超音波検査技術

ISSN: 1881-4506
一般社団法人日本超音波検査学会
〒162-0801 東京都新宿区山吹町358-5
Japanese Journal of Medical Ultrasound Technology 41(1): 17-23 (2016)
doi:10.11272/jss.41.17

原著Original Article

腱板断裂肩における棘下筋脂肪浸潤の超音波評価Sonographic Evaluation of the Fatty Infiltrations within the Infraspinatus Muscles in Patients with Rotator Cuff Tears

渡邉 恒夫1，寺林 伸夫2，多田 早織1，伊藤 亜子1，篠田 貢一1，野久 謙1，古田 伸行1，伊藤 弘康1，松岡 敏男3，清島 満1Tsuneo Watanabe1, Nobuo TerabAyashi2, Saori Tada1, Ako Ito1, Koichi Shinoda1, Yuzuru Nohisa1, Nobuyuki Furuta1, Hiroyasu Ito1, Toshio Matsuoka3, Mitsuru Seishima1

1 岐阜大学医学部附属病院検査部Division of Clinical Laboratory, Gifu University Hospital

2 岐阜大学医学部附属病院整形外科Department of Orthopaedic Surgery, Gifu University Hospital

3 岐阜大学大学院医学系研究科スポーツ医科学分野Department of Sports Medicine and Sports Science, 
Gifu University Graduate School of Medicine

受付日：2015年4月15日Received: April 15, 2015
受理日：2015年10月9日Accepted: October 9, 2015
発行日：2016年2月1日Published: February 1, 2016
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はじめに：本研究の目的は，超音波検査による棘下筋の脂肪浸潤の評価を行い，MRI結果や腱板断裂程度との関連性について検討することである．

対象と方法：腱板評価のためにMRIと超音波検査を施行した32例32肩（平均年齢68.2±11.4歳，男性20例，女性12例）を対象とした．棘下筋の脂肪浸潤については，MRIによるGoutallier分類に従い，stage0と1を軽度，stage2を中等度，stage3と4を併せて高度とした．超音波検査については，装置に搭載されているHistogram法を用い，皮下脂肪層，棘下筋内それぞれ3カ所より計測を行い，ROI中の平均階級値（MN）の平均値を指標とし，皮下脂肪を筋のMNで除した値をecho intensity ratio: ERとした．

結果：腱板断裂サイズと年齢の関連性については，断裂なし群が広範囲断裂群に比し有意に低下した．MRIにおける棘下筋脂肪浸潤評価とUS Histogram法の関連性では，皮下脂肪のMNは軽度が高度に比し有意に高値を示し，棘下筋のMNについては，軽度が高度に比し有意に低値を示した．ERについては，高度が軽度，中等度に比べ有意に高値を示した．

結語：今回の検討において超音波Histogram法は棘下筋の脂肪浸潤を簡便に定量評価できる有用な検査法であると考えられた．

Purpose: The purpose of this study was to measure the echo intensity of the infraspinatus muscle, and compare magnetic resonance imaging (MRI) and ultrasound (US) findings.

Methods: Thirty-two patients with rotator cuff tears (RCTs) were enrolled in this study (women: 12; men: 20; mean age: 68.2±11.4 years). Tear size and fatty infiltration were determined by MRI. The subjects were classified into three grades according to Goutallier’s classification: mild was stages 0 and 1, moderate was stage 2, and severe was stages 3 and 4. Gray-scale histogram analysis was used for US assessment, which was performed in both subcutaneous fat and muscle in three different regions; the echogenicity ratio (ER) was the ratio between subcutaneous fat and muscle echogenicity. Sonograms of the 32 patient’s shoulders revealed 3 shoulders with a partial tear, and 6 with a small tear, 6 with a medium tear, 7 with a large tear and 6 with a massive tear; 4 shoulders had no tear.

Results: When compared by tear size, significant differences were observed according to age [F(5, 26)＝2.75, p＝0.040]. Subsequently, age was significantly higher in the massive tear cases than in the no tear cases. Meanwhile, significant differences were observed in the echo intensities within subcutaneous fat [F(2, 29)＝3.71, p＝0.037], and infraspinatus muscle [F(2, 29)＝6.63, p＝0.004], as well as in ER [F(2, 29)＝13.30, p＜0.001], when compared by MRI fatty infiltration staging. Subsequently, in subcutaneous fat was significantly higher in the mild grade than in the severe grade subjects. Conversely, ER and muscle echo intensities were significantly lower in the mild grade than in the severe grade.

Conclusion: The study suggests that US can quantitatively and objectively assess fatty infiltration in the infraspinatus muscle.

キーワード：腱板断裂；脂肪浸潤；超音波検査；ヒストグラム分析

Key words: rotator cuff tear; fatty infiltration; ultrasound; histogram analysis

© 2016 一般社団法人日本超音波検査学会© 2016 Japanese Society of Sonographers

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