Inagaki Kenta, Ochiai Nobuyasu, Hashimoto Eiko, Hiraoka Yu, Ise Shohei, Ohtori Seiji
Department of Orthopaedic Surgery, Chiba University Hospital, Chiba-city, Chiba, Japan.
J Hand Surg Glob Online. 2024 Jul 8;6(5):654-658. doi: 10.1016/j.jhsg.2024.06.005. eCollection 2024 Sep.
Magnetic resonance imaging (MRI) is the most widely used imaging to diagnose lateral epicondylitis (LE). However, the importance of MRI findings in LE remains unclear. This study aimed to classify the signal intensity changes of the extensor carpi radialis brevis origin and the shape and length of the synovial fold using MRI and compare them with clinical symptoms. We hypothesized that MRI findings in LE are not associated with clinical symptoms.
Two hundred and forty-three patients (261 elbows, mean age: 51.2 ± 8.5 years, mean duration of LE: 18.2 ± 11.3 months) who were evaluated using pretreatment MRI were included. The signal change of the extensor carpi radialis brevis origin was classified using coronal T2-weighted (T2) imaging and coronal fat-suppressed proton density T2 imaging, and the shape and length of the synovial folds were evaluated using coronal and sagittal T2 imaging. Furthermore, MRI findings were compared with clinical symptoms at the first visit.
The number of elbows with high signal intensity on fat-suppressed proton density T2 was 252 of 261 (96.5%), and those on T2 were 207 of 261 (79.3%). Synovial folds were observed in 231 of 261 (88.5%) of the elbows, and synovial folds having a dull shape were observed in 95 of 261 (36.4%) elbows. The length of the synovial fold was >1/3 of the radial head in 87 of 261 (33.3%) of the elbows. There was no statistically significant correlation between the MRI findings and clinical symptoms.
A high rate of high signal intensity changes of the extensor carpi radialis brevis origin was observed, and fat-suppressed proton density T2 could detect finer signal changes than T2. Furthermore, synovial folds were found in many cases of LE. However, there was no association between MRI findings and clinical symptoms at first visit.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.
磁共振成像（MRI）是诊断外侧上髁炎（LE）最广泛使用的影像学检查。然而，MRI在LE中的表现的重要性仍不明确。本研究旨在利用MRI对桡侧腕短伸肌起点的信号强度变化以及滑膜皱襞的形态和长度进行分类，并将其与临床症状进行比较。我们假设LE的MRI表现与临床症状无关。
纳入243例患者（261个肘部，平均年龄：51.2±8.5岁，LE平均病程：18.2±11.3个月），这些患者在治疗前接受了MRI评估。使用冠状面T2加权（T2）成像和冠状面脂肪抑制质子密度T2成像对桡侧腕短伸肌起点的信号变化进行分类，并使用冠状面和矢状面T2成像评估滑膜皱襞的形态和长度。此外，将首次就诊时的MRI表现与临床症状进行比较。
在261个肘部中，252个（96.5%）在脂肪抑制质子密度T2上表现为高信号强度，207个（79.3%）在T2上表现为高信号强度。261个肘部中有231个（88.5%）观察到滑膜皱襞，261个肘部中有95个（36.4%）观察到形态钝圆的滑膜皱襞。261个肘部中有87个（33.3%）滑膜皱襞长度大于桡骨头的1/3。MRI表现与临床症状之间无统计学显著相关性。
观察到桡侧腕短伸肌起点高信号强度变化的发生率较高，脂肪抑制质子密度T2比T2能检测到更细微的信号变化。此外，在许多LE病例中发现了滑膜皱襞。然而，首次就诊时MRI表现与临床症状之间无关联。
研究类型/证据水平：预后性IV级。
