0.122 (1.151-1.197);all <0.001 ]. The AUC of the T values in lateral subregion diagnosing grade Ⅰ vs grade Ⅳ, grade Ⅱ vs grade Ⅳ and grade Ⅲ vs grade Ⅳ were 0.891(95%: 0.801-0.981), 0.797(95%: 0.680-0.914), 0.723(95%: 0.594-0.853) (all <0.001), and the AUC of the T values in middle subregion diagnosing grade Ⅰ vs Ⅳ, grade Ⅱ vs Ⅳ, grade Ⅱ vs Ⅲ, and grade Ⅰ vs Ⅲ were 0.946 (95%: 0.849-0.989), 0.886 (95%: 0.809-0.962), 0.746 (95%: 0.631-0.861), 0.843 (95%: 0.745-0.941)(all <0.001). The T values in the lateral and middle subregions were positively correlated with the grade of supraspinatus tendon injury (=0.542, 0.615; both <0.001), while T values and T values in the medial subregions were not significantly correlated with the grade of supraspinatus tendon injury (both >0.05). SyMRI has high clinical application value in the grading of supraspinatus tendon injury, especially T value can be used as an effective quantitative parameter for the grading of supraspinatus tendon injury.
探讨合成磁共振成像(SyMRI)定量参数在肩袖损伤分级中的诊断价值。前瞻性收集2021年7月至2022年7月在宁夏医科大学总医院临床确诊为肩袖损伤的97例患者(病例组),其中男性54例,女性43例,年龄29~56岁(37.4±9.6岁)。根据肩关节镜检查结果,将病例组分为三个亚组,即肌腱病组(37例,Ⅱ级)、部分撕裂组(34例,Ⅲ级)和完全撕裂组(26例,Ⅳ级)。同期招募28例无肩袖损伤的正常肩袖志愿者(对照组),其中男性16例,女性12例,年龄23~49岁(36.1±7.2岁),标记为Ⅰ级。所有受试者均接受肩关节MRI扫描,包括轴位T加权成像(TWI)快速自旋回波(FSE)序列、轴位TWI脂肪抑制(FS)序列、斜冠状位TWI FS序列、斜矢状位质子密度加权(PDW)成像和斜冠状位SyMRI。在斜冠状位TWI图像上,根据肩袖肌腱的形态将其分为外侧、内侧和中间亚区域,两名放射科医生测量肩袖肌腱的T、T和PD值。采用组内相关系数(ICC)比较观察者间和观察者内的一致性。采用单因素方差分析或Kruskal-Wallis检验比较不同分级定量参数的差异,采用多因素logistic回归模型分析肩袖损伤分级的危险因素,并绘制和计算受试者工作特征(ROC)曲线及曲线下面积(AUC)以评估诊断效能。采用Spearman相关性分析肩袖损伤定量值与分级之间的相关性。肩袖肌腱三个亚区域的T、T和PD值的ICC值均大于0.700。在不同分级的总体比较中,外侧亚区域的T值、外侧和中间亚区域的T值差异有统计学意义(均<0.001)。在不同分级的总体比较中,中间和内侧亚区域的T值、内侧亚区域的T值以及外侧、中间和内侧亚区域的PD值差异均无统计学意义(均>0.05)。多因素logistic回归模型分析显示,外侧和中间亚区域的T值是肩袖损伤分级的相关因素[(95%):1.1(1.037~1.216),0.122(1.151~1.197);均<0.001]。外侧亚区域T值诊断Ⅰ级与Ⅳ级、Ⅱ级与Ⅳ级、Ⅲ级与Ⅳ级的AUC分别为0.891(95%:~0.981)、0.797(95%:0.680~0.914)、0.723(95%:0.594~0.853)(均<0.001),中间亚区域T值诊断Ⅰ级与Ⅳ级、Ⅱ级与Ⅳ级、Ⅱ级与Ⅲ级、Ⅰ级与Ⅲ级的AUC分别为0.946(95%:0.849~0.989)、0.886(95%:0.809~0.962)、0.746(95%:0.6~0.861)、0.843(95%:0.745~0.941)(均<0.001)。外侧和中间亚区域的T值与肩袖损伤分级呈正相关(=0.542,0.615;均<0.001),而内侧亚区域的T值和T值与肩袖损伤分级无明显相关性(均>0.05)。SyMRI在肩袖损伤分级中具有较高的临床应用价值,尤其是T值可作为肩袖损伤分级的有效定量参数。