超音波検査における肩甲下筋腱断裂の診断能および筋内脂肪浸潤主観的評価の検討

Tsuneo Watanabe; 渡邉 恒夫; Nobuo Terabayashi; 寺林 伸夫; Ako Ito; 伊藤 亜子; Koichi Shinoda; 篠田 貢一; Yuzuru Nohisa; 野久 謙; Hiroyasu Ito; 伊藤 弘康; Mitsuru Seishima; 清島 満

doi:10.11272/jss.43.433

超音波検査における肩甲下筋腱断裂の診断能および筋内脂肪浸潤主観的評価の検討Evaluation of the Ultrasound Diagnostic Ability for the Subscapularis Tendon Tear and Subjective Assessment of the Fatty Infiltration of the Rotator Cuff

渡邉恒夫¹，寺林伸夫²，伊藤亜子¹，篠田貢一¹，野久謙¹，伊藤弘康¹，清島満¹Tsuneo Watanabe¹, Nobuo Terabayashi², Ako Ito¹, Koichi Shinoda¹, Yuzuru Nohisa¹, Hiroyasu Ito¹, 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

受付日：2017年10月20日Received: October 20, 2017

受理日：2018年4月13日Accepted: April 13, 2018

発行日：2018年8月1日Published: August 1, 2018

目的：本研究は，肩甲下筋腱断裂患者の術前US診断能を検討することと，USとMRI所見とを比較することを目的とした．

対象および方法：2016年10月から2017年8月までの期間に当院で関節鏡視下手術を行った症例より，術前のUSとMRI検査結果が確認できた25症例を対象とした．腱板の脂肪浸潤についてはMRIによる評価をgold standardとした．

結果：肩甲下筋腱断裂の関節鏡所見は，断裂あり7例（28 %），断裂なしは18例（72%）であった．USによる肩甲下筋腱断裂の診断能は感度100%，特異度94.4%，正診率96.0%であった．一方，MRIは感度85.7%，特異度94.4%，正診率92.0%であった．また，MRIによるGoutallier分類とUSによる主観的分類との関連性については棘上筋（r＝0.905, p＜0.001），棘下筋（r＝0.824, p＜0.001）ともに有意な正の相関関係を認めた．

結語：今回の検討において，肩甲下筋腱断裂の診断に対してUSは高い診断能を示し有用な検査法である．

Purpose: The purpose of this study was to assess the diagnostic accuracy of ultrasonography (US) and to compare the findings between magnetic resonance imaging (MRI) and US in patients with subscapularis tendon tear.

Methods: We evaluated a retrospective case series to compare the findings of preoperative US with those of arthroscopic inspection. Twenty-five patients, who underwent arthroscopic surgery, preoperative US and MRI examinations at Gifu University Hospital from October 2016 to August 2017 (18 males, 7 females, mean age 51.3±19.6) were included in this study. The fatty infiltration to rotator cuff was determined by MRI.

Results: We examined 16 right and 9 left shoulders. There were 18 shoulders with no subscapularis tear, and 7 with tear. Regarding the subscapularis tendon, the sensitivity, specificity and diagnostic accuracy of US and MRI were 100% and 85.7%, 94.4% and 94.4%, 96.0% and 92.0%, respectively, when the intraoperative finding was regarded as a gold standard. Consequently, Goutallier’s classification grades correlated significantly with the US simple grading assessment (suprasupinatus, r＝0.905, p＜0.001; infraspinatus, r＝0.824, p＜0.001).

Conclusion: The study suggests that US is useful for the diagnosis of subscapularis tendon tear.

Key words: subscapularis tendon tear; fatty infiltration; ultrasonography; diagnostic accuracy

超音波検査技術

原著Original Article

超音波検査における肩甲下筋腱断裂の診断能および筋内脂肪浸潤主観的評価の検討Evaluation of the Ultrasound Diagnostic Ability for the Subscapularis Tendon Tear and Subjective Assessment of the Fatty Infiltration of the Rotator Cuff