Patterns of tendon retraction in full-thickness rotator cuff tear: comparison of delaminated and nondelaminated tendons

Skeletal Radiology - To analyze full-thickness rotator cuff tears, compare retraction patterns in delaminated and nondelaminated tendons, and correlate retraction distances with anteroposterior...     

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.     

Expression of matrix metalloproteinases 1, 3, and 9 in differing extents of tendon retraction in the torn rotator cuff

Purpose  

Differing extents of tendon retraction are found in full-thickness rotator cuff tears. The pathophysiologic context of tendon degeneration and the extent of tendon retraction are unclear. Tendon integrity depends on the extracellular matrix, which is regulated by matrix metalloproteinases (MMP). It is unknown which enzymes play a role in tendon degeneration. The hypotheses are that (1) the expression of MMPs 1, 3, and 9 is altered in the torn rotator cuff when compared with healthy tendon samples; and (2) that there is a relationship between MMP expression and the extent of tendon retraction in the torn cuff.     

Increased versican content is associated with tendinosis pathology in the patellar tendon of athletes with jumper's knee

Expansion of the extracellular matrix is a prominent but poorly characterized feature of tendinosis. The present study aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. We obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel thickness and density were determined using computer-assisted image analysis. Markers for smooth muscle actin, endothelial cells (CD31) and proliferating cells (Ki67) were examined immunohistochemically. Western blot analysis and immunohistochemical staining revealed elevated versican content in the proximal patellar tendon of tendinosis patients ( P =0.042). Versican content was enriched in regions of fibrocartilage metaplasia and fibroblast proliferation, as well as in the perivascular matrix of proliferating microvessels and within the media and intima of arterioles. Microvessel density was higher in tendinosis tissue compared with control tissue. Versican deposition is a prominent feature of patellar tendinosis. Because this molecule is not only a component of normal fibrocartilagenous matrices but also implicated in a variety of soft tissue pathologies, future studies should further detail both pathological and adaptive roles of versican in tendons.     

Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score

Objectives

The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes.

Cystic changes at supraspinatus and infraspinatus tendon insertion sites: association with age and rotator cuff disorders in 238 patients

PURPOSE: To retrospectively determine the frequency of posterior and anterior cystic abnormalities at rotator cuff insertion site on the greater tuberosity and to determine their relationship to patient age and rotator cuff disorders. MATERIALS AND METHODS: Institutional review board approval was given; informed consent was waived. The study was HIPAA compliant. In 238 patients with rotator cuff diagnoses at surgery, preoperative magnetic resonance (MR) imaging studies were reviewed to localize osseous cystic changes as anterior (supraspinatus insertion site) or posterior (infraspinatus insertion site) on the greater tuberosity. If rotator cuff tear was present, tendon retraction and location of partial tear (articular or bursal surface) were recorded. Two radiologists reached conclusions by consensus. Locations of cysts were correlated to surgical cuff diagnoses: no tear, tendinopathy, partial-thickness tear, and complete tear. Prospective interpretations from original MR reports were compared with surgical results. Statistical analyses included one-way analysis of variance, chi(2), Fisher exact, and Student t tests, as well as logistic regression and receiver operating characteristic curve comparison. RESULTS: There were 238 consecutive patients (150 men, 88 women; mean age, 43 years). Cysts were located at or near footprint of cuff tendon and demonstrated fluid or soft-tissue signal intensities. Posterior cysts occurred in 56.7% of shoulders and showed no statistical correlation to age or cuff diagnosis. Anterior cysts occurred in 22.7% of shoulders and were strongly associated with cuff disorders (P<.001). Controlling for cuff disorders, there was no relationship between anterior cysts and age (P>.50). Anterior cysts were more common in partial-thickness articular (48%) than in bursal (13%) tears (P<.001). CONCLUSION: Posterior cysts were more common than anterior cysts and showed nearly random distribution among patients, regardless of age and cuff diagnosis. Anterior cysts were closely associated with cuff disorders.     

