Application of virtual touch tissue imaging quantification in diagnosis of supraspinatus tendon injury

2021 ◽  
pp. 1-10
Author(s):  
Heping Deng ◽  
Yaru Mi ◽  
Bo Lu ◽  
Ping Xu
Keyword(s):  
Shear Wave ◽  
Shoulder Arthroscopy ◽  
Supraspinatus Tendon ◽  
Tissue Imaging ◽  
Full Thickness ◽  
Tendon Tear ◽  
Partial Tear ◽  
Partial Thickness ◽  
2D Ultrasound ◽  
Sensitivity Specificity

OBJECTIVE: To explore the value of virtual touch imaging and quantification (VTIQ) shear wave elastography (SWE) in diagnosis of supraspinatus tendon tear. METHODS: Eighty patients with unilateral supraspinatus tendon tear underwent shoulder arthroscopy were prospective studied. Tendinopathy, partial-thickness tear or full-thickness tear of supraspinatus tendon were diagnosed according 2D ultrasound examination. Sensitivity, specificity and accuracy of ultrasonic diagnosis of supraspinatus tendon tear were calculated by arthroscopy as the gold standard. VTIQ was applied to measure the shear-wave velocity (SWV) of both normal and affected supraspinatus tendon. The differences of SWV in three types of supraspinatus tendon tear and receiver operating characteristic (ROC) curves were analyzed. RESULTS: Among 80 patients, there were 20 tendinopathy, 31 partial tears and 29 full-thickness tears diagnosed by shoulder arthroscopy. Sensitivity, specificity and accuracy of 2D ultrasound in diagnosis of tendinopathy, partial tear and full-thickness tear groups were 78%, 90%and 83%; 71%, 86%and 73%; 86%, 88%and 88%, respectively. SWV of 80 supraspinatus tendon tears was 4.59±1.00 m/s, which was lower than that of normal supraspinatus tendon (4.59±1.00 m/s vs. 6.68±1.05 m/s, P <  0.01). SWV of supraspinatus tendon in tendinopathy, partial tear and full-thickness tear groups respectively were 5.66±0.97, 4.66±1.00, and 3.78±0.55 m/s, all lower than that of the contralateral normal supraspinatus tendon (all P <  0.05). In addition, the analysis of variance and pairwise comparison showed that SWV of supraspinatus tendon among three different degree of injury was statistically significant (all P <  0.001). The cutoff thresholds of SWV was 4.83 m/s to identify tendinopathy tear from partial tear and was 4.08 m/s to identify full-thickness tear from partial-thickness tear. CONCLUSION: VTIQ SWE with SWV might identify degree of supraspinatus tendon tear and improve the value of ultrasonography, which should be further evaluated in large multicenter studies.

Disproportionate fluid sign as an aid in diagnosing high-grade bursal-sided supraspinatus tendon tear

2017 ◽  
Vol 59 (9) ◽  
pp. 1102-1109
Author(s):  
Seonji Jeong ◽  
Ja-Young Choi ◽  
Yu Suhn Kang ◽  
Hye Jin Yoo ◽  
Sae Hoon Kim ◽  
...  
Keyword(s):  
Glenohumeral Joint ◽  
Characteristic Curve ◽  
Supraspinatus Tendon ◽  
Observer Agreement ◽  
High Grade ◽  
Full Thickness ◽  
Relative Paucity ◽  
Partial Thickness ◽  
Magnetic Resonance Imaging Mri ◽  
Sensitivity Specificity

