高频超声与MRI检查在肩袖撕裂诊断中的比较研究

目的：比较和评价高频超声与 MRI 在肩袖撕裂诊断中的应用价值。方法选择经肩关节镜证实为单侧肩袖撕裂,且术前同时行高频超声和 MRI 检查的患者86例,以肩关节镜为评价标准,分别计算高频超声和 MRI 诊断肩袖总体(含全层和部分)、全层及部分撕裂的准确率。率的比较采用χ2检验。结果86例患者中,肩关节镜证实肩袖全层撕裂30例,部分撕裂56例。高频超声诊断全层撕裂28例,部分撕裂43例;MRI 诊断全层撕裂28例,部分撕裂51例。高频超声和 MRI 诊断肩袖总体、全层及部分撕裂的准确率分别为82.6%、93.3%、76.8%和91.9%、93.3%、91.6%。高频超声与 MRI 诊断肩袖总体和全层撕裂准确率的差异无统计学意义(P >0.05),但诊断部分撕裂的准确率高频超声略低于 MRI 检查(P <0.05)。结论高频超声与 MRI 检查在肩袖全层撕裂诊断中均具有较高的准确率,高频超声诊断价值略低于 MRI。     

肩关节疼痛的MRI检查价值评估

目的评价MRI检查对肩关节疼痛疾病诊断的应用价值。方法分析34例肩关节疼痛患者的MRI表现,并与手术所见相对比,评估MRI对疾病诊断的准确性。结果34例患者肩关节磁共振成像扫描发现:肩袖完全撕裂、肩袖部分撕裂、肌腱炎、盂唇撕裂、滑膜炎、关节积液、肱二头肌长头腱鞘炎及肌腱脱位、肿瘤等。13例手术,其中1例MRI诊断为肌腱炎,手术结果为肩袖浅表部分撕裂;1例MRI表现正常,关节镜发现肱二头肌长头肌腱炎,其余11例手术所见与MRI表现基本一致,另21例经保守治疗,症状消失或好转。结论肩关节MRI能清晰显示出肩关节的复杂解剖结构,对慢性肩关节疼痛的病因诊断有较高的准确性,是一项有价值的检查方法。     

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.     

肩关节磁共振成像扫描技术的临床应用

目的 探讨磁共振成像扫描技术在肩关节疾病诊断和鉴别诊断中的应用价值。方法 本组39例病例(男22例,女17例),应用GP FLEX柔韧线圈作肩关节磁共振成像检查,取横轴位、斜冠状位、斜矢状位三个位置采集,扫描范围包括肱骨头和整个关节盂。扫描序列为自旋回波及快速自旋回波。结果 39例肩关节磁共振成像扫描发现：肩袖撕裂,肩关节骨折,肩周炎,肿瘤,关节积液,腱鞘炎等。结论 肩关节磁共振成像因有较好的分辨力和优良的软组织对比性,以及能多平面成像,可直接显示肩袖损伤及相关的病理改变,对肩关节疾病的诊断和鉴别诊断有较高的应用价值。     

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.     

3.0T MR肩关节造影对肩袖损伤的诊断价值分析

目的探讨3. 0T MR肩关节造影在肩袖损伤诊断中的价值。方法回顾性分析2014年3月～2017年3月期间,经关节镜检查证实的111例肩袖损伤的肩关节术前常规MRI和MR关节造影资料。结果 111例肩关节中,肩袖完全撕裂15例,常规MRI和MR关节造影正确诊断率均为100%;肩袖部分撕裂96例,其中滑囊面型27例、肌腱内型26例、关节面型43例,常规MRI对以上三种类型的肩袖部分撕裂正确诊断率分别为85. 2%、88. 5%和76. 7%,MR关节造影对其正确诊断率分别为85. 2%、80. 8%和93. 0%;两种检查方法对滑囊面型和肌腱内型肩袖部分撕裂的诊断无明显差异,而对关节面型肩袖部分撕裂的诊断,MR关节造影优于常规MRI,差异有统计学意义(P 0. 05)。结论 MR关节造影对肩袖损伤的诊断具有较高的价值,但在关节滑囊型和肌腱内型两种类型的肩袖部分撕裂的诊断中仍存在一定的局限性。     

