Diagnóstico de roturas del manguito rotador por ecografía y resonancia magnética: ¿la morfología acromial influye en los resultados? / Ultrasound and magnetic resonance imaging diagnosis for rotator cuff tears: does acromial morphology affect the results?

INTRODUCCIÓN Actualmente no existen estudios que evalúen la concordancia entre la ecografía (ECO) y la resonancia magnética (RM) observando parámetros como el índice acromial (IA) y el ángulo crítico (AC) para roturas del manguito rotador (MR). Se considera que la mayor cobertura de la huella por un IA o AC incrementados podría afectar la adecuada visualización del MR en estudios de ECO al interponerse entre el complejo tendíneo y el transductor ecográfico. OBJETIVO Estimar la concordancia de la ECO y la RM en el diagnóstico de pacientes con roturas del MR confirmadas por artroscopia con IA y AC mayores al promedio normal (0.7 y 35°, respectivamente). Secundariamente, determinar si la concordancia diagnóstica es comparable entre tipos de rotura (espesor completo o parciales). MATERIALES Y MÉTODOS Estudio retrospectivo de una serie consecutiva de 100 pacientes con roturas totales o parciales del MR confirmadas por artroscopia. RESULTADOS La edad media del grupo de estudio fue de 55,7 ± 10,5 años. La media del IA fue de 0,77 ± 0,08, y la del AC, de 37,42° ± 5,88°. La concordancia entre la ECO y la RM y el IA fue > 0,7 de 56,7% (K = 0,27; p = 0,01); y < 0,7 de 35,7% (K = 0,01; p = 0,46), respectivamente. Y la concordancia entre la ECO y la RM y el AC fue > 35° de 61,5% (K = 0,32; p = 0,001); y < 35° de 33,3% (K = -0,00; p = 0,52), respectivamente. CONCLUSIÓN La concordancia diagnóstica de la ECO comparada con la de la RM, en pacientes con roturas del MR confirmada por artroscopia y con IA y AC mayores al promedio normal, fue justa. La concordancia diagnóstica de la ECO comparada con la RM, en pacientes con IA y AC menores al promedio normal, fue pobre. La capacidad diagnóstica fue similar entre la ECO y la RM para roturas parciales y totales.

INTRODUCTION Currently, there are no studies that evaluate the agreement between ultrasound (US) and magnetic resonance imaging (MRI) scans in rotator cuff (RC) tears by the observation of parameters such as the acromial index (AI) and critical shoulder angle (CSA). We hypothesize that the greater coverage of the footprint by increased AI or CSA could affect the proper visualization of the RC in US scans by its interposition between the tendinous complex and the US transducer. OBJETIVE To estimate the agreement between US and MRI in the diagnosis of patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values (0.7 and 35° respectively). The secondary objective is to determine if the diagnostic agreement is comparable regarding different types of tear (partial and complete). MATERIALS AND METHODS A retrospective study of a consecutive case series of 100 patients with partial or complete RC tears confirmed by arthroscopy. RESULTS The mean age of the study group was of 55.7 10.5 years. The mean AI was of 0.77 0.08, and the mean CSA was of 37.42° 5.88°. The agreement regarding the US, the MRI and the AI was > 0.7 of 56.7% (K » 0.27; p » 0.01); and < 0.7 of 35.7% (K » 0.01; p » 0.46) respectively. And the agreement regarding the US, the MRI and the CSA was > 35° of 61.5% (K » 0.32; p » 0.001); and < 35° of 33.3% (K »-0.00; p » 0.52) respectively. CONCLUSION The diagnostic agreement of the US compared with the MRI, in patients with RC tears confirmed by arthroscopy and with AI and CSA greater than the normal average values was fair. The diagnostic agreement of the US compared with the MRI, in patients with AI and CSA lower than the normal average values was poor. The diagnostic performance of the IS and MRI was similar for partial and complete tears.

Shoulder MRI evaluation of the association of os acromiale with supraspinatus and infraspinatus injury / 中国骨伤

