经皮超声造影对肩袖撕裂亚型的诊断价值
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作者Author单位AddressE-Mail
留碧丽 LIU Bi-li 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China 49558419@qq.com 
单悦 SHAN Yue 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
钟琦 ZHONG Qi 浙江中医药大学附属杭州市中医院放射科, 浙江 杭州 310007 Department of Radiology, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
葛丹 GE Dan 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
李艳萍 LI Yan-ping 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
吕娟 LYU Juan 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
甘书智 GAN Shu-zhi 浙江中医药大学附属杭州市中医院超声科, 浙江 杭州 310007 Department of Ultrasound, Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang, China  
期刊信息:《中国骨伤》2023年,第36卷,第10期,第975-981页
DOI:10.12200/j.issn.1003-0034.2023.10.013
基金项目:浙江省基础公益研究计划项目(编号:LGF21H180006);浙江省医药卫生科技计划项目(编号:2021KY257)
中文摘要:

目的:探讨肩袖撕裂亚型的超声造影(contrast-enhanced ultrasound,CEUS)图像特征及其对肩袖撕裂亚型的诊断价值。

方法:自2019年1月至2022年3月,采用经皮超声引导下肩峰下滑囊造影(percutaneous ultrasound-guided subacromial bursography,PUSB)联合经皮超声引导下肌腱造影(persutaneous ultrasound-guide tendon lesionog-raphy,PUTL)评估疑似肩袖损伤的患者114例,其中男54例,女60例;年龄35~75(58.8±8.7)岁;右侧76例,左侧38例。采用美国GE LOGIQ E9 彩色多普勒超声诊断仪线阵探头,探头频率6~12 MHz,对患者进行超声造影检查。以肩关节镜为金标准,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估超声(ultrasound,US),MRI及CEUS对肩袖损伤的诊断效能,并计算敏感度、特异性、阳性预测值、阴性预测值和准确度,采用Kappa检验比较US、MRI及CEUS诊断肩袖撕裂分型与关节镜结果的一致性。

结果:US诊断全层撕裂的敏感度为 72.1%,特异性为 93.0%,准确度为85.1%;MRI诊断全层撕裂的敏感度为 90.9%,特异性为 92.6%,准确度为92.1%;CEUS诊断全层撕裂的敏感度、特异性、准确度均为100%。US诊断部分撕裂的敏感度为 85.7%,特异性为 77.2%,准确度为79.8%;MRI诊断部分撕裂的敏感度为 83.7%,特异性为 81.7%,准确度为82.5%;CEUS诊断部分撕裂的敏感度为 95.7%,特异性为 92.6%,准确度为93.9%。US、MRI和CEUS对肩袖滑囊侧部分撕裂的诊断结果比较,差异有统计学意义(P<0.001)。Kappa检验比较显示CEUS诊断肩袖撕裂亚型(全层及部分撕裂)与关节镜检查结果具有较好的一致性。

结论:采用 PUSB/PUTL,观察造影剂在滑囊、肌腱及关节腔的分布情况,来评估肩袖撕裂的类型,其诊断效能明显优于US和MRI。经皮超声造影可作为诊断肩袖撕裂亚型的可靠方法。
【关键词】肩袖撕裂  超声  超声造影  关节镜检查  诊断
 
Value of contrast-enhanced percutaneous ultrasound in the diagnosis of rotator cuff tear subtype
ABSTRACT  

Objective To explore characteristics of contrast-enhanced ultrasound (CEUS) images features and diagnostic value of rotator cuff tear subtypes.

Methods From January 2019 to March 2022,percutaneous ultrasound-guided subacromial bursography (PUSB) with persutaneous ultrasound-guide tendon lesionography (PUTL) was performed on 114 patients with suspected rotator cuff injury were evaluated,including 54 males and 60 females ranged in age from 35 to 75 years old with an average of (58.8±8.7) years old;76 patients on the right side and 38 patients on the left side;the course of disease ranged from 0.13 to 111 months with an average of (10.2±9.8) months. GE LOGIQ E9 color doppler ultrasound diagnostic high frequency(6 to 12 MHz) was used to CEUS Using arthroscopy as gold standard,receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy of US,MRI and CEUS for rotator cuff injury,also sensitivity,specificity,positive predictive value,negative predictive value and accuracy were calculated.

Results The sensitivity of US in diagnosing full-thickness tears was 72.1%,specificity was 93.0%,and accuracy was 85.1%. The sensitivity,specificity and accuracy of MRI diagnosis of full-thickness tear were 90.9%,92.6% and 92.1% respectively. The sensitivity,specificity and accuracy of CEUS in diagnosis of full-thickness tear were 100%. The sensitivity,specificity and accuracy of US in the diagnosis of partial tear were 85.7%,77.2% and 79.8% respectively. The sensitivity,specificity and accuracy of MRI diagnosis of partial tear were 83.7%,81.7% and 82.5% respectively. The sensitivity,specificity and accuracy of CEUS in diagnosis of partial tear were 95.7%,92.6% and 93.9% respectively. There were significant differences in diagnosis results of US,MRI and CEUS for rotator cuff bursa tear (P<0.001). Kapp test showed good consistency between CEUS and arthroscopy in diagnosing rotator cuff tear subtypes (full-thickness and partial tears).

Conclusion Using PUSB/PUTL to observe distribution of contrast media in bursa,tendon and joint cavity to evaluate the type of rotator cuff tear,its diagnostic performance is significantly better than US and MRI. Therefore,percutaneous contrast-enhanced ultrasound can be a reliable method for diagnosing subtypes of rotator cuff tears.
KEY WORDS  Rotator cuff tear  Ultrasound  Contrast-enhanced ultrasound  Arthroscopy  Diagnosis
 
引用本文,请按以下格式著录参考文献:
中文格式:留碧丽,单悦,钟琦,葛丹,李艳萍,吕娟,甘书智.经皮超声造影对肩袖撕裂亚型的诊断价值[J].中国骨伤,2023,36(10):975~981
英文格式:LIU Bi-li,SHAN Yue,ZHONG Qi,GE Dan,LI Yan-ping,LYU Juan,GAN Shu-zhi.Value of contrast-enhanced percutaneous ultrasound in the diagnosis of rotator cuff tear subtype[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(10):975~981
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