Objective: To investigate the diagnostic value of quantitative parameters of synthetic magnetic resonance imaging (SyMRI) in the grade of supraspinatus tendon injury. Methods: Ninety-seven patients with clinical definite of supraspinatus tendon injury from July 2021 to July 2022 in General Hospital of Ningxia Medical University were prospectively collected (case group), including 54 males and 43 females, with an age of 29 to 56 (37.4±9.6) years. According to the results of shoulder arthroscopy, the case group were divided into three subgroups included tendinopathy group (37 cases, grade Ⅱ), partial tear group (34 cases, grade Ⅲ) and complete tear group (26 cases, grade Ⅳ). During the same period, 28 normal rotator cuff volunteers without supraspinatus tendon injury were recruited (control group), including 16 males and 12 females, aged 23 to 49 (36.1±7.2) years, and marked as grade Ⅰ. All the subjects underwent MRI scan of articulatio humeri included T1-weighted imaging(T1WI) fast spin echo(FSE) sequences in axial view, T2-weighted imaging(T2WI) fat suppression(FS) sequences in axial view, T2WI FS sequences in oblique coronal view, proton density-weighted (PDW) imaging in oblique sagittal view and SyMRI in oblique coronal view. The supraspinatus tendon was divided into lateral, medial and middle subregions according to its shape in oblique coronal T2WI view, two radiologists measured the T1, T2 and PD values of the supraspinatus tendon. The interclass correlation coefficient (ICC) were used to compare the consistency between and within observers. One-way analysis of variance or Kruskal-Wallis H test were used to compare the differences of quantitative parameters in different grades, the multivariate logistic regression model was used to analyze the risk factors of supraspinatus tendon injury grade, and the receiver operating characteristic (ROC) curves and area under curve (AUC) was drawn and calculated to evaluate the diagnostic efficacy. The Spearman correlation was used to analyze the correlation between the quantitative values and grades of supraspinatus tendon injury. Results: The ICC values of T1, T2 and PD values for the three subregions of the supraspinatus tendon were greater than 0. 700. The differences of T1 values in the lateral subregion, T2 values in the lateral and middle subregions were statistically significant in the overall comparison across different grades (all P<0. 001).The differences of T1 values in the middle and medial subregions, T2 values in the medial subregion and PD values in the lateral, middle and medial subregions were not statistically significant in the overall comparison of different grades (all P>0. 05). Multiple logistic regression model analysis showed that T2 values in the lateral and middle subregions were related factors for the grade of supraspinatus tendon injury[ OR (95%CI):1.123 (1.037-1.216), 0.122 (1.151-1.197);all P<0.001 ]. The AUC of the T2 values in lateral subregion diagnosing grade Ⅰ vs grade Ⅳ, grade Ⅱ vs grade Ⅳ and grade Ⅲ vs grade Ⅳ were 0.891(95%CI: 0.801-0.981), 0.797(95%CI: 0.680-0.914), 0.723(95%CI: 0.594-0.853) (all P<0.001), and the AUC of the T2 values in middle subregion diagnosing grade Ⅰ vs Ⅳ, grade Ⅱ vs Ⅳ, grade Ⅱ vs Ⅲ, and grade Ⅰ vs Ⅲ were 0.946 (95%CI: 0.849-0.989), 0.886 (95%CI: 0.809-0.962), 0.746 (95%CI: 0.631-0.861), 0.843 (95%CI: 0.745-0.941)(all P<0.001). The T2 values in the lateral and middle subregions were positively correlated with the grade of supraspinatus tendon injury (r=0.542, 0.615; both P<0.001), while T1 values and T2 values in the medial subregions were not significantly correlated with the grade of supraspinatus tendon injury (both P>0.05). Conclusion: SyMRI has high clinical application value in the grading of supraspinatus tendon injury, especially T2 value can be used as an effective quantitative parameter for the grading of supraspinatus tendon injury.
目的： 探讨集成MRI（SyMRI）技术在冈上肌肌腱损伤分级中的定量价值。 方法： 前瞻性招募2021年7月至2022年7月宁夏医科大学总医院门诊确诊冈上肌肌腱损伤的97例患者（病例组），男54例，女43例，年龄29~56（37.4±9.6）岁。病例组患者根据肩关节镜结果分为3个亚组：肌腱病组（37例，Ⅱ级）、部分撕裂组（34例，Ⅲ级）及完全撕裂组（26例，Ⅳ级）。同期招募无冈上肌肌腱损伤的正常肩袖志愿者28名（对照组），男16名，女12名，年龄23~49（36.1±7.2）岁，分级为Ⅰ级。所有受试者均接受肩关节MRI轴位T1加权像（T1WI）快速自旋回波序列、轴位T2加权像（T2WI）脂肪抑制（FS）序列、斜冠状位T2WI FS及斜矢状位质子密度加权（PDW）序列扫描，同时行SyMRI序列斜冠状位扫描。于T2WI斜冠状位图像上根据冈上肌肌腱走形将其分为外侧、内侧及中间亚区，由2名放射科医生测量3个亚区的T1、T2及PD值。采用组内相关系数（ICC）评估观察者间及观察者内的一致性。采用单因素方差分析或Kruskal-Wallis H检验比较不同分级各定量参数的差异。采用多因素logistic回归模型分析冈上肌肌腱损伤分级的危险因素，并绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评价其诊断效能。采用Spearman 相关性分析各定量值与损伤分级的相关性。 结果： 冈上肌肌腱3个亚区T1、T2及PD值的观察者间及观察者内ICC值均>0.700。外侧亚区的T1值、外侧及中间亚区的T2值在冈上肌肌腱损伤不同分级中的总体比较差异有统计学意义（均P<0.001），中间及内侧亚区的T1值、内侧亚区的T2值及外侧、中间及内侧亚区的PD值在冈上肌肌腱损伤不同分级中的总体比较差异均无统计学意义（均P>0.05）。多因素logistic回归模型分析结果显示外侧及中间亚区的T2值是冈上肌肌腱损伤分级的相关因素［OR值（95%CI）分别为1.123（1.037~1.216）、0.122（1.151~1.197）；均P<0.001］。外侧亚区T2值诊断Ⅰ级与Ⅳ级、Ⅱ级与Ⅳ级及Ⅲ级与Ⅳ级冈上肌肌腱损伤的AUC值分别为0.891（95%CI：0.801~0.981）、0.797（95%CI：0.680~0.914）、0.723（95%CI：0.594~0.853）（均P<0.001），中间亚区T2值诊断Ⅰ级与Ⅳ级、Ⅱ级与Ⅳ级、Ⅱ级与Ⅲ级及Ⅰ级与Ⅲ级冈上肌肌腱损伤的AUC分别为0.946（95%CI：0.849~0.989）、0.886（95%CI：0.809~0.962）、0.746（95%CI：0.631~0.861）、0.843（95%CI：0.745~0.941）（均P<0.001）。外侧及中间亚区的T2值与冈上肌肌腱损伤分级呈正相关（r=0.542、0.615，均P<0.001），T1值及内侧亚区的T2值与冈上肌肌腱损伤分级无相关性（均P>0.05）。 结论： SyMRI技术在冈上肌肌腱损伤程度分级中有很高的临床应用价值，尤其T2值可作为损伤分级的有效量化参数。.