超声引导下磁共振关节造影在诊断冈上肌腱撕裂中的临床应用
Clinical application of ultrasound-guided magnetic resonance arthrography for the diagnosis of supraspinatus tendon tears.
作者信息
Zhang Huimei, Xu Huajun, Fan Huihui
机构信息
Department of Radiology, Huzhou Central Hospital, Huzhou, China.
Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
出版信息
Quant Imaging Med Surg. 2024 Dec 5;14(12):8489-8501. doi: 10.21037/qims-24-765. Epub 2024 Nov 21.
BACKGROUND
There are only a few isolated studies that have examined ultrasound-guided magnetic resonance arthrography (USMRA) of the glenohumeral joint and subacromial bursa with the use of gadolinium contrast agent. This study aimed to determine the clinical value of USMRA in the diagnosis of supraspinatus tendon tears and its subtypes.
METHODS
Musculoskeletal ultrasound (MSKUS) was performed in 207 patients with shoulder pain as confirmed by arthroscopic examination, 103 of whom underwent shoulder joint magnetic resonance imaging (MRI), and 104 of whom underwent USMRA. Based on tear subtypes and grading matching, the diagnostic value of MSKUS, MRI, and USMRA was assessed in terms of identifying the presence of supraspinatus tendon tears and its subtypes.
RESULTS
The results demonstrated statistically significant differences between the three groups in terms of diagnostic sensitivity, specificity, positive and negative predictive values, and accuracy in identifying supraspinatus tendon tears (P<0.05). The analysis of area under the receiver operating characteristic curve (AUC) indicated that MSKUS (AUC =0.76) and MRI (AUC =0.86) had moderate diagnostic value, while USMRA (AUC =0.95) had a higher diagnostic value. Regarding the tear subtypes in the MSKUS, MRI, and USMRA groups, the AUCs for articular-sided tears were 0.62, 0.75, and 0.87, respectively, while those for intratendinous tears were 0.57, 0.72, and 0.89, respectively, indicating moderate diagnostic value across the three groups; meanwhile, the AUCs for bursal-sided tears were 0.71, 0.73, and 0.92, respectively, while those for full-thickness tears were 0.75, 0.87, and 0.93, respectively, indicating moderate diagnostic values in the MSKUS group and MRI group and high diagnostic values in the USMRA group. The incidence of adverse reactions in the USMRA group was 1.92% (2/104).
CONCLUSIONS
USMRA demonstrated high diagnostic value for the diagnosis of supraspinatus tendon tears and bursal-sided and full-thickness tears.
背景
仅有少数孤立的研究使用钆造影剂对盂肱关节和肩峰下囊进行超声引导下磁共振关节造影（USMRA）。本研究旨在确定USMRA在诊断冈上肌腱撕裂及其亚型方面的临床价值。
方法
对207例经关节镜检查确诊为肩痛的患者进行肌肉骨骼超声（MSKUS）检查，其中103例接受肩关节磁共振成像（MRI）检查，104例接受USMRA检查。根据撕裂亚型和分级匹配情况，评估MSKUS、MRI和USMRA在识别冈上肌腱撕裂及其亚型方面的诊断价值。
结果
结果显示，三组在诊断敏感性、特异性、阳性和阴性预测值以及识别冈上肌腱撕裂的准确性方面存在统计学显著差异（P<0.05）。受试者工作特征曲线（AUC）下面积分析表明，MSKUS（AUC =0.76）和MRI（AUC =0.86）具有中等诊断价值，而USMRA（AUC =0.95）具有较高诊断价值。关于MSKUS、MRI和USMRA组中的撕裂亚型，关节侧撕裂的AUC分别为0.62、0.75和0.87，而肌腱内撕裂的AUC分别为0.57、0.72和0.89，表明三组的诊断价值中等；同时，滑囊侧撕裂的AUC分别为0.71、0.73和0.92，全层撕裂的AUC分别为0.75、0.87和0.93，表明MSKUS组和MRI组的诊断价值中等，而USMRA组的诊断价值较高。USMRA组的不良反应发生率为1.92%（2/104）。
结论
USMRA对冈上肌腱撕裂、滑囊侧撕裂和全层撕裂的诊断具有较高的诊断价值。
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