To remark the characteristics of rotator cuff lesions on MRI compared with arthroscopic shoulder. Subjects and methods: 114 patients (71 males and 43 females), the average age was 53.38 ± 9.27 (from 31 to 75 ages), who had rotator cuff tear based on MRI and were undergone arthroscopic shoulder in Orthopaedic Department, 175 Military Hospital from May 2015 to November, 2017.
Journal of military pharmaco-medicine no6-2019 CHARACTERISTICS OF ROTATOR CUFF LESIONS ON MRI COMPARED WITH ARTHROSCOPIC SHOULDER Phan Dinh Mung1; Tran Dinh Chien2; Pham Dang Ninh2 SUMMARY Objectives: To remark the characteristics of rotator cuff lesions on MRI compared with arthroscopic shoulder Subjects and methods: 114 patients (71 males and 43 females), the average age was 53.38 ± 9.27 (from 31 to 75 ages), who had rotator cuff tear based on MRI and were undergone arthroscopic shoulder in Orthopaedic Department, 175 Military Hospital from May 2015 to November, 2017 Results: Correlation between MRI and arthroscopy in detecting rotator cuff tear in bursal-sided partial-thickness of rotator cuff tear: suitable rate 63.64% Articular-sided partial-thickness of rotator cuff tear was suitable rate 56.52% The highest in full-thickness of rotator cuff tear was 81.04% Conclusion: MRI has high value in diagnosis of rotator cuff tear, especially in full- thickness of rotator cuff tear * Keywords: Rotator cuff tear; MRI; Arthroscopic shoulder INTRODUCTION Rotator cuff (RC) tear is a common disease in the shoulder joint, causing pain, affecting daily life and labor There are many methods for early diagnosis of rotator cuff tear: Ultrasound, MRI, arthroscopic shoulder Each method has its own advantages and disadvantages, accuracy in diagnosis and evaluation of different lesions in the shoulder area According to Phan Chau Ha (2012), MRI is a noninvasive image diagnostic method, which has the advantage in observing the whole of the rotator tendons, distinguishing the diseases of the rotator tendon and other lesions with the highly accuracy, up to 81% [1] In order to contribute to early diagnosis, accurate rotator pathology that is foundation for effective early treatment, we carried out this study with the aim of Commenting on the characteristic RC lesions MRI from comparison with arthroscopic shoulder SUBJECTS AND METHODS Subjects 114 patients (71 males and 43 females), average age 53.38 ± 9.27 (maximum 75 years, minimum 31 years) were diagnosed with RC tear and treatments by arthroscopic shoulder at Orthopaedic Department, 175 Military Hospital from May 2015 to November 2017 175 Military Hospital 103 Military Hospital Corresponding author: Phan Dinh Mung (bacsipdmung@gmail.com) Date received: 10/07/2019 Date accepted: 14/08/2019 181 Journal of military pharmaco-medicine no6-2019 Methods suitable between MRI and arthroscopy; inadequate number of diagnosis cases: in the partial bursal-sided and articularsided tear and the full-thickness RC tear * Data processing methods: Research data were analyzed according to results of objective and processed by SPSS 22.0 software - Prospective descriptive, comparison research - Statistics of RC lesions images on MRI and arthroscopic shoulder - Correlation of RC lesions on MRI images with arthroscopic shoulder lesions images: the number of diagnoses RESULT AND DISCUSSION Patient characteristics Table 1: Age, gender (n = 114) Gender Age Male Female Sum Ratio Number of patients Ratio % Number of patients Ratio % < 35 7.0 2.3 5.3 From 35 - < 45 10 14.1 9.3 14 12.3 From 45 - < 55 27 38.0 15 34.9 42 36.8 From 55 - < 65 22 31.0 21 48.8 43 37.7 From 65 - 75 9.9 4.7 7.9 Sum 71 100 43 100 114 100 Average age X ± SD (min - max ) 52.49 ± 10.02 (from 31 - 75) 54.84 ± 7.77 (from 34 - 69) 53.38 ± 9.27 (from 31 - 75) Average age was 53.38 ± 9.27 The age group of 45 - 65 was the highest (74.57%) According to Muthami, the age group of 45 - 49 was 24%, he commented that RC tear was common in middle age and elderly people [2] This study had 71 males and 43 females, male/female rate was approximately 1.65/1 According to A Lamber, male/female was 1:4 [3] The difference in this ratio was probably due to the differences in the study population and the different sample size characteristics Characteristics of rotator RC on MRI and arthroscopic shoulder Table 2: Image of RC tear on MRI and arthroscopic shoulder (n =114) MRI imagine RC tear Arthroscopy No of patients Ratio % No of patients Ratio % Partial bursal-sided 33 28.95 34 29.82 Partial articular-sided 23 20.17 21 18.43 Full-thickness 58 50.88 59 51.75 114 100% 114 100 Sum 182 Journal of military pharmaco-medicine no6-2019 In both MRI images and arthroscopic shoulder, majority percentage of RC was full-thickness tear Meanwhile, partial bursal-sided RC tear and articular-sided rate was not much different The difference in image on two diagnostic methods was not much different Furthermore, on MRI according to this study, the fullthickness RC tear rate was nearly 1.5 times higher than that of the partial bursal-sided