OBJECTIVE@#To explore the MRI findings of os acromiale and to analyze the relationship between os acromiale and the supraspinatus and infraspinatus injury.@*METHODS@#From January 2010 to August 2020, 21 patients with os acromiale (os arcomiale group) were compared with 21 subjects with no evidence of os acromiale (no os arcomiale group). There were 14 males and 7 females in the os arcomiate group, aged from 29 to 77 years old, mean aged (55.5±11.5) years old. While in the control group, there were 10 males and 11 females in no os arcomiale group, aged from 31 to 70 years old, mean aged (51.1±10.0) years old. The os acromiales were classified as edematous os acromiale or non-edematous os acromiale based on whether the presence of marrow edema, and as displaced os acromiale or non-displaced os acromiale based on whether the presence of displacement of the os acromiale. The MRI features of os acromiale were analyzed. Statistical analyses were performed to identify the differences between the os arcomiale group and no os arcomiale group regarding rotator cuff tear, supraspinatus and infraspinatus injury. Differences in the supraspinatus and infraspinatus tear between the edematous and non-edematous os acromiale group, the displaced and non-displaced os acromiale group, the displaced os acromiale and no os arcomiale group were also assessed.@*RESULTS@#On MRI, all the 21 os acromiales appeared as a triangular or irregular bone fragment of the distal acromion, and forms a pseudo-acromioclavicular joint with the acromion. Eleven cases were edematous os acromiale, 11 cases were displaced os acromiale. In the os arcomiale group, 17 had supraspinatus tear, 1 had supraspinatus tendinitis, 11 had infraspinatus tear, and 4 had infraspinatus tendinitis. In the no os arcomiale group, 11 had supraspinatus tear, 2 had supraspinatus tendinitis, 5 had infraspinatus tear, and 1 had infraspinatus tendinitis. No statistically significant difference between the os arcomiale group and no os arcomiale group regarding the rotator cuff tear, supraspinatus and infraspinatus injury (P>0.05). In the 11 cases of edematous os arcomiale, 10 had supraspinatus tear and 7 had infraspinatus tear. In the 10 cases of non-edematous os acromiale, 7 had supraspinatus tear and 4 had infraspinatus tear. No statistically significant difference was noted between the edematous os acromiale and non-edematous os acromiale in terms of supraspinatus and infraspinatus tear (P>0.05). In the 11 cases of displaced os acromiale, 11 had supraspinatus tear and 9 had infraspinatus tear. In the 10 cases of non-displaced os acromiale, 6 had supraspinatus tear and 2 had infraspinatus tear. In the no os arcomiale group, 11 had supraspinatus tear and 5 had infraspinatus tear. There was a statistically significant increases in the prevalence of supraspinatus and infraspinatus tear in the displaced os acromiale group compared with non-displaced os acromiale group, the displaced os acromiale group and no os arcomiale group(P<0.05).@*CONCLUSION@#Shoulder MRI can very well depict os acromiale and can reveal associated abnormalities such as adjacent bone marrow edema, displaced deformity, and rotator cuff tear, and it can be used to assess the stability of the os acromiale. The presence of os acromiale may not increase the risk of supraspinatus and infraspinatus tear significantly. However, the presence of displaced os acromiale is at greater risk of supraspinatus and infraspinatus tear.

Diagnosis value of MRI in acute rotator interval injury / 中国骨伤

OBJECTIVE@#To compare clinical application of 1.5 T MRI in acute rotator interval injury.@*METHODS@#Totally 160 patients with acute rotator cuff tear by clinical diagnosis were retrospectively analyzed by MRI examination and arthroscopy from March 2016 to February 2019, including 122 males and 38 females, aged from 22 to 71 years old with an average of (42.35±3.48) years old. Based on the results of arthroscopy as the gold standard, the shape and signal changes of rotator cuff, rotator interval, peripheral bursa, bone and soft tissue were observed by MRI on axial, oblique coronal and oblique sagittal imagese.@*RESULTS@#The direct MRI signs of acute rotator interval injury displayed thickening, diminution, distortion, interruption of the coracohumeral ligament and superior glenohumeral ligament complex with highsignal intensity on fat-suppression by proton weighted sequence. The indirect MRI signs displayed rotator cuff, peripheral bone and soft tissue injury. The consistency of the results between the two methods was quite satisfactory (Kappa=0.85), and the concordance rate of the two methods has statistically significant (@*CONCLUSION@#MRI could clearly display acute rotator interval, and could accurately diagnose acute rotator interval injury, which provide more accurate imaging basis for clinical diagnosis and treatment.

Rupturas del tendón del supraespinoso: correlación entre RMN y hallazgos quirúrgicos / Supraspinatus tendon ruptures: correlation between MRI and surgical findings

