Keywords:
Musculoskeletal joint, MR
Authors:
S. Martin Martin, J. M. Rapariz, M. L. Pico Fuster, M. A. Garcia, C. Martinez; Palma de Mallorca/ES
DOI:
10.1594/ecr2012/C-0521
Methods and Materials
MATERIALS AND METHODS:
PATIENTS:
This study was performed with approval from our institutional review board.
From February 15,
2009,
to April 24,
2011,
a total of 984 MR images of the shoulder were taken at our institution.
Inclusion criteria were the performance of a standardized MRI protocol.
Two radiologists,
in consensus,
who had 2 and 10 years of experience in musculoskeletal radiology,
retrospectively reviewed all 984 MR images in order to identify rotator cuff injuries at the level of its distal insertion on the footprint.
Of these 984 MR images,
a total of 81 showed tears at the rotator cuff footprint.
Therefore,
MR images of 81 consecutive patients were included in this study,
consisting of 45 female and 36 male patients with a mean age of 58 years.
MR IMAGES:
All MR images were taken using a 1.5T MR system (General Electric Sygma Medical Systems) and a dedicated shoulder coil (MRI USAI PA Shoulder).
The MR examinations were performed with the shoulder in the neutral position.
Proton density-weighted images (TR/TE,
2400-2500 ms/34) with fat suppression were acquired in the coronal oblique plane and the transverse plane.
T2-Weighted fast spin-echo images (TR/TE 2800-4000 ms,
40-85 ms) were obtained in the coronal oblique plane and sagittal oblique plane.
T1-Weighted fast spin-echo images (TR/TE,
650 ms/min full) were obtained in the transverse plane.
The parameters for all sequences were a section thickness of 4 mm with an intersection gap of 0.4 mm and a field of view of 18.
In some cases,
a MR arthrograms were performed.
The cuff injuries were classified into four groups (Fig.
1):
- Partial articular-side supraespinatus tendon avulsion (PASTA) lesions were diagnosed if there was a discontinuity of the undersurface tendon fibres into the tendon from the articular side (Fig.
1a).
- Concealed interstitial delamination (CID) lesions were diagnosed if there was focal high signal intensity on T2-weighted images (Fig.
1b).
- Bursal-side tendon avulsion (reverse PASTA) lesions were diagnosed if there were tendon lesions continuous to the subdeltoid bursa (Fig.
1c).
- Full-thickness tear lesions were diagnosed if the lesions extended through the entire articular-to-bursal thickness of the tendon (Fig.
1d).
The anatomical location was determined using three different categories: 1.
supraspinatus – anterior half of the greater tuberosity; 2.
transition zone – superior facet of the greater tuberosity; 3.
infraspinatus – posterior half of the greater tuberosity.
REVIEW OF THE CLINICAL DATA:
The same orthopaedic surgeons retrospectively reviewed the clinical records of these 81 patients.
A Constant Score was obtained in 32 patients.
The patients were classified into four groups: O: Severe pain; 5: Moderate pain; 10: Mild pain and 15: No pain.
An ultrasound evaluation was later performed in 25 patients between 1 day and 2 years and 3 months since the MR imaging.
A total of 10 patients were operated.