or articular-sided (50.87% of full-thickness compared to 28.95% partial bursal-sided and 20.18% partial articularsided) In the RC tear diagnostic study, it was verified by arthroscopic shoulder’s Waldt, there were 275 patients, 46.7% (92 patients) had full-thickness RC tear and 53.3% (105 patients) had partial-thickness tear [4] The characteristics of the percentage of these tear types varied according to the studies probably due to differences in research population and different sample size characteristics Table 3: RC studies on MRI imagines RC tear lesions on MRI Full- thickness Partial bursal-sided Partial articular-sided RC cuff tear Our study 58 (50.88%) 33 (28.85%) 23 (20.17%) 114/114 patients Waldt [4] 92 (46.7%) 105 (53.3%) 197/275 patients Suitability RC lesions between MRI and arthroscopic shoulder Table 4: Characteristics of bursal-sided RC tear on MRI and arthroscopy Partial bursalsided RC tear (n = 33) Suitability between MRI and arthroscopy: 21 patients Not suitable: 12 patients 63.64% patients: partial articular-sided 6.06% 10 patients: full-thickness 30.3% There were 33/114 patients with bursal-sided RC tear, suitable between MRI and arthroscopy 21/33 patients (63.64%) In the RC tear, the partial bursa-sided was difficult to assess in arthroscopy because hypertrophic inflammatory tissue will cover the surface of rotator cuff According to Magee, MRI had a higher sensitivity of 84% due to the use of Tesla MRI to increase the ratio of noise and higher resolution [5] Table 5: Characteristics of articular-sided RC tear on MRI and arthroscopy Partial articularsided RC tear (n = 23) Suitability between MRI and arthroscopy:13 patients Not suitable: 10 patients 56.52% patients: partial bursal-sided 34.78% patients: full-thickness 8.7% There were 23/114 patients with articular-sided RC tear, suitable between MRI and arthroscopy 13/23 patients (56.52%) 183 Journal of military pharmaco-medicine no6-2019 Partial articular-sided RC was diagnosed on coronal plane with T1FS and T2FS pulses T2W and T2FS pulses have a lower value than T1FS pulses in diagnosis of partial articular-sided in comparison with full-thickness RC tear because it is difficult to identify inflammation of synovial bursa or fluid from the shoulder joint cavity absorbed into acromion space (when there is full-thickness-tear) Table 6: Characteristics of full-thickness RC tear on MRI and arthroscopy Suitability between MRI and arthroscopy: 47 patients Full-thickness RC tear (n = 58) Not suitable: 11 patients patients: partial articular-sided 10,34% patients: partial bursal-sided 8.62% There were 58/114 patients with fullthickness RC tear, suitable between MRI and arthroscopy 47/58 patients (81.04%) The diagnosis of full-thickness RC tear on MRI had high accuracy, equivalent to studies by Phan Chau Ha (97.8%), Waldt (98%) [1, 4] This study shows that MRI is highly accuracy in detecting full-thickness RC tear, but is limited in partial RC tear diagnostics Lenza et al’s study about diagnostic correlation between MRI and arthroscopy: MRI had been determined to have a very good diagnostic value for fullthicness RC tear but had poor sensitivity for partial RC tear [6] Newer techniques have been developed to increase the sensitivity of detecting partial lesions of RC tear Fat removal techniques increase the signal contrast fluid on T2W pulses which is considered a means of increasing the ability to diagnose partial RC tear Quinn et al reported 82% of sensitivity, 99% of specificity in 11 patients that partial RC tear compared 184 81.04% with arthroscopy when using fat removal technique [7] In addition, the agreement problem between readers of MRI and surgeons is also common limitations in the study by Waldt, Kyung authors this agreement is very high among observers and surgeons in the evaluate full-thickness RC tear, but only average in partial RC tear evaluation CONCLUSION MRI of shoulder is diagnostic devices with a high level of suitable between MRI and arthroscopy: the highest for fullthichness RC tear was 81.04%; lower than that of partial bursal-sided RC tear (63.64%), the lowest with partial articularsided RC tear was 56.52% REFERENCES Phan Châu Hà Vai trò cộng hưởng từ có chất tương phản nội khớp chẩn đốn rách chóp xoay Luận văn Thạc sỹ Y học Trường Đại học Y Dược Thành phố Hồ Chí Minh 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Vol 195, pp.497-501 185 ... population and the different sample size characteristics Characteristics of rotator RC on MRI and arthroscopic shoulder Table 2: Image of RC tear on MRI and arthroscopic shoulder (n =114) MRI imagine... results of objective and processed by SPSS 22.0 software - Prospective descriptive, comparison research - Statistics of RC lesions images on MRI and arthroscopic shoulder - Correlation of RC lesions. .. surface of rotator cuff According to Magee, MRI had a higher sensitivity of 84% due to the use of Tesla MRI to increase the ratio of noise and higher resolution [5] Table 5: Characteristics of articular-sided