高频超声及声触诊组织量化技术对男性肩袖损伤患者冈上肌腱的评价

目的:应用高频超声及声触诊组织量化技术(VTIQ)评价男性肩袖损伤患者冈上肌腱的变化.方法:收集50例确诊的肩袖损伤男性患者,分为A组(35～59岁)28例和B组(≥60岁)22例.患者均行常规检查及VTIQ检查,测量冈上肌腱的厚度及其近端、远端的剪切波速度(SWV).结果:常规检查示B组双侧冈上肌腱厚度均大于A组(均...     

The guanine-thymine dinucleotide repeat polymorphism within the tenascin-C gene is associated with achilles tendon injuries

BACKGROUND: Although there is a high incidence of tendon injury as a result of participation in physical activity, the mechanisms responsible for such injuries are poorly understood. Investigators have suggested that some people may have a genetic predisposition to develop tendon injuries; in particular, genes on the tip of the long arm of chromosome 9 might, at least in part, be associated with this condition. The tenascin-C gene, which has been mapped to chromosome 9q32-q34, encodes for a structural component of tendons. HYPOTHESIS: The tenascin-C gene is associated with Achilles tendon injury. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: A total of 114 physically active white subjects with symptoms of Achilles tendon injury and 127 asymptomatic, physically active white control subjects were genotyped for the guanine-thymine dinucleotide repeat polymorphism within the tenascin-C gene. RESULTS: A significant difference in the allele frequencies of this polymorphism existed between the 2 groups of subjects (chi(2) = 51.0, P = .001). The frequencies of the alleles containing 12 repeats (symptomatic group, 18.9% vs control group, 10.2%) and 14 repeats (symptomatic group, 9.2% vs control group, 0.8%) were significantly higher in the symptomatic group, while the frequencies of the alleles containing 13 repeats (symptomatic group, 8.8% vs control group, 24.0%) and 17 repeats (symptomatic group, 7.5% vs control group, 20.1%) were significantly lower in this same group. Subjects who were homozygous or heterozygous for the underrepresented alleles (13 and 17 repeats) but who did not possess an overrepresented allele (12 and 14 repeats) may have a lower risk of developing Achilles tendon injuries (odds ratio, 6.2; 95% confidence interval, 3.5-11.0; P < .001). CONCLUSIONS: The guanine-thymine dinucleotide repeat polymorphism within the tenascin-C gene is associated with Achilles tendon injury. Alleles containing 12 and 14 guanine-thymine repeats were overrepresented in subjects with tendon injuries, while the alleles containing 13 and 17 repeats were underrepresented. CLINICAL RELEVANCE: Persons who have variants of the tenascin-C gene with 12 and 14 guanine-thymine repeats appear to have a 6-fold risk of developing Achilles tendon injuries.     

Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears

Rationale and Objectives.Recent evidence suggests an inhomogeneous distribution of intramuscular rotator cuff fat infiltration (FI) in a small sample of individuals with rotator cuff tears, yet clinically just a few slices at the scapular Y-view are used to evaluate FI in patients with rotator cuff tears. The purpose of this study was to determine if assessment of FI using the scapular Y-view is representative of the entire muscle in patients with full-thickness rotator cuff tears, and whether this varies by tear size.Materials and methodsPatients (N = 25) diagnosed with full-thickness rotator cuff tear and confirmed with magnetic resonance imaging (MRI) were included. Fat-water sequences were used to objectively quantify mean FI (%) in the entire 3D muscle and the mean from 3 slices at the Y-view. Mixed-model 2 × 2 ANOVAs were used to assess for differences between methods, and if results vary by tear-size.ResultsThere were no statistically significant differences between mean amount of FI of the entire 3D muscle and mean Y-view in the supraspinatus or infraspinatus muscles (p > 0.05). Additionally, this did not differ across tear size groups (p > 0.05).ConclusionResults of this study suggest FI assessed in the Y-view is not different (mean difference < 1.0%) from FI of the entire 3D muscle in patients with full-thickness rotator cuff tears. Therefore, the clinical utility of evaluating rotator cuff intramuscular fat infiltration with the Y-view is further supported in patients with full-thickness rotator cuff tears across tear sizes.     

MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears

ObjectiveTo assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR).Materials and methodsThis is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed.Results24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1 months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5 ± 6.1 mm) than those without tear (mean 6.1 ± 3.8 mm) (p = 0.028). SSD > 7.9 mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (p = 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (p = 0.005) and forward elevation (p = 0.021) although there was no correlation between clinical outcome and integrity of the graft.ConclusionSCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.     

Increased FDG uptake in breast cancer is associated with prognostic factors

Purpose

To evaluate the relationship between FDG uptake and prognostic factors of breast cancer such as hormone receptors (estrogen and progesterone), expression of c-erbB-2, axillary lymph node status, tumor histology, grade and size.

Materials and methods

Between May 2009 and February 2011; 79 patients (mean age?±?SD: 52.9?±?13.9?years) with biopsy proven breast cancer underwent F-18 FDG PET/CT scanning for staging. Patients with excisional biopsy or neoadjuvant chemotherapy were excluded from the study. Histological types included were invasive ductal carcinoma (n?=?68), invasive lobular carcinoma (n?=?2), and invasive ductal plus lobular mixed carcinoma (n?=?9). Maximum standardized uptake values (SUVmax) were compared with estrogen (ER) and progesterone receptors (PR), expression of c-erbB-2, as well as tumor grade and tumor size. For the evaluation of relationship between tumor SUVmax values and prognosticators such as hormone receptors, tumor histologic grade, and tumor size, statistical analyses were performed using Student t test, Mann?CWhitney U Test and Pearson correlation coefficient and p values of less than 0.05 were considered to indicate statistically significant differences.

Results

All primary breast neoplasms were detected by PET/CT scanner. The mean SUVmax values and breast cancer tumor sizes ranged from 2.09 to 39.0 and 0.7 to 10?cm, respectively. Tumors with negative ER [(n?=?19); SUVmax median (min?Cmax): 15 (2.09?C39.0)] were associated with higher SUVmax values (p?=?0.01). Tumors with overexpression of C-erbB-2 [(n?=?28); SUVmax median (min?Cmax): 16.0 (5.0-39.0)]; tumor grade 3 [(n?=?25); SUVmax median (min?Cmax): 15 (6.43?C39)]; axillary lymph node involvement [(n?=?60); SUVmax median (min?Cmax): 13.61 (4.0?C39.0)]; tumor histopathology and increased tumor size were associated with higher maximum standardized uptake values. However, PR did not show any relationship with SUVmax values.

Conclusion

In the present report, strong relationships were detected between the negativity of ER, overexpression of c-erbB-2, tumor grade, tumor size, histopathology, axillary lymph node involvement and SUVmax values. Accordingly, we believe that SUVmax values obtained with ¹⁸F-FDG PET/CT may provide some information about tumor biology of breast cancer.     

Increased expression of GRP94 protein is associated with decreased sensitivity to X-rays in cervical cancer cell lines

