肩峰下撞击综合征合并肩袖撕裂的MR诊断

目的:分析肩峰下撞击综合征合并肩袖撕裂的MRI表现特征,旨在提高对肩袖撕裂影像学的认识.方法:回顾分析17例经关节镜手术证实的肩峰下撞击综合征合并肩袖撕裂病例的临床及MR影像资料.结果.17例肩峰下撞击综合征合并肩袖撕裂的病例:6例肩袖为完全撕裂,撕裂贯穿冈上肌腱全层,MR表现为冈上肌腱部分肌腱纤维不连续,充填液体样高信号,并与关节腔及肩峰下滑囊液体信号相通,部分病例断裂处局部肌腱缺损、肌肉回缩;11例肩袖为部分撕裂,其中4例表现为冈上肌腱滑膜侧部分肌腱纤维断裂,另7例表现为冈上肌腱关节面侧部分肌腱纤维断裂,MR表现为肌腱断裂处充填液体样高信号,或表现为肌腱滑膜侧部分肌腱信号增高,边缘毛糙.结论:MR检查能够直观地显示肩袖的撕裂,准确地显示撕裂的部位、撕裂累及的范围及严重程度,为临床诊疗提供可靠的影像学依据.     

常规MRI与MR关节造影诊断肩袖撕裂的初步对比研究

目的 比较3.0T常规MRI和MR关节造影检查对肩袖撕裂的诊断价值.方法 分析48例肩关节病变患者的常规MRI和MR关节造影检查资料,确定肩袖有无撕裂并进行分型.其中4例行肩关节镜检查.采用配对x2检验比较两种检查方法诊断肩袖撕裂的差异性.结果 常规MRI显示冈上肌腱全层撕裂6例,冈上肌腱部分撕裂9例;MR关节造影显示冈上肌腱全层撕裂7例,冈上肌腱部分撕裂8例.常规MRI和MR关节造影检查方法对肩袖全层撕裂诊断有6例相同,1例常规MRI诊断无撕裂MR关节造影诊断为撕裂;对肩袖部分撕裂的诊断有7例相同,3例不同,其中2例常规MRI诊断为撕裂而MR关节造影诊断为无撕裂,1例常规MRI诊断为无撕裂而MR关节造影诊断为撕裂;两种检查方法对肩袖全层撕裂(x2=0.000,P＞0.05)及部分撕裂(x2=o.000,P＞0.05)的诊断差异无统计学意义.结论 初步显示3.0T常规MRI对肩袖全层撕裂和肩袖部分撕裂的诊断能达到MR关节造影的诊断效果,同时可以显示肩袖撕裂伴发的各种异常.     

MRI对肩袖撕裂的诊断价值

目的 评价肩关节MRI对肩袖撕裂的诊断价值,并分析其影像特征及损伤机制.方法 回顾性分析76例肩袖撕裂的MRI表现及临床症状.结果 肩袖全层撕裂共25例.其中冈上肌腱撕裂23例,同时向冈下肌腱延伸5例,6例合并肩胛下肌腱部分撕裂,1例合并肱二头肌长头腱断裂,2例合并关节盂前上盂唇撕脱.肩袖部分撕裂共51例,全部发生在冈上肌腱.其中上表面侧11例,下表面侧32例,肌腱内部分撕裂8例.其中8例同时在上表面及下表面发生部分撕裂,3例同时合并下表面及肌腱内部分撕裂.结论 肩关节MRI是评价肩袖撕裂比较有效的检查方法,为临床制定正确的治疗方案提供可靠的依据.     

