肩甲下筋腱最頭側部の MRI 評価

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Background: Our previous study revealed that the most proximal portion of the subscapularis tendon supports the long head of biceps (LHB), indicating that repair of this part is important for the stability of LHB. However, several authors previously reported that preoperative MRI scans of the shoulder do not reliably predict subscapularis tendon tears. The purpose of this study was to evaluate the diagnostic value of MRI assessment of subscapularis tendon tears with the results determined by arthroscopic evaluations of the same shoulders. Methods: Sixty-four patients who received primary arthroscopic rotator cuff repairs participated in this retrospective review. MRI findings of the most proximal portion of the subscapularis tendon were evaluated on the axial and oblique-sagittal images, and were classified into five grades including grade 0, which indicates equal low intensity on T2 weighted image with normal thickness, grade 1: with partial change of intensity, grade 2: insufficient thickness, grade 3: the appearance of partial high intensity, and grade 4: the entire appearance of high intensity around the lesser tuberosity. Results: Among the 64 patients, 28 (44%) were diagnosed arthroscopically as having a full-thickness subscapularis tendon tear. Twenty-five patients had MRI scans that were preoperatively evaluated as having subscapularis tendon tear. Twenty-three patients (92%) were matched with the arthroscopic results. With preoperative MRI scans, sensitivity was 82%, specificity was 94%, and accuracy was 89%. Conclusion: Preoperative MRI scans of the shoulder on the axial and oblique sagittal views reliably predict subscapularis tendon tears. Even the smaller, intra-joint tears are more detectable than previously thought.

肩甲下筋腱最頭側部の MRI 評価

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