Tasaki Atsushi, Nozaki Taiki, Tamaki Tomoshige, Saito Masayoshi, Mashimo Shota, Kitamura Nobuto
Department of Orthopedic Surgery, St. Luke's International Hospital, Tokyo, Japan.
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan.
JSES Int. 2024 Jun 10;8(5):963-969. doi: 10.1016/j.jseint.2024.05.013. eCollection 2024 Sep.
This study aimed to evaluate the association between specific, reproducible findings of an anteroinferior capsulolabral complex obtained using conventional 3.0-Tesla nonenhanced magnetic resonance imaging (MRI) and pathologic arthroscopic findings and to assess the confidence level of the findings.
Of 125 cases of traumatic anterior instability surgery from January 2017 to November 2019, 66 patients (52 men, 14 women; 23.5 ± 7.9 year old) who underwent conventional 3.0-Tesla MRI at our hospital were reviewed. The following anteroinferior capsulolabral complex features were observed on the T2-star axial image: size difference of the labrum (swelling, diminished), difference in marginal and internal signals (irregularity), and capsule edema image (capsular thickening). We also reviewed fraying, flattening, cracking, and capsular hypertrophy as pathologic arthroscopic findings of the capsulolabral complex. These findings allowed for the simultaneous description of the MRI and arthroscopic evaluations. Three orthopedic surgeons and one radiologist measured the interobserver reliability. We investigated the correlation between the MRI and arthroscopic findings.
The interobserver reliability of MRI irregularities was low (κ = -0.16), whereas reliability was moderate (κ = 0.554-0.595) for swelling in 22 cases (33%), diminished in 34 cases (52%), and capsular thickness in 40 cases (59%). Labral detachment was found in 26 patients (39%) and fluid collection in 24 patients (36%). The agreement of MRI findings with arthroscopic findings was κ = 0.46 (95% confidence interval [CI]: 0.268-0.654) for swelling to fraying; κ = 0.42 (95% CI: 0.202-0.638) for swelling to capsular hypertrophy; and 0.46 (95% CI: 0.268-0.654) for flattening to diminished.
The swelling and diminished findings of the anteroinferior capsulolabral complex on conventional MRI were moderately related to pathologic arthroscopic findings in patients with traumatic anterior shoulder instability. These findings contribute to achieving an accurate clinical diagnosis.
本研究旨在评估使用传统3.0特斯拉非增强磁共振成像（MRI）获得的前下盂唇复合体的特定、可重复发现与关节镜病理发现之间的关联，并评估这些发现的置信水平。
回顾了2017年1月至2019年11月期间125例创伤性前不稳定手术病例，其中66例患者（52例男性，14例女性；年龄23.5±7.9岁）在我院接受了传统3.0特斯拉MRI检查。在T2*轴位图像上观察以下前下盂唇复合体特征：盂唇大小差异（肿胀、缩小）、边缘和内部信号差异（不规则）以及关节囊水肿图像（关节囊增厚）。我们还回顾了盂唇复合体的磨损、扁平、破裂和关节囊肥大等关节镜病理发现。这些发现允许同时描述MRI和关节镜评估。三名骨科医生和一名放射科医生测量了观察者间的可靠性。我们研究了MRI和关节镜检查结果之间的相关性。
MRI不规则性的观察者间可靠性较低（κ=-0.16），而22例（33%）肿胀、34例（52%）缩小和40例（59%）关节囊厚度的可靠性为中等（κ=0.554-0.595）。26例患者（39%）发现盂唇分离，24例患者（36%）发现积液。MRI结果与关节镜检查结果的一致性为：肿胀与磨损的κ=0.46（95%置信区间[CI]：0.268-0.654）；肿胀与关节囊肥大的κ=0.42（95%CI：0.202-0.638）；扁平与缩小的κ=0.46（95%CI：0.268-0.654）。
传统MRI上前下盂唇复合体的肿胀和缩小发现与创伤性前肩关节不稳定患者的关节镜病理发现有中度相关性。这些发现有助于实现准确的临床诊断。