肩袖全层撕裂:肩关节MRI评价

目的 评价肩关节MRI对肩袖全层撕裂的诊断价值,并对比分析肩关节MRI造影和常规肩关节MRI的诊断性能.资料与方法 由两名影像诊断医师独立回顾分析264例肩关节MRI图像,包括127例常规肩关节MRI检查和137例肩关节MRI造影,分析结果与肩关节镜手术相比较.计算肩关节MRI评价肩袖全层撕裂的敏感性和特异性.采用Kappa统计计算两名影像诊断医师评价的一致性.结果 264例患者中,肩袖全层撕裂60例(冈上肌腱全层撕裂60例,冈下肌腱全层撕裂5例,肩胛下肌腱全层撕裂5例,小圆肌腱全层撕裂4例).肩关节MRI评估肩袖全层撕裂的敏感性和特异性两名医师分别为88.33%(53/60)和97.55%(199/204),95.00%(57/60)和95.10%(194/204),K=0.906.肩关节MRI与肩关节MRI造影对于肩袖全层撕裂的敏感性和特异性差异无统计学意义.结论 肩关节MRI是评价肩袖全层撕裂可靠的方法.对于冈上肌腱全层撕裂,肩关节MRI造影和常规肩关节MRI的诊断价值相似.     

磁共振化学位移成像定量测量肩袖损伤后冈上肌脂肪性退变

目的：探讨MR化学位移成像技术在定量测量肩袖损伤后冈上肌脂肪性退变中的临床应用价值。方法：38例临床上疑有肩袖损伤或肩峰撞击的患者为研究对象,行MR间接关节造影后,进行常规序列和化学位移序列MRI扫描。根据MR间接关节造影检查结果,肩袖损伤后冈上肌肌腱病理改变可分为4组：正常组、肌腱炎组、部分撕裂组和完全撕裂组。通过测定冈上肌的信号强度,然后分别计算出信号强度抑制率和信号指数值作为反映脂肪变性程度的指标,对比分析正常组和肩袖损伤各组的冈上肌脂肪变性程度。统计学方法采用Wilcoxon秩和检验。结果：正常组、肌腱炎组、部分撕裂组和完全撕裂组冈上肌信号强度抑制率中位数分别是-5．51％（-7．85％～3．50％）、-14．78％（-29．31％～-5．63％）、-31．74％（-45．54％～-13．63％）和-44．50％（-57．32％～-26．27％）,信号强度指数中位数依次为3．91％（-4．37％～13．83％）、12．75％（5．73％～27．38％）、25．17％（14．32％～34．13％）和38．26％（27．66％～53．94％）。正常组与部分撕裂组、正常组与完全撕裂组、肌腱炎组与完全撕裂组间两两比较,差异有高度统计学意义（P〈0．01）;正常组与肌腱炎组、肌腱炎组与部分撕裂组、部分撕裂组与完全撕裂组间两两比较,差异有统计学意义（P〈0．05）。结论：MR化学位移成像技术是定量测定冈上肌脂肪性退变程度的-种有I临床应用价值的手段,有助于对肌腱病变进行分级并指导临床治疗。     

MRI对肩腱袖撕裂的诊断及分级价值

目的探讨MRI检查对肩腱袖撕裂的诊断及分级价值。方法回顾性分析36例肩腱袖撕裂MRI表现与文献及骨科手术对照。结果 36例肩腱袖撕裂,完全性撕裂11例,表现为肌腱连续性中断,肩腱袖肌腱回缩;部分性肩腱袖撕裂25例,表现为边界清晰不累及关节面或滑膜囊面的线样高信号,肩腱袖的滑膜面或关节囊面撕裂区可见积液。结论 MRI能准确判断肩腱袖撕裂范围及程度,是肩腱袖撕裂的最佳检查方法。     

慢性肩袖病变的MR特点——大体解剖和组织学对照研究

目的:与大体解剖和组织学对照,探讨慢性肩袖损伤的MR影像特点。材料和方法:采用Philips Gy- roscant 1.0-NT磁共振扫描仪。对20只人离体肩关节标本进行MR成像。结果:肌腱变性表现为T_1W/ PDW信号增高,无明显形态改变。依据组织学结果,我们将慢性肌腱部分撕裂分为三型:典型撕裂口(Ⅰ型)表现为肌腱撕裂口T_2WI水样高信号;瘢痕型(Ⅱ型)信号表现多样,常表现为T_2序列稍高信号伴肌腱显著增粗,多见于慢性肩袖损伤;肌腱内撕裂(Ⅲ型)与肌腱变性难以区分。肌腱完全撕裂包括"隧道征"、宽大裂口伴或不伴肌腱断端退缩三种表现。结论:慢性肩袖损伤尤其是肩袖部分撕裂的MR表现较为复杂,必须将信号和形态特点相结合慎重诊断。     

