Siriwanarangsun Palanan, Pakdee Wisitsak, Pisanuwongse Arin, Keyurapan Ekavit, Lektrakul Nittaya
Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
Quant Imaging Med Surg. 2023 Dec 1;13(12):8274-8289. doi: 10.21037/qims-23-273. Epub 2023 Nov 9.
BACKGROUND: Magnetic resonance image (MRI) of the subscapularis tendon plays an important role in preoperative planning. This retrospective study aimed to evaluate the diagnostic value and quantitative measurement of an additional internal rotation sequence in the detection of partial subscapularis tendon tears. METHODS: The study included 76 patients who underwent arthroscopy and magnetic resonance (MR) shoulder between January 2018 to December 2019. Three different sets of images were evaluated in each case to determine the diagnostic value in the detection of partial subscapularis tendon tears including Set 1: standard axial fat-suppressed proton density (PD/FS) image and sagittal fat-suppressed T2 weight image (T2W/FS) images, Set 2: standard axial PD/FS and internal rotation PD/FS images, and Set 3: standard axial PD/FS, sagittal T2W/FS and axial internal rotation PD/FS images. Subscapularis tendon tear was diagnosed by arthroscopy and patients with or without tears were grouped. The coracohumoral distance (CHD), coracoglenoid angle (CGA), coracohumeral angle (CHA), CHD difference and CHD ratio were evaluated and compared between groups using univariate and multivariate analysis. The interreader agreement was assessed. The cut-off point for the prediction of subscapularis tears was calculated. RESULTS: Twenty-nine shoulders revealed partial subscapularis tendon tears (29/76, 38.2%). Imaging Set 3 provided the highest sensitivity and accuracy {79-83% [confidence interval (CI): 0.60-0.95], 75-76% (CI: 0.63-0.85)}, compared to image Set 2 [31-58% (CI: 0.15-0.76), 67-68% (CI: 0.55-0.79)] and Set 1 [17-21% (CI: 0.06-0.40], 61-66% (CI: 0.54-0.76)], and a moderate level of interobserver agreement (Kappa =0.55). Axial CHD [odd ratio (OR) =1.48, P=0.044], internal rotate CHD (OR =0.68, P=0.02), CHD difference (OR =2.58, P<0.001), and CHD ratio (OR =1.34, P<0.001) were associated with subscapularis tears. A CHD difference and CHD ratio of more than 0.04 mm and 1.01 achieved a 90% sensitivity and 72% specificity, both. CONCLUSIONS: Internal rotation during MRI can increase diagnostic accuracy for subscapularis tendon partial tears. The CHD differences and CHD ratio are useful parameters to indicate subscapularis tears. This technique may improve preoperative management and reduce the consequences of delayed diagnosis and treatment.
背景：肩胛下肌腱的磁共振成像（MRI）在术前规划中起着重要作用。本回顾性研究旨在评估额外的内旋序列在检测肩胛下肌腱部分撕裂中的诊断价值和定量测量。 方法：该研究纳入了2018年1月至2019年12月期间接受关节镜检查和肩部磁共振（MR）检查的76例患者。对每个病例评估三组不同的图像，以确定在检测肩胛下肌腱部分撕裂中的诊断价值，包括：第1组：标准轴位脂肪抑制质子密度（PD/FS）图像和矢状位脂肪抑制T2加权图像（T2W/FS）；第2组：标准轴位PD/FS和内旋PD/FS图像；第3组：标准轴位PD/FS、矢状位T2W/FS和轴位内旋PD/FS图像。通过关节镜检查诊断肩胛下肌腱撕裂，并将有或无撕裂的患者分组。使用单因素和多因素分析评估和比较两组之间的喙肱距离（CHD）、喙盂角（CGA）、喙肱角（CHA）、CHD差值和CHD比值。评估阅片者间的一致性。计算预测肩胛下肌腱撕裂的截断点。 结果：29个肩部显示肩胛下肌腱部分撕裂（29/76，38.2%）。与第2组图像[31 - 58%（CI：0.15 - 0.76），67 - 68%（CI：0.55 - 0.79）]和第1组图像[17 - 21%（CI：0.06 - 0.40），61 - 66%（CI：0.54 - 0.76）]相比，第3组成像提供了最高的敏感性和准确性{79 - 83%[置信区间（CI）：0.60 - 0.95]，75 - 76%（CI：0.63 - 0.85）}，且阅片者间一致性为中等水平（Kappa = 0.55）。轴位CHD[比值比（OR）= 1.48，P = 0.044]、内旋CHD（OR = 0.68，P = 0.02）、CHD差值（OR = 2.58，P < 0.001）和CHD比值（OR = 1.34，P < 0.001）与肩胛下肌腱撕裂相关。CHD差值大于0.04 mm和CHD比值大于1.01时，敏感性和特异性均达到90%和72%。 结论：MRI检查时内旋可提高肩胛下肌腱部分撕裂的诊断准确性。CHD差值和CHD比值是提示肩胛下肌腱撕裂的有用参数。该技术可能改善术前管理并减少延迟诊断和治疗的后果。
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