PURPOSE: Radiation therapy is one of the standard treatments for cervical cancer. Glucose regulated protein 94 (GRP94) is a molecular chaperone, which increases in amount after X-ray irradiation. This study examined the involvement of GRP94 in radio-resistance in human cervical cancer cells. MATERIALS AND METHODS: Seven human cervical carcinoma cell lines (HeLa, SKG-I, SKG-IIIb, QG-U, Caski, SiHa and C33A) were examined for basal levels of GRP94 protein by western blotting analysis. Sensitivity to X-ray irradiation of these cell lines was determined with a colony survival assay. The suppression of GRP94 expression was performed using specific small-interfering RNA (siRNA) in HeLa and Caski cells. RESULTS: HeLa cells and QG-U cells, with higher basal levels of GRP94, exhibited a low sensitivity to X-ray cell killing. In HeLa cells, the sensitivity increased when protein GRP94 levels were reduced by specific siRNA transfection. However, a reduction in GRP94 protein had little effect on the X-ray sensitivity of Caski cells, which expressed low basal GRP94 protein levels but showed a low sensitivity to X-rays. CONCLUSIONS: High basal protein levels of GRP94 were correlated with a modest decrease in sensitivity to X-ray cell death in some cervical cancer cell lines. These results suggest that higher GRP94 protein expression is one of the molecular mechanisms causing resistance to radiation, and therefore GRP94 siRNA might be useful in tumor-specific gene therapy by reversing radio-resistance prior to radiation in cervical cancer.     

Hormone therapy is associated with smaller Achilles tendon diameter in active post-menopausal women

The effects of hormonal status and activity levels on Achilles tendon structure were examined in asymptomatic post-menopausal women. It was hypothesized that women using hormone replacement therapy (HRT) would have better tendon structure than those not using HRT and that active women would have poorer tendon structure than inactive women. Eighty-five women including 53 active women (regular golf players) and 32 controls (healthy but inactive women) recorded their HRT and menopausal history and underwent basic anthropometric measurements. Women were divided into two groups based on their hormonal status: those currently using HRT; and those who had never used HRT or ceased using HRT at least 12 months prior to the study. Achilles tendons were examined with ultrasound and categorized as normal or abnormal, and the diameter of each tendon (mm) was recorded. Active women had a greater prevalence of tendon abnormality (P=0.10) and thicker Achilles tendons than inactive women (P<0.05). Active women on HRT had less tendon abnormality (P=0.056) than active women not on HRT and significantly less tendon thickness (P<0.05). This study indicates that Achilles tendon diameter is greater in active post-menopausal women. Hormone replacement therapy appeared to ameliorate this effect in active women. A similar effect from HRT on the Achilles tendons of inactive women was not apparent.     

Increased dopamine transporter availability associated with the 9-repeat allele of the SLC6A3 gene.

A polymorphism involving a variable number of tandem repeats (VNTR) has been described in the 3' untranslated region of the gene (SLC6A3) coding for the dopamine transporter (DAT). This polymorphism has 2 common alleles, designated as 10-repeat (*10R) and 9-repeat (*9R), that have been linked with several human clinical phenotypes. Previous investigations of the effects of the SLC6A3 polymorphism on DAT availability in smaller samples of humans have yielded divergent results. METHODS: We assessed genotype at the SLC6A3 promoter VNTR polymorphism in 96 healthy European Americans (age range, 18-88 y) who also underwent SPECT with (123)I-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane (beta-CIT) for measurement of striatal DAT protein availability. A ratio of specific to nondisplaceable brain uptake (i.e., V(3)' = [striatal -occipital]/occipital), a measure proportional to the binding potential, was derived. For this analysis, 9-9 homozygotes and 9-10 heterozygotes were grouped as SLC6A3 *9R carriers and contrasted with SLC6A3 *10R homozygotes. RESULTS: The SLC6A3 *9R carriers had significantly higher striatal DAT availability (V(3)') than did the SLC6A3 *10R homozygotes, controlling for age (F(1,93) = 6.25, P = 0.014, analysis of covariance). The *9R carriers (n = 41, 49.8 +/- 19.5 y) had a mean increase in striatal DAT availability of 8.9% relative to the *10R homozygotes (n = 53, 49.9 +/- 19.2 y). Striatal subregion analysis revealed that the effect of DAT genotype was significant for both the caudate and the putamen. CONCLUSION: These results support the interpretation of higher DAT levels in association with the *9R allele in European Americans and may relate to previously observed associations between DAT genotype and neuropsychiatric diseases.