UTE技术的冈上肌腱定量值与肩峰厚度联合诊断肩袖撕裂

目的：通过超短回波时间（UTE）序列定量评价冈上肌腱,联合肩峰厚度诊断肩袖撕裂。方法：搜集52例肩袖损伤患者,行UTE序列扫描,由2名放射科医生对肩袖影像分别进行Zlatkin分型及肩峰厚度分级。肩袖撕裂程度按Zlatkin分型法共分为3型;肩峰厚度共分为3级。不同观察者之间用Kappa一致性检验。肩峰厚度与冈上肌腱定量值的相关性采用Pearson相关性分析,肩袖撕裂分型的比较采用Kruskal-Wallis H检验。诊断效能采用ROC曲线分析。结果：肩袖撕裂诊断结果在2名观察者间几乎完全一致（Kappa=0.872）。肩峰厚度与冈上肌腱的定量值有显著负相关关系（r=-0.347,P<0.05）。Ⅰ型、Ⅲ型撕裂与肩峰厚度和冈上肌腱定量值间差异有统计学意义（P<0.05）。联合诊断的ROC曲线下面积（AUC）显著高于单独诊断的AUC值。结论：UTE序列冈上肌腱的定量值、肩峰厚度与肩袖撕裂均具有显著相关性,联合诊断比单独诊断具有更高的诊断效能。UTE序列冈上肌腱的定量值越低,肩峰厚度越厚,肩袖越有可能全层撕裂。     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

肩袖损伤的MR诊断进展

肩袖损伤是引起肩部疼痛和功能障碍的常见原因,可表现为全层撕裂或部分撕裂。MRI具有较高的软组织分辨力,可直接显示肩袖损伤部位及相关病理改变。本文复习肩袖的解剖结构,总结肩袖撕裂的MR诊断标准和主要表现及与X线平片、CT、B超相比的优越性、敏感性。研究表明,高场强MRI能更好地显示肌腱未受损部分与撕裂的对比,为临床制定正确的治疗方案提供帮助。     

Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging.

The purpose of this study was to describe MR findings in full-thickness tears of the rotator cuff. Of 102 shoulders examined by MR imaging, 31 were found to have a full-thickness tendon tear at arthroscopy/bursoscopy (five shoulders) or open surgery (26 shoulders). All shoulders were imaged in oblique coronal and axial planes. MR images of the 102 shoulders were evaluated for (1) the presence of fluid in the subacromial and subdeltoid bursae; (2) abnormal signal of the supraspinatus, subscapularis, infraspinatus, and teres minor tendons; (3) interruption of tendon continuity and thinning of the tendon; and (4) proximal retraction of the junction of the muscle and tendon. The presence or absence of each finding was determined by consensus of two radiologists, who interpreted the images without knowledge of the surgical findings. Results in those 31 shoulders with proved full-thickness tears were: fluid in the subacromial bursae (29 shoulders), interruption of tendinous continuity (22 shoulders), focally increased signal of the tendon equivalent to that of water (27 shoulders), and musculotendinous retraction (24 shoulders). The finding of subacromial fluid was a sensitive indicator (93%) of a full-thickness tear, and interruption of tendinous continuity was a specific finding (96%) in diagnosing a full-thickness tear. Our experience shows interruption of tendon continuity is the most specific MR finding of full-thickness rotator cuff tears, while subacromial fluid is the most common finding.     

MR imaging of the shoulder: appearance of the supraspinatus tendon in asymptomatic volunteers.

