Nghiên cứu đặc điểm hình ảnh và giá trị của cộng hưởng từ 3 0 tesla trong chẩn đoán tổn thương khớp vai do chấn thương tt tiếng anh

MINISTRY OF EDUCATION AND TRAINING MINISTRY OF DEFENCE 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES - LE DUY DUNG A STUDY ON CHARACTERISTICS AND VALUE OF 3.0 TESLA MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF TRAUMATIC SHOULDER JOINT INJURIES Speciality: Diagnostic imaging Code: 62.72.01.66 ABSTRACT OF MEDICAL PHD THESIS Hanoi – 2020 THE THESIS WAS DONE IN: 108 INSTITUTE OF CLINICAL MEDICAL AND PHARMACEUTICAL SCIENCES Supervisor: Ass Prof PhD Lam Khanh Ass Prof PhD Le Van Doan Reviewer: This thesis will be presented at Institute Council at: 108 Institute of Clinical Medical and Pharmaceutical Sciences Day Month Year The thesis can be found at: National Library of Vietnam Library of 108 Institute of Clinical Medical and Pharmaceutical Sciences INTRODUCTION The shoulder joint is a large, flexible joint that often suffers from trauma In the US, Zacchilli et al (2010) studied 8,940 patients, showing that the rate of shoulder joint injury is 23.9 / 100,000 people According to Bui Van Duc (2004), evaluated over 8056BN, the rate of shoulder joint injury accounts for 45.0% Common traumatic shoulder joint disease is a rotating cuff lesion, labrum Clinical examination is difficult to fully and fully assess lesions Magnetic resonance imaging (MRI) of the shoulder joint has many advantages compared with each other diagnostic imaging methods, especially high-magnetic field machines such as 1.5 - 3.0 Tesla and magnetic resonance arthrography (MRA) contrast media According to Lambert.A et al (2009), 3.0T MRI is valuable in assessing small lesions and has a higher accuracy for surgical planning According to Magnee.T (2015), 3.0 Tesla MRI and MRA are very useful in preoperative evaluation In Vietnam, there is currently no domestic research on shoulder joint injury with 3.0 Tesla MRI machines That is why we performed the thesis "A study on imaging characteristics and value of 3.0 Tesla magnetic resonance in the diagnosis of traumatic shoulder joint injuries” with two following objectives: Studying on charactistics of 3.0 Tesla magnetic resonance imaging in evaluating some shoulder joint injuries lesions due to trauma Comment on the value of magnetic resonance and magnetic resonance arthrography in the diagnosis of traumatic shoulder joint injuries compared with surgery Chapter 1: OVERVIEW 1.1 Shoulder joint anatomy The anatomical structure of the shoulder joint consists of active and passive holding elements Rotator cuff tendons, labrum and ligaments around the joint are closely related to the image of traumatic shoulder joint injuries on MRI 1.3 Diagnostic imaging of the shoulder joint Diagnostic imaging of the shoulder joint includes X-ray, ultrasound, computed tomography, magnetic resonance imaging and diagnostic shoulder arthroscopy In which, MRI is an effective and non-invasive method 1.4 Shoulder joint MRI Bursae, ligaments, tendons of muscles and labrum have low signals on all pulses, determined by the anatomic site The basic magnetic resonance sections include transverse, vertical, and vertical sections to ensure that they cut through the shoulder joint 1.4.4 Image of the labrum on MRI On the magnetic resonance of the labrum clearly visible on the horizontal and cross vertical images, characterized by moderate signal reduction on all pulse sequences, there is a triangle or a wedgeshaped shape between two strong suppressor structures of the head humerus and glenoid cartilage 1.4.5 Image of the rotator cuff tendons on MRI The rotator cuff tendons has a low signal on all pulse sequences on MRI The rotator cuff evaluation consists of muscle tendons: supraspinatus, infraspinatus, subscapularis and teres minor, accompanied by a long head with biceps tendon characteristics with trajectory, shoreline based on anatomy and examination of slice layers 1.5 Some lesions of shoulder joint injury on MRI 1.5.1 Rotator cuff lesions Rotator cuff lesions include partial tear lesions, complete tears, inflammation and degenerative tendon muscle 1.5.2 Labrum lesions On MRI, the labrum is clearly seen in transverse and coronal plan and moderate signal reduction on all pulse sequences 1.5.2.1 Bankart lesions Bankart lesions are the lesion of labrum from anterior to lower, usually from o'clock to o'clock (and often combine with Hill-Sachs lesion), this is considered to be basic and common most in recurrent shoulder dislocation 1.5.2.2 Labrum defects A congenital glenoid labrum variant where the anterosuperior labrum is absent in the 1-3 o'clock position and the middle glenohumeral ligament is thickened (Buford complex) 1.5.3 SLAP lesion ( Superior Labral Anterior to Posterior lesion) Lesions of the labrum and biceps tendons at the site sticking to the edge of the glenoid, the front to the back lesions, limited from 10 -14 o'clock with or without tearing the biceps tendon 1.5.5 Ligament