高频超声及肩峰下滑囊超声造影在肩袖损伤诊断中的应用价值

目的：探讨高频超声及经皮肩峰下滑囊超声造影在肩袖损伤中的应用价值，分析两种超声检查技术在肩袖损伤诊断中的的效能差异。方法：选取2019年3月至2021年3月我院骨科运动医学门诊临床确诊为肩袖损伤的患者42例，其中男23例、女19例。术前均行高频超声、肩峰下滑囊超声造影及磁共振成像(MRI)检查，以肩关节镜下所见作为肩袖撕裂诊断的金标准，采用受试者工作特征(ROC)曲线分析高频超声、肩峰下滑囊超声造影与MRI对不同类型肩袖损伤的诊断效能。结果：肩关节镜证实的42例患者中，肩袖损伤36例(85.71%)。其中全层撕裂15例(41.67%)，高频超声诊断7例，肩峰下滑囊超声造影诊断13例，MRI诊断14例；部分撕裂21例(58.33%)，高频超声诊断12例，肩峰下滑囊超声造影诊断18例，MRI诊断19例。对于全层撕裂，高频超声、肩峰下滑囊超声造影及MRI的ROC曲线下面积(AUC)分别为0.604、0.896、0.930；对于部分撕裂，高频超声、肩峰下滑囊超声造影及MRI的AUC分别为0.643、0.905、0.929；对于无撕裂，高频超声、肩峰下滑囊超声造影及MRI的AUC分别为0.653...     

常规MRI及MRI肩关节造影在肩袖撕裂中的应用

目的:探讨常规MRI及MRI肩关节造影在肩袖撕裂诊断中的价值。方法:226例肩关节损伤的患者,分别行常规MRI及MRI肩关节造影检查,以近期肩关节镜检查为金标准,对比2种检查方法的敏感性及特异性。结果:常规MRI对肩袖撕裂诊断的敏感性为70.8%(17/24),特异性100%(2/2),准确性65.4%(17/26);MRI肩关节造影对肩袖撕裂的敏感性为95.8%(23/24),特异性100%(2/2),准确性88.5%(23/26)。两者的诊断敏感性差异有统计学意义(P=0.016)。结论:MRI肩关节造影可以显著提高肩袖撕裂诊断的敏感性。     

肩关节损伤MRI与关节镜的对比分析

目的探讨常规MRI对肩关节损伤的诊断价值。方法回顾性分析因肩关节损伤行常规MRI和关节镜检查的55例病人资料,MRI观察指标包括肩袖、盂唇形态及信号,有否肩峰下撞击及骨性损伤。以肩关节镜为诊断金标准,统计MRI对不同类型肩关节损伤的诊断结果,并分别计算MRI的诊断敏感度、特异度和准确度。采用Kappa检验分析MRI与肩关节镜诊断结果的一致性。结果肩关节损伤的MRI征象中分别有25%部分肩袖撕裂、13.3%Bankart’s损伤、20%盂唇上部前后方向(SLAP)损伤和11.6%肩峰下撞击漏诊。MRI诊断损伤性病变的特异度及肩袖全层撕裂(100%)、骨性损伤(100%)、肩峰下撞击(88%)和Bankart’s损伤(87%)的敏感度较高,诊断SLAP损伤(75%)和肩袖部分撕裂(75%)的敏感度较低;诊断肩袖全层撕裂(100%)和骨性损伤(100%)的准确度最高,其次是Bankart’s损伤(96%),诊断SLAP损伤(89%)的准确度较低。MRI和关节镜诊断肩袖全层撕裂、骨性损伤的κ值为1,结果完全一致,诊断Bankart’s损伤的κ值为0.904,一致性较好,诊断肩袖部分撕裂、SLAP损伤和肩峰下撞击的κ值虽稍低,但均0.75,一致性也较好,P均0.05。结论 MRI是有效诊断肩关节损伤的影像方法,但对SLAP损伤和肩袖部分撕裂的诊断准确度有待提高。     