Background Deep, high-grade bursal-sided supraspinatus tendon tears are sometimes preoperatively misinterpreted as full-thickness tears on shoulder magnetic resonance imaging (MRI). Purpose To determine the usefulness of disproportionate fluid sign for differentiating high-grade bursal-sided partial-thickness tears from full-thickness tears on conventional MRI. Material and Methods Preoperative MRIs of 198 patients with arthroscopically confirmed high-grade bursal-sided partial-thickness tears and full-thickness tears were independently reviewed by two readers on two occasions. The presence of high-grade bursal-sided partial-thickness tears with a confidence level using a five-point grading scale was assessed based on tear depth alone and also in combination with disproportionate fluid sign, defined as a prominent subdeltoid or subacromial-subdeltoid bursal fluid distension with a relative paucity of effusion in the glenohumeral joint. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated, as well as inter-observer reliability. Results The disproportionate fluid sign was identified in 60/74 (81.2%) bursal-sided partial-thickness tears and 9/124 (7.5%) full-thickness tears. The sensitivity and accuracy of the diagnosis of bursal-sided tear were higher when disproportionate fluid sign was used in conjunction with the tear depth, compared with tear depth alone ( P < 0.001). There was excellent inter-observer agreement for disproportionate fluid sign and deep bursal-sided tear. The AUCs were significantly higher in combination with disproportionate fluid sign. Conclusion The disproportionate fluid sign indicates the presence of a deep, high-grade bursal-sided partial-thickness tear, which can be misinterpreted as a full-thickness tear. Thus, it can provide greater diagnostic assistance to less-experienced radiologists and clinicians.

The “bridging sign”: A MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

2013 ◽  
Vol 54 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Jin Young Jung ◽  
Young Cheol Yoon ◽  
Dong Ik Cha ◽  
Jae-Chul Yoo ◽  
Jee Young Jung
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Rotator Cuff Tear ◽  
Supraspinatus Tendon ◽  
Subscapularis Tendon ◽  
Full Thickness ◽  
Tendon Tear ◽  
Anterior Portion ◽  
Cuff Tear ◽  
Sensitivity Specificity

Background In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the “bridging sign”, which has not been previously described. Purpose To describe the “bridging sign” on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the “bridging sign” and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the “bridging sign” was assessed and the sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the “bridging sign” were compared. Results The “bridging sign” was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the “bridging sign” had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the “bridging sign” for the diagnosis of combined FTTs of the SSC tendon and anterior portion of the SSP tendon were 81.0%, 100%, and 86.2%, respectively. The patients with the “bridging sign” had longer duration of shoulder pain and more frequent associated arthroscopic and MR findings than the patients without the “bridging sign”. Conclusion The “bridging sign” is a highly specific finding for combined full-thickness tears of the subscapularis tendon and anterior portion of the supraspinatus tendon, associated with more chronic shoulder pain and more sever rotator cuff tear.

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

scholarly journals Chronic non-traumatic shoulder pain: evaluation with ultrasonography and conventional mr imaging

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M N Elaassar ◽  
A Emadeldin ◽  
D Z Zidan ◽  
H M Sakr ◽  
H Abdelazim
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Shoulder Joint ◽  
Supraspinatus Tendon ◽  
Radiology Department ◽  
Dominant Hand ◽  
Full Thickness ◽  
Duration Of Symptoms ◽  
Partial Thickness ◽  
Chronic Shoulder Pain

