Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Acromial Morphology in Different MR Oblique Sagittal Slices: Correlation with Rotator Cuff Disorder

자기 공명 영상의 사 시상면에서의 견봉 형태의 변화: 회전근 개 질환과의 임상적 연관성 분석

  • Jo, Chris H. (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Kim, Ji-Beom (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Choi, Hye-Yeon (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Ko, Young-Whan (Department of Radiology, Seoul National University Boramae Hospital) ;
  • Yoon, Kang-Sup (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Lee, Ji-Ho (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Kang, Seung-Baik (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Lee, Jae-Hyup (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Han, Hyuk-Soo (Department of Orthopedic Surgery, Seoul National University Boramae Hospital) ;
  • Rhee, Seung-Whan (Department of Orthopedic Surgery, Seoul National University Boramae Hospital)
  • 조현철 (서울대학교 보라매병원 정형외과) ;
  • 김지범 (서울대학교 보라매병원 정형외과) ;
  • 최혜연 (서울대학교 보라매병원 정형외과) ;
  • 고영환 (서울대학교 보라매병원 영상의학과) ;
  • 윤강섭 (서울대학교 보라매병원 정형외과) ;
  • 이지호 (서울대학교 보라매병원 정형외과) ;
  • 강승백 (서울대학교 보라매병원 정형외과) ;
  • 이재협 (서울대학교 보라매병원 정형외과) ;
  • 한혁수 (서울대학교 보라매병원 정형외과) ;
  • 이승환 (서울대학교 보라매병원 정형외과)
  • Published : 2009.12.15
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Abstract

Purpose: On the hypothesis that the acromion morphology is changed according to the its site, we identified the morphology of the acromion on the oblique slices of MRI and we investigated the association of the acromial shape with the clinical stages of rotator cuff disorder on the magnetic resonance (MR) images. In addition, we compared the acromion morphology on MRI and simple X-rays. Material and Methods: The MR images of seventy one patients with rotator cuff disorder and who underwent arthroscopic surgery were compared with that of a control group of sixteen patients who didn't have rotator cuff disorder on MRI. On three subsequent oblique sagittal slices from the lateral edge of the acromion (S1, S2 and S3), each acromion morphology on the MRI slices was classified according to Epstein et al: flat, curved or hooked. We investigated the changing parttern of the acromion shape and we compared the acromion shape on MRI and that on simple X-rays. We classified the rotator cuff tear by the severity: bursitis, partial thickness tear or full thickness tear. We investigated which acromial type on the MRI oblique slice was associated with the severity of rotator cuff disease. Results: Changes of the acromial shape occurred in 54 patients (76.1%). The most frequent pattern was that the types are same on S1 and S2 and different on S3 (22 cases, 31.0%). The acromial type on S1 and S2 was significantly associated with the severity of rotator cuff disorder (p=0.001 and 0.022), respectively. There was no reliability of the acromial shape on MRI and roentgenography (p>0.05) Conclusion: The type of acromion changed from lateral to medial. Among the three positions, the shape of the acromion on S1 and S2 had meaningful correlation with the clinical stage of rotator cuff disorder. There was no statistical correlation of the acromial shape between MRI and simple X-ray.

목적: 견봉의 형태가 부위별로 변화한다는 가설하에 자기공명영상에서 사 시상면을 통해 부위별 견봉의 형태를 분석한 뒤 회전근 개 질환과 견봉의 형태가 연관이 있는 사 시상면을 찾고, 단순방사선 사진과 자기공명영상간의 견봉의 형태를 비교 분석해 보았다. 대상 및 방법: 견관절 자기공명영상 검사를 하고 회전근 개 질환으로 관절경 수술을 받은 71명을 대상군으로 하고 자기공명영상 검사상 회전근개 질환이 없는 16명을 대조군으로 하였다. 사 시상면 영상에서 견봉의 외측단부터 4 mm까지 단면을 S1, 그 내측 8 mm, 12 mm 부분을 S2, S3로 정하고, 각 사 시상면에서 견봉의 형태를 제1형:편평형, 제2형:만곡형, 3형:갈고리형으로 형태를 파악하고 변화여부를 확인하였다. 회전근 개 질환을 점액낭염, 부분층 파열, 전층 파열로 경중도를 나누고, 견봉의 형태가 이러한 경중도를 반영하는 사 시상면을 찾아보았고, 각 사 시상면의 견봉의 형태와 단순방사선 사진에서의 견봉의 형태를 비교하였다. 결과: 54명 (76.1%)에서 견봉 형태 변화를 보였으며 (p<0.001), S1, S2에서 같고 S3에서 달라지는 경우가 22건 (31%)으로 가장 많았다. S1영상에서는 제1형 (49.3%), S2에서는 제2형 (53.5%), S3에서는 제3형 (49.3%)이 가장 많았다. S1, S2영상에서 견봉 형태와 질환의 경중도 사이에 유의한 연관성이 있었다 (p=0.001, 0.022). 단순방사선과 자기공명영상간의 결과는 통계적으로 유의하게 일치하지 않았다 (p>0.05). 결론: 견봉의 형태는 사 시상면마다 변하였고, 자기공명영상의 사 시상면 영상 중 외측(S1, S2) 단면에서의 형태가 회전근 개 질환의 임상 증상과 관련성이 많음을 확인하였다. 단순 방사선 영상과 자기공명영상에서 통계적인 일치성은 없었다.