肩关节造影和MRI诊断肩袖损伤

目的评定肩关节造影、MRI诊断肩袖损伤的价值.材料和方法将33例临床诊断肩袖损伤患者的术前关节造影和MRI检查结果与术中观察结果的比较.另有13例复发性肩关节不稳、无肩袖损伤症状和体征的年轻患者术前的关节造影和MRI结果以及术中观察结果作为正常肩袖对照.结果在诊断肩袖完全断裂中,肩关节造影的敏感性为91%,特异性为100%;MRI的敏感性为95%,特异性为88%.结论关节造影诊断肩袖完全撕裂方法简单、迅速且费用低,易于广泛开展.但不能直接显示病变部位.MRI不但能够准确显示断裂的部位,反映肩袖病变的病理过程,而且能同时显示相邻组织的病理改变,更利于诊断和鉴别诊断.     

MR imaging of the shoulder. Impingement and instability-related abnormalities

In addition to the case history and the clinical examination, MR imaging has an important role in the diagnosis and differential diagnosis of numerous shoulder abnormalities and in the investigation of chronic shoulder pain. Important indications for MR imaging are any conditions or symptoms making assessment of the rotator cuff and the labrocapsular complex necessary. Assessment of the rotator cuff muscles, in particular, is crucial. The value of MR arthrography, which is still controversial, is discussed. The greatest potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities and shoulder instability-related lesions, and the assessment of pathologic conditions of the long biceps tendon. This paper describes the most common pathologic findings of the shoulder joint and describes how the relevant findings are reported and quantified for the orthopaedic shoulder surgeon.     

Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff

OBJECTIVE: This study was performed to examine the relationship and association of abnormalities seen in the long head of the biceps brachii tendon to abnormal findings in the rotator cuff. MATERIALS AND METHODS: One hundred eleven patients underwent MR imaging for shoulder pain followed by arthroscopic or open shoulder surgery from January 1997 to December 2000. Patients were identified by a retrospective search, and all consecutive patients having undergone both MR imaging and surgery were included in the patient cohort. Official MR imaging interpretations were compared with operative reports, and all findings were recorded. RESULTS: Twenty-three patients were identified with partial- or full-thickness tears of the long head of the biceps tendon. The sensitivity, specificity, and accuracy of unenhanced MR imaging of the shoulder for detecting these bicipital tears were 52%, 86%, and 79%, respectively. When a tear was present in the biceps tendon, the prevalence of supraspinatous, infraspinatus, and subscapularis tendon tears was 96.2%, 34.6%, and 47.1%, respectively. Patients with biceps tendon tears were significantly more likely to also have subscapularis tendon tears (p < 0.0001) and supraspinatous tendon tears (p < 0.008) than those patients who did not have biceps tendon tears. No significant relationship was found between the presence or absence of a biceps tendon tear and the presence or absence of a infraspinatus or teres minor tendon tear (p = 0.17). CONCLUSION: Tears of the long head of the biceps tendon have a statistically significant association with tears of the anterior and superior rotator cuff and are highly correlated with tears of the supraspinatous and subscapularis tendons. When tears of these tendons are detected, specific attention directed toward the long biceps tendon is warranted to characterize the status of this structure that provides additional stability to the shoulder joint.     

Adhesive capsulitis: role of MR imaging in differential diagnosis

The purpose of this study was to describe and characterize the MR imaging findings in a group of patients who underwent surgery for adhesive capsulitis. Twenty-four MR imaging studies in 24 consecutive patients with clinical evidence of adhesive capsulitis were performed prior to arthroscopic capsulotomy. There were 17 women and 7 men with a mean age of 53.5 years. Images were scrutinised for changes in the synovium particularly in the rotator interval, around the biceps anchor and axillary pouch. Intravenous gadolinium was given routinely. We also examined a control group of 22 patients who underwent the same MR imaging protocol after referral for rotator cuff pathology. Soft tissue density showing variable enhancement after gadolinium administration was visible in the rotator interval in 22 of 24 studies on MR imaging. Seventeen patients showed soft tissue density partially encasing the biceps anchor. Ten patients showed thickening and gadolinium enhancement of the axillary pouch. Three patients from the study cohort had partial tears of the supraspinatus tendon. All the patients subsequently had surgery which confirmed fibrovascular scar tissue in the rotator interval, around the biceps anchor and a variable degree of synovial inflammation of the glenohumeral capsule. Two patients from a control group with suspected rotator cuff pathology showed abnormal intensity in the rotator interval on MR imaging. Magnetic resonance imaging can identify changes in the shoulder joint that correspond to abnormalities seen at surgery. This may be useful for discriminating adhesive capsulitis from other causes of shoulder pain.     