Abstract Background Shoulder pain is a common and disabling complaint. It is responsible for approximately 16 % of all musculoskeletal disorders1 Shoulder pain is defined as chronic when it has been present for longer than six months, regardless of whether the patient has previously sought treatment2. The most common causes of chronic shoulder pain are reported to be rotator cuff disorders, acromioclavicular joint (ACJ) disease and glenohumeral joint (GHJ) disorders3 Aim of the Work The aim of this study is to evaluate the role of both ultrasonography and conventional MRI imaging in diagnosing various causes of chronic shoulder pain not caused by trauma. Patients and Methods 101 patients were evaluated for chronic shoulder pain ranging in age from 20 to 70-years-old. They were referred to the radiology department (Ultrasound unit and MRI unit) at Ain Shams University hospitals during the period between September 2016 and June 2018, from orthopaedic, rheumatology and physical medicine departments. Once a patient satisfied the inclusion and exclusion criteria for this study, an elaborate history was taken from all the patients which was followed by a thorough clinical evaluation, in which duration of symptoms, affected side, dominant hand, range of movement was checked. Patients were subjected to sonographic evaluation of the shoulder joint followed by MRI of the affected shoulder with mean interval between sonography and MRI about 10 days (range, 5-15 days). Results Total of 101 patients with chronic shoulder joint pain were enrolled in our study. 58 % of the patients were in the age group of 41-55 years with mean age of 48 years. Majority (42 %) of patients had chronic shoulder pain over 6-9 months. Complaints mainly resided in the form of tenderness (65 %) and night pain (25 %). Females constituted most of the patients around 68% of the cases. Majority (72%) patients in our study had right hand dominance. 57 % of the sampled patients gave positive history of heavy use of the affected shoulder. 78 % of patients demonstrated acromion morphological changes that had a direct impact on the rotator cuff findings. Amongst the rotator cuff tendons, Supraspinatus tendon was the most common tendon to be involved in our study in both USG and MRI. USG detected 92 patients and MRI detected 96 patients with supraspinatus tendon pathologies which included tendinosis, tears and calcifications and other non-rotator-cuff related findings. Total of 53 were diagnosed as rotator cuff-tear, followed by subacromial-subdeltoid bursitis (n = 32), supraspinatus impingement (n = 14), calcific tendinitis (n = 7) respectively. Supraspinatus tendinopathy was the most common diagnoses (n = 51) followed by Partial thickness tear of supraspinatus (n = 19) then full thickness of supraspinatus (n = 17). USG showed a sensitivity of 52.6% and specificity of 87.8 %, NPV of 88.9 % and PPV of 50 % with 78.8 % MRI agreement for partial thickness tears. USG showed 88 % sensitive, 97% specific, had 97 % PPV, 100% NPV, and was 96 % accurate in diagnosing complete tendon tear. MRI had a higher efficacy for both full thickness as well as partial thickness tears, whereas USG had a higher efficacy for full thickness tears only. Our study shows MRI to be a highly sensitive as well as specific technique for differentiation among different shoulder pathologies.

scholarly journals Diagnostic Accuracy of Ultrasonography for Rotator Cuff Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110351
Author(s):  
Ali S. Farooqi ◽  
Alexander Lee ◽  
David Novikov ◽  
Ann Marie Kelly ◽  
Xinning Li ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Diagnostic Accuracy ◽  
Biceps Tendon ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Diagnostic Values ◽  
Tendon Tears ◽  
Sensitivity Specificity

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears ( P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

scholarly journals ROLE AND CORELATION OF ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING IN EVALUATION OF ROTATOR CUFF IN PATIENTS WITH SHOULDER PAIN

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Niti More ◽  
R P Bansal ◽  
Mukesh Kumar Sharma ◽  
Bijendra Kumar Meena ◽  
Abhishek Gupta
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Age Groups ◽  
Rotator Cuff Tears ◽  
Joint Effusion ◽  
Full Thickness ◽  
Mri Findings ◽  
Partial Thickness ◽  
Labral Tears ◽  
Sensitivity Specificity

Background: Shoulder pain is one of the most common musculoskeletal complain encountered in general practice with an estimated point prevalence of 6.9 to 26% in the general population. The aim of the study was to determine the accuracy of ultrasonography in detecting rotator cuff tears taking MRI findings as the standard. Available literature related to the present study was reviewed and salient features of each pathology discussed. Methods: This observational, prospective study was carried out in the Department of Radiodiagnosis, National Institute Of Medical Sciences & Research, Jaipur, Rajasthan. A total of 80 patients from all age groups with symptomatology related to rotator cuff of the shoulder joint, on the basis of inclusion criteria, were examined by USG and MRI from a period of January 2019 to June 2020. Results: USG had good sensitivity (82 to 93%), specificity (92 to 97%), PPV (85 to 87%), NPV (91 to 98%) and accuracy (90 to 96%) as compared MRI for diagnosing supraspinatus lesions. The sensitivity and accuracy of USG for detecting full thickness tears was better than the same for partial thickness tears and tendinosis. Conclusion: In our study, USG examination had excellent sensitivity, specificity and accuracy as compared MRI for diagnosing full thickness rotator cuff tears. It was also fairly accurate in detecting partial thickness tears and tendinosis. It was comparable to MRI in diagnosing and quantifying joint effusion and acromioclavicular degenerative changes. USG scored over MRI in diagnosing calcific tendinosis while some findings, such as labral tears, were only detected by MRI. Keywords: MRI, USG, Shoulder pain.

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