Kim Ju-Hyeon, Yang Dahae, Lee Jae-Hyun
Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan 49267, Republic of Korea.
Department of Laboratory Medicine, Kosin University Gospel Hospital, Busan 49267, Republic of Korea.
Biomedicines. 2025 Feb 21;13(3):551. doi: 10.3390/biomedicines13030551.
: Plain radiography is the primary diagnostic tool for calcific tendinitis of the shoulder. Several qualitative grading methods have been proposed to represent the pathophysiologic phase and guide treatment decisions. However, these methods have demonstrated low reliability, complicating their effectiveness for such purposes. This study aims to perform the first quantitative analysis of calcific lesions using radiographic imaging and explore their correlation with ultrasonographic parameters to enhance their diagnostic utility. : A total of 57 shoulders presenting with painful calcific tendinitis in either the supraspinatus or subscapularis tendon were reviewed. The calcific deposits and tendon regions of interest were meticulously identified and annotated. Image brightness was reduced to 256 grayscale levels, and descriptive and heterogeneity parameters, including skewness, kurtosis, complexity, and entropy, were quantified and analyzed. : In the region of calcification, the average grayscale values were 21.69 units higher than those of tendon tissue. All spatial heterogeneity parameters, except for skewness, demonstrated statistically significant differences when compared with the adjacent tendon. Notably, entropy and complexity were the most distinctive features, with an area under the curve of 0.93 and cut-off values of 4.62 and 4.18, respectively. Significant correlations were observed between the heterogeneity parameters and ultrasonographic findings, such as bursal contact and peri-calcific hypoattenuation. : Calcific deposits demonstrated not only increased brightness in grayscale levels but also distinct spatial heterogeneity. The correlation with ultrasonographic findings indicates that these heterogeneity parameters may reflect underlying pathophysiological characteristics. Future prospective research could explore the whole temporal changes of calcifications more thoroughly.
X线平片是肩部钙化性肌腱炎的主要诊断工具。已经提出了几种定性分级方法来表示病理生理阶段并指导治疗决策。然而，这些方法的可靠性较低，使其在此类目的上的有效性变得复杂。本研究旨在使用放射成像对钙化病变进行首次定量分析，并探索它们与超声参数的相关性，以提高其诊断效用。
共回顾了57例出现冈上肌或肩胛下肌腱疼痛性钙化性肌腱炎的肩部病例。对钙化沉积物和感兴趣的肌腱区域进行了细致识别和标注。将图像亮度降低到256级灰度，对包括偏度、峰度、复杂度和熵在内的描述性和异质性参数进行量化和分析。
在钙化区域，平均灰度值比肌腱组织高21.69个单位。与相邻肌腱相比，除偏度外，所有空间异质性参数均显示出统计学上的显著差异。值得注意的是，熵和复杂度是最显著的特征，曲线下面积分别为0.93，截断值分别为4.62和4.18。在异质性参数与超声检查结果（如滑囊接触和钙化周围低衰减）之间观察到显著相关性。
钙化沉积物不仅在灰度水平上显示出亮度增加，而且具有明显的空间异质性。与超声检查结果的相关性表明，这些异质性参数可能反映潜在的病理生理特征。未来的前瞻性研究可以更全面地探索钙化的整个时间变化。
