Tuite M J, Turnbull J R, Orwin J F
Department of Radiology, University of Wisconsin Hospital and Clinics, Madison 53792-3252, USA.
Skeletal Radiol. 1998 May;27(5):237-43. doi: 10.1007/s002560050374.
To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images.
We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed.
The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years) (P = 0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P = 0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized partial tears not involving the insertion was 40 years old (P = 0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect.
Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in younger patients with shoulder pain.
确定肩袖撕裂部位的相对分布情况，以及磁共振成像（MR）图像上前侧撕裂与后侧撕裂的敏感性。
我们纳入了110例连续的患者，这些患者均进行了肩部MR检查，且在关节镜检查中被诊断为部分厚度或小的全层肩袖撕裂。根据关节镜录像，我们将撕裂分类为位于肩袖前半部分或后半部分的中央，以及位于关键区域或邻近骨质附着处。将最初的MR诊断结果与关节镜检查结果进行比较。比较了肩袖前半部分撕裂患者与后半部分撕裂患者的MR敏感性及患者年龄。此外，对于直径小于2 cm的部分撕裂患者，比较了关键区域撕裂患者与邻近骨质附着处关节面撕裂（边缘撕裂）患者的年龄。
在36岁以下的患者中，79%的撕裂位于肩袖前半部分中央；在36岁及以上的患者中，这一比例为89%。前半部分撕裂患者的平均年龄（44岁）与后半部分撕裂患者的平均年龄（40岁）无显著差异（P = 0.23）。MR对前侧撕裂的敏感性为0.69，对后侧撕裂的敏感性为0.56（P = 0.17）。9例边缘撕裂患者的平均年龄为31岁，而28例同样大小但不涉及附着处的部分撕裂患者的平均年龄为40岁（P = 0.048）。最初的MR报告正确解读了9例边缘撕裂中的5例（0.56）；其他撕裂中有2例被误诊为肌腱内积液，但回顾时可诊断。
即使在36岁以下的患者中，大多数部分厚度和小的全层肩袖撕裂也位于冈上肌前半部分中央。尽管我们报道的这些撕裂的MR敏感性低于近期文章中的数据，但我们发现MR诊断后侧撕裂与冈上肌腱前半部分撕裂的敏感性之间无显著差异。边缘撕裂可能被误认为肌腱内信号，对于有肩部疼痛的年轻患者应仔细查找。