MR imaging has been shown to be accurate in the diagnosis of rotator cuff disruption and tear. Uncertainty remains about the significance of increased signal intensity in the critical zone of the supraspinatus tendon without visible disruption of tendon fibers and about the significance of other secondary findings commonly encountered with rotator cuff abnormalities, such as musculotendinous retraction or obliteration and fluid in the subacromial space. We evaluated proton density-weighted and T2-weighted coronal images (obtained on a 1.5-T superconductive MR imager) of 55 shoulders in 32 asymptomatic volunteers for signal intensity in the supraspinatus tendon, location of the musculotendinous junction, fluid in the subacromial-subdeltoid space, and appearance of the fat plane. In 89% of shoulders, the supraspinatus tendon showed focal, linear, or diffuse increased signal intensity with or without loss of the low-signal-intensity tendon margin on proton density-weighted images. None of these findings were confirmed on T2-weighted images. The musculotendinous junction was always located within an area 15 degrees medial to 30 degrees lateral to the highest point (12 o'clock) on the humeral head convexity. A peribursal fat plane was poorly defined or absent in 49%, and fluid in the subacromial-subdeltoid space was found in 20%. Increased signal intensity in the supraspinatus tendon on proton density-weighted images without a corresponding increase on T2-weighted images, the presence of small amounts of fluid in the subacromial space, and the lack of preservation of the subdeltoid fat plane are common findings in asymptomatic shoulders and by themselves are poor predictors of rotator cuff disease.     

Rotator cuff lesions: signal patterns at MR imaging

The signal intensity patterns of rotator cuff lesions at magnetic resonance (MR) imaging were evaluated in 80 patients who had surgical correlation and in 13 asymptomatic individuals (14 shoulders). Six cadaver shoulders were examined with MR, and histologic correlation was obtained in four. All studies were performed at 1.5 T with a flexible circular surface coil. The accuracy of MR imaging in detection of full-thickness cuff tears (31 patients) was 0.95 and of partial thickness tears (16 patients), 0.84. The most common and accurate pattern for full-thickness cuff tears (22 of 31 tears) was a region of intense signal seen on T2-weighted images. Less often the torn region consisted of an extremely degenerated and attenuated tendon with moderate signal intensity or was obscured by low-signal-intensity scar. The intense signal pattern on T2-weighted images was also accurate, although a less common finding (seven of 16 cases), in the diagnosis of partial tears. Tendinitis was recognized as focal or diffuse regions of increased signal intensity or a nonhomogeneous pattern of increased signal often associated with tendinous enlargement. In some patients, manifestations of subacromial-subdeltoid bursitis was present. Tendon degeneration was also manifested as regions of increased signal intensity. Some similarity and overlap of signal patterns of partial interstitial tears, tendinitis, and tendon degeneration are observed.     

Shoulder after rotator cuff repair: MR imaging findings in asymptomatic individuals--initial experience

PURPOSE: To assess the magnetic resonance (MR) imaging appearance of the successfully repaired rotator cuff in an asymptomatic population. MATERIALS AND METHODS: Fifteen subjects who had undergone clinically successful rotator cuff repair were included in the study. All underwent functional testing of the affected shoulder and had good to excellent scores on the Constant scale. Standard MR imaging sequences were performed at 1.5 T, including oblique coronal fast spin-echo T2-weighted MR imaging with fat saturation. RESULTS: Three (10%) of 30 supraspinatus and infraspinatus tendons had normal signal intensity, and 16 (53%) had mildly increased signal intensity on fast spin-echo T2-weighted fat-saturated images, compatible with tendonitis or tendinosis. Three partial and four complete tears of the supraspinatus tendon and two partial and two complete tears of the infraspinatus tendon were seen. Other findings included subacromial-subdeltoid effusion (10 subjects), joint effusions (five subjects), and bone marrow edema (six subjects). CONCLUSION: Postoperative signal intensity changes consistent with tendonitis or tendinosis were common, and clinically "silent" partial and complete rotator cuff tears were seen. Such postoperative MR imaging findings should be interpreted with caution, and meticulous correlation with symptoms and clinical results is recommended.     

