Bachmann G F, Melzer C, Heinrichs C M, Möhring B, Rominger M B
Department of Diagnostic Radiology, Justus Liebig University, D-35 392 Giessen, Germany.
Eur Radiol. 1997;7(2):192-7. doi: 10.1007/s003300050133.
An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive) and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. Ultrasound should be the primary diagnostic method in screening of shoulder pain because it is economic and fast. The MRI technique should be used secondary because it provides more information about extent of tendons and has lower risk of artefacts.
对肩关节尸体关节标本进行了一项实验研究，以确定超声（US）和磁共振成像（MRI）在诊断肩袖异常方面的准确性。评估了不同形态学标准在鉴别退变以及部分和完全撕裂方面的价值。通过超声、MRI和病理方法，以相同的轴向和纵向方向观察肩袖肌腱，对38个手术暴露的肩关节标本进行了检查。三位经验丰富的检查人员分别对这三种成像方式进行了评估，他们对其他结果不知情。评估标准包括形态学征象（变薄、增厚、连续性中断和肩袖缺失）和结构（超声中的回声改变、MRI中的信号强度增加、病理中的组织变化）。最终将超声和MRI的检查结果与病理结果进行比较，以评估敏感性和特异性。病理检查显示有4例全层撕裂、6例部分层撕裂、16例退变和12例正常肩袖。超声在所有异常肩袖中均显示出病理征象，而一份MRI报告为假阴性。超声的特异性为67%（12例中有4例假阳性），MRI的特异性为100%（健康肌腱无异常发现）。两种方法对肩袖不同病理疾病的鉴别能力均有所下降。仅使用超声时，16例退变中有10例、6例部分撕裂中有2例、4例完全撕裂中有3例被正确诊断。使用MRI时，16例退变中有13例、6例部分撕裂中有3例、4例完全撕裂中有3例被检测到。MRI技术在所有3例中均未能显示肌腱内钙化。我们得出结论，MRI和超声在检测肩袖异常方面均很敏感。超声应作为筛查肩部疼痛的主要诊断方法，因为它经济且快速。MRI技术应作为次要方法使用，因为它能提供更多关于肌腱范围的信息，且伪影风险较低。