Resumen: Introducción: En la ruptura del manguito de los rotadores, el tendón del supraespinoso ocupa el primer lugar en frecuencia. La resonancia magnética es el estudio de elección para el diagnóstico y planificación preoperatoria. El objetivo de este estudio fue evaluar la concordancia entre los hallazgos observados con la IRM y los hallazgos transoperatorios en pacientes con ruptura del tendón del supraespinoso. Material y métodos: Se realizó un análisis retrospectivo de Enero de 2014 a Enero de 2020. Se incluyeron pacientes mayores de 18 años, con IRM y reporte de ruptura del tendón del supraespinoso. Se realizó un análisis de χ2 para la sensibilidad, especificidad, valores predictivos y certeza diagnóstica utilizando los hallazgos quirúrgicos como referencia. Se utilizó el índice de Kappa para mostrar la concordancia entre IRM y hallazgos transoperatorios. Resultados: Un total de 79 pacientes se incluyeron en el estudio, 45 masculinos y 34 femeninos. La edad promedio fue de 52.14 años. La IRM diagnosticó correctamente 60.76% de las rupturas del supraespinoso, mostró una sensibilidad de 74% y especificidad de 96% para rupturas completas. Para rupturas parciales mostró una sensibilidad de 96% y una especificidad de 33%. El índice de Kappa mostró una concordancia de 0.90 para rupturas totales y de 0.53 para rupturas parciales. Conclusiones: La resonancia magnética demostró una buena sensibilidad y especificidad para el diagnóstico de rupturas completas, con una buena concordancia con los hallazgos quirúrgicos. La IRM demostró ser un estudio poco específico para la identificación de rupturas parciales, lo cual genera que estas lesiones estén sobrediagnosticadas.

Abstract: Introduction: In rotator cuff rupture, the supraspinatus tendon ranks first in frequency. MRI is the study of choice for preoperative diagnosis and planning. The objective of this study was to assess the concordance between findings observed with MRI and transoperative in patients with supraspinatus tendon rupture. Material and methods: A retrospective analysis was conducted from January 2014 to January 2020. Including patients over the age of 18, with MRI and supraspinatus tendon rupture report. A χ2 analysis was performed for sensitivity, specificity, predictive values and diagnostic certainty using surgical findings as a reference. The kappa index was used to show the concordance between MRI and transoperative findings. Results: A total of 79 patients were included in the study, 45 male and 34 female. The average age was 52.14 years. MRI correctly diagnosed 60.76% of supraspinatus ruptures, showing 74% sensitivity and 96% specificity for complete ruptures. For partial ruptures I show a sensitivity of 96%, a specificity of 33%. The kappa index showed a match of 0.90 for total ruptures and 0.53 for partial. Conclusions: MRI demonstrated good sensitivity and specificity for diagnosing complete ruptures, with good match to surgical findings. MRI proved to be a non-specific study for the identification of partial ruptures, which causes these lesions to be overdiagnosed.

Eficacia diagnóstica del ultrasonido de alta resolución en pacientes con rupturas del manguito rotador / Diagnostic Efficacy of High-Resolution Ultrasound in Patients with Rotator Cuff Ruptures

RESUMEN Introducción: Diferentes estudios relacionan el diagnóstico del ultrasonido de alta resolución con el diagnóstico artroscópico del manguito rotador, ambos métodos son favorables y muestran una alta sensibilidad y especificidad al compararlos. Objetivo: Establecer la eficacia diagnóstica entre los hallazgos ecográficos de alta resolución y el diagnóstico artroscópico de rupturas parciales y completas del manguito rotador. Métodos: Se realizó un estudio analítico transversal con el objetivo de evaluar la eficacia diagnóstica del ultrasonido de alta resolución en pacientes del Hospital Provincial General Docente Dr. Antonio Luaces Iraola, de Ciego de Ávila, con diagnóstico clínico de rupturas parciales y completas del manguito rotador, de enero del 2016 a enero del 2019. El universo estuvo constituido por 62 pacientes con diagnóstico clínico de ruptura del manguito rotador que presentaban indicaciones quirúrgicas, a los que se les indicó un estudio imagenológico con ultrasonido de alta resolución y, con posterioridad, se les realizó la intervención quirúrgica por artroscopia, que fue tomada como criterio de verdad. Resultados: Predominó el sexo masculino, con una edad media menor que los del sexo femenino. Los hallazgos diagnósticos por ambos métodos mostraron concordancia en más de dos tercios de los pacientes que presentaron rupturas parciales y completas del espesor del manguito rotador. La ultrasonografía según el método empleado resultó un medio diagnóstico eficaz para las rupturas parciales y completas del espesor del manguito rotador. Conclusiones: El ultrasonido de alta resolución presentó una adecuada correlación en el diagnóstico de lesiones parciales o completas del manguito rotador, confirmada por artroscopia y es considerado un medio diagnóstico eficaz(AU)

