MRI、MR肩关节造影及高频超声诊断肩袖损伤的差异性分析

目的探讨MRI、MR肩关节造影(MRAr)及高频超声诊断肩袖损伤的差异性。方法收集2015年2月—2016年9月间于天津市第五中心医院就诊的疑似肩袖损伤病人84例,其中男52例,女32例,年龄22~64岁,平均(48.2±12.1)岁。回顾分析病人的MRI、MRAr及高频超声影像资料,采用χ~2检验比较MRI和高频超声2种方法诊断效能的差异。采用Kappa检验分析MRI、高频超声,以及MRI、高频超声和MRAr 3种方法联合分别与肩关节镜检查结果的一致性。结果对于Ⅰ型肩袖撕裂,MRI、MRAr和高频超声3种检查方法的准确度均为100%。MRAr对于Ⅰ型、Ⅱ型、Ⅳ型肩袖损伤有较高的检出率,总准确度为97.8%(45/46),而对于Ⅲ型、Ⅴ型、Ⅵ型肩袖撕裂则无法检出。MRI和高频超声诊断肩袖损伤的敏感度、特异度及准确度分别为88.8%、75.0%、88.1%和87.5%、75.0%、86.9%,2种方法对肩袖损伤诊断效能的差异无统计学意义(χ~2=0.856,P=0.1)。MRI、高频超声和MRAr 3种方法联合诊断肩袖损伤的敏感度、特异度及准确度分别为93.7%、100%、94.0%。3种方法分别与肩关节镜检查结果比较,均具有较高的一致性(κ=0.81,P=0.001;κ=0.79,P0.001;κ=0.94,P0.001)。结论高频超声可以作为肩袖损伤的初筛检查方法,MRI可作为有效补充,MRAr对于Ⅰ型、Ⅱ型、Ⅳ型肩袖损伤有较高的检出率,3种方法相互补充,明显提高诊断准确性。

Comparison of MRI,MR shoulder joint arthrography and high frequency ultrasound in the diagnosis of rotator cuff injury

Objective To investigate the abilities of MRI, MR shoulder joint arthrography (MRAr) and high fre-quency ultrasound in diagnosis of rotator cuff injury. Methods Eighty four patients with suspected rotator cuff injury were treated in The Fifth Central Hospital of Tianjin from February 2015 to September 2016, there were 52 males and 32 fe-males, aged 22-64 years, with an average of (48.2 ±12.1) years. Retrospectively analyzed the imaging data of MRI, MR shoulder joint arthrography and high frequency ultrasound,χ2 test was used to compare the difference in diagnostic efficacy between MRI and high frequency ultrasound. Kappa test was used to analyze the consistency of MRI, high frequency ultra-sound with shoulder arthroscopy, and the consistency of the 3 methods of MRI, high frequency ultrasound and MRAr com-bined with shoulder arthroscopy was analyzed respectively. Results The accuracy of MRI, MRAr, and high frequency ul-trasound in the diagnosis of typeⅠrotator cuff injury was 100%. MRAr has a very high detection rate for typeⅠ, type Ⅱ and type Ⅳ rotator cuff injury, and the accuracy was 97.8%(45/46), but was invalid for type Ⅲ, typeⅤand typeⅥrota-tor cuff injury. The sensitivity, specificity and accuracy of MRI and high frequency ultrasound in the diagnosis of rotator cuff injury were:88.8%, 75.0%, and 88.1%;87.5%, 75%, and 86.9%, respectively, and there were not statistically signif-icant between them (χ2=0.856, P=0.1). Combining MRI, MRAr and high frequency ultrasound, the sensitivity, specificity and accuracy in diagnosing rotator cuff injury were 93.7%, 100%and 94%, respectively. The three methods had good con-sistency compared with shoulder arthroscopy in detecting rotator cuff injury (κ=0.81, P=0.001;κ=0.79, P<0.001;κ=0.94, P<0.001, respectively). Conclusion High frequency ultrasound can be used as the primary method for rotator cuff injury, and MRI is an effective complement. MRAr has a very high detection rate for type Ⅰ,Ⅱ type, and type Ⅳ rotator cuff in-jury. The three methods complement each other, and combination can improve the diagnostic accuracy.