and capsular lesions Many studies show that the tendon lesions of the rotator cuffs, labrum often has other lesions such as ligaments and capsular, especialy with Bankart lesions 1.6 Outline of shoulder joint treatments 1.6.1 Conservative treatment Conservative treatment with analgesic, anti-inflammatory drugs or injecting corticosteroids into the subacromial space can provide good results for patients with early rotator cuff tear and mild lesions Strength excercise helps a lot for patients with non-traumatic shoulder dislocations, pediatric patients, and patients with intentional instability 1.6.2 Surgical treatment Some authors have compared the results of conservative treatment with rotator cuff tear fixation and labrum surgery, showing that the surgical method offers better results in terms of motor recovery, muscle strength and joint stability Nowadays, laparoscopic surgery is commonly used 1.7 The situation of shoulder joint resonance studies 1.7.1 Foreign research situation Shoulder-joint imaging was performed immediately after magnetic resonance imaging was used in medicine In 1986, Michaen B and Zlatkin were the first to have a shoulder joint scan of a cadaver In 1992, Fritts HM studied the image of MRI shoulder joint In 1994, Tirman studied spontaneous tendon and labrum injuries due to trauma on MRI Research by Richard Kijowski et al (2009), 3.0T magnetic resonance increases the ability to diagnose knee cartilage damage compared with 1.5T sewing According to Lambert.A et al (2009), conclude MRI 3.0T is valuable in detecting small lesions According to Thomas Magee (2009), MRI joint injection increases the sensitivity to detect semi-surface tear lesions of the tendon joints on the spine, tear cartilage anterior border and SLAP lesions better than on 3.0T 1.7.2 Researches in domestic Although studies abroad are quite rich about shoulder joint injuries due to trauma on MRI However, in Vietnam, there are still very few studies on images of MR of general shoulder joint lesions and shoulder joint due to trauma in particular, most of the domestic studies often use low-field magnetic resonators and the number of patients is few Chapter SUBJECTS AND METHODS 2.1 Studying subjects 154 patients with shoulder joint injury were taken by 3.0 Tesla MRI at the Department of Diagnostic Imaging, 108 Military Central Hospital from December 2012 to September 2017 2.1.1 Selection criteria for study patients Including patients with shoulder joint injury, have enough film were perform on 3.0T MRI The group of patients undergoing surgery has sufficient medical records 2.1.2 Exclusion criteria The patient has no injury, lack of imagings and medical records 2.2 Reseach method 2.2.1 Study Design Research method prospective, cross-sectional description with comparison, calculation of diagnostic validity The assessment consists of two parts: + Part 1: Characteristic description of lesions on MRI + Part 2: Calculate the value of MRI compared with surgery 2.2.2 Sample size Applying the formula for calculating the sample size in the Cross-sectional study we have n = 143 patients We have taken data on 154 patients in accordance with selection criteria 2.2.3 Study devices MR machine includes systems: Gyroscan Achieva 3.0T of Phillip-Netherlands and Discovery MR750w 3.0T of GE-USA 2.2.4 Magnetic resonance imaging protocol technique MRI shoulder joint technique with basic plan and depends on the magnetic field, as well as the lesions to be found - Patient's position: lying on suppine, hands lying down and on suppine or in ABER position (Abduction External Rotation) The shoulder joint puts in dedicated coils - 2-4mm thickness, 0.3 mm GAP, 256 x 256 matrix, 12-16 cm FOV cover all shoulder joints The basic series of pulses sequences include: + T1W fat suppressed spin-echo (TR / TE 400-800 / 8-20 ms) + T2W fast spin-echo (TR / TE 3000-4200 / 90-120 ms) + Proton (PD) density (TR / TE 2200-3000 / 20-30 ms) * Technique for contrast media injection of arthrography Joint injection was carried out under fluorography guides or based on anatomical landmarks in a number of 39 patients Needle size 20-22G The injection solution is a mixture mixed with 0.1ml of gadolium, 5ml of contrast fluid + 5ml of lidocaine 1% + 10 ml of 0.9% NaCl when injected under the fluorography or 0.1ml gadolium injection solution and 5ml of lidocaine mixed with 10 -15 ml of 0.9% NaCl when injected according to anatomical landmarks Injection volume 12-20ml, average 15ml Perform MRI and evaluate images on workstation 2.2.5 Research variables Patients were studied according to a uniform medical record format, including the following research variables: 2.2.5.1 Common variables for the study groups - Age group: < 20 y.o, 20-39 y.o, 40-59 y.o and ≥ 60 y.o - Gender: Male Female - Injury position: right, left shoulder, both sides - Causes include: traffic accident, sports, daily life, labor, continuous micro-injury and other causes - The time from the injury to the examination: