Gratz S, Köster G, Behr T, Vosshenrich R, Grabbe E, Becker W
Department of Nuclear Medicine, Georg August University of Göttingen, Germany.
Nuklearmedizin. 1998;37(8):272-8.
In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint.
After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard.
In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification.
Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.
为评估关节闪烁造影术对疑似肩袖撕裂的诊断效能，对17例有肩袖损伤临床体征的患者进行了20次这种新的成像检查。将闪烁造影结果与肩关节的超声检查（n = 20）、关节造影（n = 20）及关节镜检查（n = 10）结果进行比较。
在静脉注射300 MBq 99m锝-亚甲基二膦酸盐（MDP）进行标准骨闪烁造影以确定肩部区域的标志点后，关节内注射99m锝微胶体（ALBU-RES 400微居里/5毫升），然后进行关节闪烁造影。注射操作要么直接与关节造影联合进行（n = 10），要么与局部麻醉剂混合超声引导下进行（n = 10）。以关节镜手术结果（n = 10）作为金标准。
在肩袖完全撕裂的病例（n = 5）中，关节闪烁造影与放射学关节造影在5/5的病例中结果相同。1例肩关节有晚期退行性改变的患者，放射学关节造影错误地显示为完全撕裂，而关节闪烁造影和关节镜检查未发现。在3例不完全撕裂的患者中，2/3的结果一致。1例曾接受过翻修手术且患有囊炎和钙化的肩袖患者结果存在差异。
关节闪烁造影术是检测肩袖撕裂的一种敏感技术。由于活性化合物的粘度较低，小撕裂很容易被检测到，比放射学关节造影和超声检查具有额外价值，尤其对于评估不完全肩袖撕裂。