Keywords

References

  1. Aoki M Isaum: Surgery of the shoulder. St. Luis, Mosby-Year Book: 200-203, 1990.
  2. Bigliani LU, April EW: The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans, 10, 1986.
  3. Epstein RE, Schweitzer ME, Frieman BG, Fenlin JM, Mitchell DG: Hooked acromion: prevalence on MR images of painful shoulders. Radiology, 187: 479- 481, 1993. https://doi.org/10.1148/radiology.187.2.8475294
  4. Getz JD, Recht MP, Piraino DW: Acromial morphology: relation to sex, age, symmetry, and subacromial enthesophytes. Radiology, 199: 737-742, 1996. https://doi.org/10.1148/radiology.199.3.8637998
  5. Haygood TM, Langlotz CP, Kneeland JB, Iannotti JP, Williams GR, Dalinka MK: Categorization of acromial shape: interobserver variability with MR imaging and conventional radiography. Am J Roentgenol, 162: 1377-1382, 1994. https://doi.org/10.2214/ajr.162.6.8192003
  6. Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP: Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am, 73: 17-29, 1991.
  7. Liotard JP, Cochard P, Walch G: Critical analysis of the supraspinatus outlet view: rationale for a standard scapular Y-view. J Shoulder Elbow Surg, 7: 134-139, 1998. https://doi.org/10.1016/S1058-2746(98)90223-3
  8. Hirano M, Ide J, Tagagi K: Acromial shape and extension of rotator cuff tears: Magnetic resonance imaging evaluation. J Shoulder and Elbow Surg, 11: 576-578, 2002. https://doi.org/10.1067/mse.2002.127097
  9. Mallon WJ, Brown HR, Vogler JB, Martinez S: Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res, 277: 142-154, 1992.
  10. Mayerhoefer ME, Breitenseher MJ, Roposch A, Treitl C, Wurnig C: Comparison of MRI and conventional radiography for assessment of acromial shape. Am J Roentgenol, 184: 671-675, 2005. https://doi.org/10.2214/ajr.184.2.01840671
  11. Morrison DS: The clinical significance of variation in acromial morphology. Orthop Trans, 11: 165-167, 1987.
  12. Morrison DS: The use of magnetic resonance imaging in the diagnosis of rotator cuff tears. Orthop Trans, 13: 633-637, 1990.
  13. Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S: Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera. J Bone Joint Surg Am, 70: 1224- 1230, 1988.
  14. Peh WC, Farmer TH, Totty WG: Acromial arch shape: assessment with MR imaging. Radiology, 195: 501-505, 1995. https://doi.org/10.1148/radiology.195.2.7724774
  15. Seeger LL, Gold RH, Bassett LW, Ellman H: Shoulder impingement syndrome: MR findings in 53 shoulders. Am J Roentgenol, 150: 343-347, 1988. https://doi.org/10.2214/ajr.150.2.343
  16. Hahn SH, Yang BK , Yi SR, Jung SU, Yoo SH: Radiologic Assessment of Normal Acromial Arch. J Korean Shoulder Elbow Soc, 2: 106-109: 1999.
  17. Tasu JP, Miquel A, Rocher L, Molina V, Gagey O, Blery M: MR evaluation of factors predicting the development of rotator cuff tears. J Comput Assist Tomogr, 25: 159-163, 2001. https://doi.org/10.1097/00004728-200103000-00001
  18. Youn TH, Moon YL, Kim JH: Discrimination between Traumatic and Degenerative Rotator Cuff Lesion in Rotator Cuff Injury Patient. J Korean Shoulder Elbow Soc, 10: 10-16, 2007. https://doi.org/10.5397/CiSE.2007.10.1.010
  19. Toivonen DA, Tuite MJ, Orwin JF: Acromial structure and tears of the rotator cuff. J Shoulder Elbow Surg, 4: 376-383, 1995. https://doi.org/10.1016/S1058-2746(95)80022-0
  20. Tuite MJ, Toivonen DA, Orwin JF, Wright DH: Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears. Am J Roentgenol, 165: 609-613, 1995. https://doi.org/10.2214/ajr.165.3.7645479
  21. Uhthoff HK, Sano H: Pathology of failure of the rotator cuff tendon. Orthop Clin North Am, 28: 31-41, 1997. https://doi.org/10.1016/S0030-5898(05)70262-5
  22. Wuelker N, Plitz W, Roetman B: Biomechanical data concerning the shoulder impingement syndrome. Clin Orthop Relat Res, 303: 242-249, 1994.
  23. Wuh HCK SS: A modified classification of the supraspinatus outlet view based on the configuration and the anatomic thickness of the acromion. Orthop Trans, 16: 203-208, 1992.