Shoulder impingement syndrome: MR findings in 53 shoulders

The shoulder impingement syndrome refers to a condition in which the supraspinatus tendon and subacromial bursa are chronically entrapped between the humeral head inferiorly and either the anterior acromion itself, spurs of the anterior acromion or acromioclavicular joint, or the coracoacromial ligament superiorly. As a result, the space for the bursa and tendon is reduced, and repeated trauma to these structures leads to bursitis and rotator cuff injury. Although pain and limitation of motion are common early findings, the diagnosis is often delayed until a complete tear of the rotator cuff has occurred. In an attempt to determine if MR can be used to depict the abnormalities associated with impingement syndrome (subacromial bursitis, supraspinatus tendinitis, and rotator cuff tear), we reviewed 107 MR scans of painful shoulders. Changes consistent with impingement syndrome were found in 53 patients (50%), 32 of whom underwent subsequent arthrography or surgery. MR was found capable of depicting several soft-tissue and bony abnormalities that have been clinically described in impingement syndrome. In regions of inflammation, we found that the supraspinatus tendon and/or the subacromial bursa were compressed by spurs (25 shoulders), capsular hypertrophy of the acromioclavicular joint (six shoulders), and/or low-lying acromion (14 shoulders). While T1-weighted MR imaging was highly sensitive to abnormalities of the supraspinatus tendon, tendinitis could be differentiated from a small tear of the supraspinatus tendon only with T2-weighted imaging. Large, full-thickness tears, especially if chronic, produced characteristic MR findings on both T1- and T2-weighted images. We conclude that MR can be used to detect several abnormalities associated with the shoulder impingement syndrome.     

MR evaluation of subscapularis tears.

PURPOSE: The purpose of this work was to describe the MR appearance of tears of the subscapularis tendon and compare the usefulness of different imaging planes as well as note the association of subscapularis tears with other rotator cuff tears and biceps tendon dislocations. METHOD: MR studies at 1.5 T over an 8 year interval were retrospectively assessed for the presence of a rotator cuff tear and/or tear of the subscapularis tendon. Images that showed a subscapularis tear were reviewed for the presence of a visible tear separately on the axial, coronal, and sagittal images. The MR studies were also evaluated for associated tears of the supraspinatus, infraspinatus, and teres minor muscles as well as biceps tendon dislocation and the "naked humerus sign" on coronal images. Last, clinical records and surgical reports were reviewed. RESULTS: Forty-five (2%) of 2,167 rotator cuff tears involved the subscapularis; 27% were partial and 73% were complete tears. Tears were best seen in the sagittal oblique plane. Almost all subscapularis tears were an extension of typical rotator cuff tears: supraspinatus in 35 patients (79%), extending into infraspinatus tears in 25 (56%) and into teres minor tears in 2 patients (4%). Bicipital dislocations were seen in 22 patients (49%), and three complete tears of the biceps (7%) were noted as well. The naked humerus sign was demonstrated in 31 patients (69%). Surgical reports that confirmed the MR findings were available for 15 patients. CONCLUSION: About 2% of rotator cuff tears involve the subscapularis tendon. Most subscapularis tears are extensions of supraspinatus tears and frequently involve the biceps tendon.     

Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

Purpose To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Materials and methods Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. Results There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Conclusion Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear.     

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months’ follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.     

Normal rotator cuff: MR imaging with conventional and fat-suppression techniques

The signal intensity and morphologic characteristics of the rotator cuff and surrounding structures at magnetic resonance (MR) imaging were investigated with five pulse sequences in 15 asymptomatic subjects. In all subjects, a focal region of relative increased signal intensity corresponding to the critical zone was observed in the supraspinatus tendon just proximal to its insertion. Soft-tissue signal intensity (isointense with muscle) was also located between the supraspinatus tendon and underlying joint capsule, interposed between the conjoined leaves of the supraspinatus and infraspinatus tendons, and superolateral to the conjoined cuff tendon, near its insertion. These regions were most conspicuous and most clearly defined with fat-suppression imaging. Small amounts of fluid were observed within the joint space and its recesses, the bicipital tendon sheath, and the subacromial-subdeltoid bursa. These and other MR imaging findings of this study previously have been regarded as indicative of rotator cuff abnormalities. These results will help refine the criteria for diagnosis of rotator cuff disorders with MR imaging.