A Retrospective Comparative Study of Ultrasound and MRI in the Diagnosis of Supraspinatus Tendon Tears at a Medical Center in Taiwan

超音波及磁振造影於診斷棘上肌斷裂之回溯性比較研究

馮仕豪(Shih‐Hao Feng) ； 鄭宇軒(Yu‐Hsuan Cheng) ； 王亭貴(Tyng‐Guey Wang)

《台灣復健醫學雜誌》 44卷4期 (2016/12) Pp. 187-199

https://doi.org/10.6315/2016.44(4)03

摘要

Objective: To evaluate the diagnostic accuracy of ultrasound (US) in comparison with magnetic resonance imaging (MRI), which is the gold standard for detecting full- and partial-thickness supraspinatus (SS) tendon tears at our general practice. Methods: From January 2015 to January 2016, 107 patients suffering from shoulder pain underwent both US and MRI of the shoulder at a medical center to identify their shoulder pathology, and were included in this work. The US was performed by a physiatrist at a US laboratory, and the US findings for the SS tendon were classified as normal, tendinosis (calcific/ non-calcific), a partial-thickness tear, or a full-thickness tear. MRI results were reported by a radiologist. The sensitivity, specificity, and accuracy of the sonographic assessment were determined by comparing them with the MRI findings. Correlations between the US and MRI results were analyzed using Cohen's kappa coefficient. Results: The results showed that the kappa coefficient of association was 0.80 for SS full-thickness tendon tears. This indicated that the agreement between US and MRI for the diagnosis of SS full-thickness tendon tears was excellent. Moreover, the accuracy of US in detecting full-thickness tears of the SS tendon, if we take MRI to be the gold standard, was 0.91, with a sensitivity of 0.91, and a specificity of 0.90. However, when using US to detect partial-thickness tears of the SS tendon, the accuracy and sensitivity were low-0.73 and 0.30 respectively-although there was high specificity (0.92). Conclusions: US was highly accurate for detecting SS full-thickness tendon tears in daily general practice, but was less sensitive and accurate for detecting SS partial-thickness tendon tears. Further large-scale studies are needed.

關鍵字

rotator cuff tears ； shoulder ； magnetic resonance imaging (MRI) ； ultrasound

並列摘要

研究目的：以磁振造影為標準診斷來評估超音波檢查對於棘上肌斷裂之診斷準確性。研究方法：此研究分析107位罹患肩痛且接受過肩關節超音波及磁振造影檢查之病人；軟組織超音波由一群醫學中心復健科醫師所執行，將棘上肌之超音波影像區分為正常、肌腱病變(鈣化/非鈣化)、部分斷裂及全厚度斷裂。磁振造影結果則由影像科醫師負責判讀。比較超音波與磁振造影於診斷棘上肌斷裂之敏感性、特異性、診斷準確性，更進一步利用kappa統計量來評估兩檢查之相關性。結果：超音波及磁振造影對於棘上肌全厚度斷裂的診斷有高度相關性(Kappa coefficient =0.8)，超音波對於棘上肌全厚度斷裂之診斷準確率、敏感性及特異性分別為0.91、0.91、0.90；但超音波對於偵測棘上肌部分斷裂的診斷準確率為0.73、敏感性也只有0.3，雖然其特異性高達0.92。結論：超音波檢查對於診斷棘上肌斷裂有相當高的診斷準確率，但針對棘上肌部分斷裂的敏感性及準確率則較差，未來仍需要更多研究釐清相關原因來提升棘上肌部分斷裂之診斷準確率。

並列關鍵字

旋轉肌腱破裂(rotator cuff tears) ； 肩(shoulder) ； 磁振造影(MRI) ； 超音波(ultrasound)

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