肩關節的彩色杜卜勒超音波檢查：技術層面的思考

本研究的目的在建立彩色杜卜勒超音波(Color Doppler Ultrasound, CDU) 於肩關節檢查中的基本掃描技術及其例行程序，並確定姿勢對肩關節疾病之彩色血流信號(color flow signals, CFS)偵測的影響。在92年12月共收集105例病患(男45人；女60人)，其主訴皆為慢性肩部疼痛，其年齡分佈自27至84歲(平均61歲)。我們使用Logiq 700 MR(GE Medical system, Milwaukee, WI, USA)的機器掃描，探頭頻率為9~13 MHz，灰階超音波掃描步驟包括以不同的姿勢掃描肩胛下肌腱，二頭肌腱，棘上肌腱，棘下肌腱及小圓肌腱，最後將手以稍息的姿勢再清楚的掃描棘上肌腱。CDU檢查先測量稍息的姿勢(hyperextensive internal rotation)下的CFS，再以手掌心向內轉放輕鬆的姿勢下作檢查所測的CFS，觀察棘上肌腱及其鄰近組織血流分佈的情形，將兩種姿勢做比較是否因姿勢的不同而使血流產生變化，將結果做分類並比較兩種姿勢所測得CFS多寡。超音波檢查結果共分為七類：肩部旋轉環肌腱在超音波檢查中並無異常發現者(negative finding, NF)共39例；二頭肌腱滑液膜炎(biceps tenosynovitis) 有6例；鈣化性肌腱炎(calcified tendinitis)有12例；退化或肌腱炎(degeneration or tendinitis)有13例；肌腱部分斷裂(partial tear)有7例；肌腱完全斷裂(full thickness tear)有23例；三角肌下滑囊炎(subdeltiod bursitis)有5例。我們發現病人在稍息姿勢下，其所測得知血流訊號明顯地較手掌心向內轉放輕鬆的姿勢時少。由以上結果，我們建議在接受CDU檢查時，應採取最放鬆之姿勢以提高CFS偵測的敏感度，並建議在描述CDU檢查之方法時，需加上病人之姿勢之陳述，且CDU檢查需於一定步驟或姿勢下進行，以便提高其可重覆性，方可在同一姿勢下作評估或追蹤比較。

關鍵字

彩色杜卜勒超音波；彩色血流信號

並列摘要

The purpose of this study is to set up the color Doppler ultrasound (CDU) scanning technique of the rotator cuff tendon and to evaluate the effect of position change on color flow signals (CFS) detection at CDU study. In December 2003 we enrolled 105 patients (45male;60female) with complaint of chronic shoulder pain. Their age, ranged from 27 to 84 years, with an average of 61 years. The ultrasound we used was Logiq 700 MR (GE Medical system, Milwaukee,WI,USA) equipped with a high-resolution transducer (frequency: about 9~13 MHz). The routine scanning procedure included: 1. external rotation of shoulder for scanning the subscapularis tendon, 2. neutral position for biceps tendon, 3. internal rotation (relax) for supraspinatus tendon, 4. crossing to contralateral side for infraspinatus and teres minor tendons, and 5. putting the hand on the back (ie, hyperextensive internal rotation) for scanning more detail evaluation of the supraspinatus tendon. The tips of CDU included gentle scanning on the shoulder without significant pressure and optimal setting of the color gain and pulse repetition frequency (PRF). Generally, we set color gain about 52 dB and the color scale at about 2 cm/s. First we measured (hyperextensive internal rotation) position then internal rotation (relax) and recorded the flow of supraspinatus tendon and the surrounding tissue. The CFSs obtained from these two positions were compared. The final results from the ultrasound study showed negative finding (NF) in 39 patients; biceps tenosynovitis in 6; calcified tendinitis in 12; degeneration or tendinitis in 13, partial tear of tendon in 7; full thinckness tear in 23; and subdeltiod bursitis in 5. Patients in hyperextensive internal rotation showed significant less CFS than internal rotation (relax). Based on the results of this study, we suggest that CDU should be done with the shoulder in the most relaxing position so that the CFS can be detected. To increase the reproducibility of CFS detection, a more precise position taking should be routinely checked during CDU study.

並列關鍵字

color Doppler ultrasound ； color flow signals

國際替代計量

肩關節的彩色杜卜勒超音波檢查：技術層面的思考

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