ABSTRACT Introduction: Different studies relate the diagnosis of high-resolution ultrasound with the arthroscopic diagnosis of the rotator cuff. Both methods are favorable and show high sensitivity and specificity when they are compared. Objective: To establish diagnostic efficacy between the findings of high-resolution ultrasound and the arthroscopic diagnosis of partial and complete ruptures of the rotator cuff. Methods: A cross-sectional analytical study was carried out, aimed at evaluating the diagnostic efficacy of high-resolution ultrasound in patients of Dr. Antonio Luaces Iraola Provincial General Teaching Hospital, in Ciego de Ávila, with a clinical diagnosis of partial and complete ruptures of the rotator cuff, from January 2016 to January 2019. The universe consisted of 62 patients with a clinical diagnosis of rotator cuff rupture who presented surgical indications, and who were also indicated for an imaging study with high-resolution ultrasound and, subsequently, performed arthroscopic surgery, taken as a criterion of truth. Results: The male sex predominated, with an average age lower than those corresponding to female sex. The diagnostic findings by both methods showed agreement in more than two thirds of the patients who presented partial and complete ruptures of the rotator cuff's thickness. Ultrasonography, according to the method used, was an effective diagnostic tool for partial and complete ruptures of the rotator cuff's thickness. Conclusions: High-resolution ultrasound showed an adequate correlation in the diagnosis of partial or complete ruptures of rotator cuff, as confirmed by arthroscopy. It is considered an effective diagnostic means(AU)

Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.

Accuracy of Magnetic Resonance Arthrography in Detecting Rotator Cuff Tears / Precisión de la artrografía por resonancia magnética en la detección de desgarros del manguito rotador

ABSTRACT Objective: Shoulder pain, a common cause of productivity loss and health-related expense, is commonly due to rotator cuff tears. Magnetic resonance (MR) imaging with intra-articular gadolinium, MR arthrography, is accepted internationally as an excellent modality for evaluating the rotator cuff. Ultrasound is cheaper and only slightly less sensitive in detecting rotator cuff tears, but MR is superior in detecting ancillary lesions. Magnetic resonance arthrography was introduced at the University Hospital of the West Indies (UHWI), Jamaica, in July 2003. This study aimed to evaluate our experience with MR arthrography and assess its accuracy. Methods: A retrospective study was carried out. All MR arthrography cases performed at UHWI between July 2003 and July 2006 were reviewed. Medical records were reviewed to determine surgical correlation. Results: A total of 140 MR arthrograms were performed; 55% of the patients were female. Ages ranged from the second to the ninth decade, having a distribution approaching but not attaining a normal distribution (p = 0.03) with clustering in the middle years. Magnetic resonance arthrography demonstrated torn rotator cuffs in 40 patients, none of whom was under the age of 40 years (p < 0.001). Fifteen patients had surgery which confirmed torn rotator cuffs in all 15. Conclusion: Magnetic resonance arthrography was found to be accurate in detecting rotator cuff tears. It should be considered in the evaluation of patients with suspected rotator cuff tears. For patients under the age of 40 years, sonography could be used as an alternative.

RESUMEN Objetivo: El dolor en el hombro, el cual es causa común de pérdida de productividad y gastos relacionados con la salud, se debe comúnmente a desgarros del manguito rotador. La imagen por resonancia magnética (IRM) con gadolinio intra-articular - conocida como artrografía RM - se acepta internacionalmente como una excelente modalidad para evaluar el manguito rotador. El ultrasonido es más barato y sólo ligeramente menos sensible a la hora de detectar desgarros del manguito rotador, pero la RM es superior en la detección de lesiones secundarias. La artrografía por resonancia magnética se introdujo en el Hospital Universitario de West Indies (HUWI), Jamaica, en julio de 2003. Este estudio tuvo como objetivo evaluar nuestra experiencia con la artrografía RM y evaluar su precisión. Métodos: Se realizó un estudio retrospectivo. Se revisaron todos los casos de artrografías RM realizadas en HUWI entre julio de 2003 y julio de 2006. Se revisaron las historias clínicas a fin de determinar la correlación quirúrgica. Resultados: Un total de 140 artogramas RM fueron realizados. El 55% de los pacientes eran mujeres. Las edades variaron del segundo al noveno decenio, con una distribución que se acercaba pero no llevaba a alcanzar una distribución normal (p = 0.03), concentrándose en los años intermedios. La artrografía de resonancia magnética mostró desgarros de los manguitos rotadores en 40 pacientes, ninguno de los cuales tenía menos de 40 años (p < 0.001). Quince pacientes tuvieron cirugía que confirmaba desgarros de los manguitos rotadores en los 15. Conclusión: Se halló que la artrografía por resonancia magnética era exacta a la hora de detectar los desagarros del manguito rotador. Debe considerarse en la evaluación de pacientes con sospecha de desgarros del manguito rotador. Para los pacientes menores de 40 años de edad, la sonografía podría ser utilizada como alternativa.