Diagnostic evaluation of athletes with posttraumatic chronic shoulder pain

We examined 20 consecutively admitted athletes suffering from chronic shoulder pain for more than 6 months following a single shoulder trauma without dislocation. All had pain during loading, especially during over-the-head activities with a clicking sensation, and symptoms of dead arm were also present. On examination, 8 patients had decreased range of motion and 14 patients had a positive apprehension test. Three had signs of impingement. Diagnostic evaluation with special X-ray, ultrasonography, magnetic resonance imaging (MRI) and arthroscopy identified IS lateral tears, 3 partial and 1 total rotator cuff lesions and 2 patients with synovitis of the rotator cuff with subacromial impingement. Three patients had tendinitis of the biceps tendon and 1 had a lesion of the greater tubercle. In conclusion, chronic shoulder pain after a single nondislocated shoulder trauma in athletes should be evaluated due to a possible intraarticular cause of the pain. MRI seems to be the most valuable noninvasive method of evaluating patients with chronic shoulder pain and should be performed before arthroscopy and operative procedures.     

Rotator cuff lesions: evaluation with RM and US

Physical and instrumental examination of the patients with an "aching shoulder" is often difficult and a positive out-come of surgical treatment may be impaired by the late diagnosis of long-standing rotator cuff lesions causing tendon adhesions and muscle atrophy. The authors report the results obtained in 25 selected patients with an aching shoulder examined with arthrography, real-time ultrasound (US) with a 5 MHz linear probe, and high-field (1.5 T) Magnetic Resonance (MR) imaging. Arthrography was able to demonstrate a cuff tear in 14/25 cases; US detected signs of tear in 14/25 (1 false negative); MR imaging showed a cuff lesion in 16/25 patients, and in one case allowed a partial cuff tear to be demonstrated, which had not been visualized with arthrography. MR imaging could also demonstrate other signs of periarticular pathologies (tendinitis, longhead of biceps inflammation, and bursitis) that may represent the early stages of the inflammatory-degenerative process underlying most of cuff lesions. The high diagnostic accuracy of US (95%) is stressed in the detection of cuff tears, in patients with an aching shoulder; as for questionable cases at US, MR imaging is indicated as a valid alternative to arthrography, which is more invasive and less accepted by the patients.     

Magnetresonanztomographie der Schulter

In addition to the case history and the clinical examination, MR imaging has an important role in the diagnosis and differential diagnosis of numerous shoulder abnormalities and in the investigation of chronic shoulder pain. Important indications for MR imaging are any conditions or symptoms making assessment of the rotator cuff and the labrocapsular complex necessary. Assessment of the rotator cuff muscles, in particular, is crucial. The value of MR arthrography, which is still controversial, is discussed. The greatest potential benefit of MR arthrography is the accurate evaluation of subtle rotator cuff abnormalities and shoulder instability-related lesions, and the assessment of pathologic conditions of the long biceps tendon. This paper describes the most common pathologic findings of the shoulder joint and describes how the relevant findings are reported and quantified for the orthopaedic shoulder surgeon.     

Arthrography of the biceps tendon

The purpose of this study was to analyse the factors having an influence on the arthrographic imaging of the biceps tendon. The study comprised 174 patients suffering from chronic shoulder pain. They underwent conventional shoulder arthrography with sodium meglumine metrizoate or metrizamide as a contrast medium. In the patients with a full-thickness tear of the rotator cuff, the biceps tendon sheath failed to fill with contrast medium more often than in those with an intact tendinous cuff. Metrizamide filled the biceps tendon sheath more readily than sodium meglumine metrizoate in patients with a full-thickness tear of the rotator cuff. The volume of the contrast medium injected had no influence on the imaging of the biceps tendon.