| Purpose.The purpose of this study is to research the manifestations of high frequency ultrasound in diagnosis of rotator cuff tears (RCT) and assess its clinical application values, and explore the method to improve the accuracy, sensitivity and specificity. Research the manifestations of Elastography in normal and abnormal rotator cuffs. And assess the using promise of Elastosonography in diagnosis of RCT.Materials and Methods.1.Retrospective analyze the diagnoses of 122 patients performed high frequency ultrasound examinations and shoulder arthroscopy during January 2008 and Auguest 2010.Caculate the sensitivity, specificity, accuracy, positive predictive value, negative predictive value.2.Retrospective analyze the diagnoses of 56 patients performed 17MHz ultrasound examinations and shoulder arthroscopy during September 2009 and Auguest 2010.Caculate the sensitivity, specificity, accuracy, positive predictive value, negative predictive value.3.Perform Elastosonography on 25 volunteers without any shoulder symptom, endocrine disease, tissue disease or experience of trauma. Determine the manifestations to 6 grades. Red is 1, yellow 2, green 3, blue-green 4, light blue 5 and green for 6.4.Take examinations of Elastography for 31 patients with shoulder symptoms, research the manifestations of rotator cuff tears with method of Elastography, compare to arthroscopy, assess its values and values combined with the two dimensional ultrasound(2DU).5.Machine 12MHz (PHILIPS HDI-5000. L12-5),17MHz (PHILIPS IU-22, L17-5),13MHz (HITACHI EUB-7500, L13-5) 6. Examination Methods The patients were seated on a chair with the arm hanging free. The examiner was standing behind the patient, facing the screen, with one hand leading the transducer. Each component of the rotator cuff and the biceps tendon in the bicipital groove were examined in both axial and sagittal planes. Evaluation of the supraspinatus, infraspinatus and subscapularis tendons included views in internal and external rotation of the shoulder. For evaluation of the supraspinatus tendon, the shoulder was extended downward and rotated internally. The rotator cuff tendons were displayed in two different transducer positions. During longitudinal scanning, the transducer was placed just in front of the lateral and anterior edges of the acromion, translated downward parallel to the tendon fibers, with depiction of the tapering-off supraspinatus and infraspinatus tendons. The Transverse view was at a right angle to the previous position, with scanning of the cuff tendons parallel to the anterior edge of the acromion. For evaluation of the subscapular tendon, the arm is externally rotated, during longitudinal scanning, the transducer is lean to the inside with the other end pointing to the humeral. The Transverse view was at a right angle to the previous position. For evaluation of the infraspinatus tendon, during longitudinal scanning, the transducer is parallel to the spina scapulae, and the transverse scanning is perpendicular to it. To the elastography examination, with the same positions and press 3 times every region of interest, and store the beast picture.7.Statistical method SPSS 16.0 Chi-square test and Fisher'exact test, P<0.05.Result.1.In the 122 patients,99 were diagnosed rotator cuff tears (RCT) by high frequency ultrasound,29 were full thickness rotator cuff tears (FRCT),60 were partial thickness rotator cuff tears (PRCT),10 were both. By arthroscopy,87 were diagnosed RCT,42 were FRCT,42 were PRCT,3 were both. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of high frequency ultrasound were 92.0%,45.7%,80.8%,69.6%,78.7%, respectively. And 68.9%,89.6%,79.5%,83.1%,82.0%, respectively, in diagnosis of FRCT, but 77.8%, 54.5%,50.0%,80.8%,63.1% for PRCT.2.In the 56 patients,43 were diagnosed rotator cuff tears (RCT) by 17MHz ultrasound,10 were full thickness rotator cuff tears (FRCT),28 were partial thickness rotator cuff tears (PRCT).5 were both. By arthroscopy,39 were diagnosed RCT,18 were FRCT,19 were PRCT,2 were both. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of high frequency ultrasound were 89.7%,52.9%,78.6%,81.4%,69.2%, respectively. And 65%, 94.4%,83.9%,86.7%,82.9%, respectively. In diagnosis of FRCT, but 81.0%,54.3%, 64.3%,51.5%,82.6%, for PRCT.3.Normal rotator cuff (RC) can be distinguished with the tissue around, in the 25 volunteers.23 volunteers have a 6 grade supraspinatus,2 volunteers is 5 grade. Regarding to subscapular tendon, the numbers are same. Some volunteers have a difference in the supraspinatus at the top of great tubercle,11 with 3 grade at this place.4.8 of 31 were diagnosed as FRCT with 3 grade mingled with 1 grade.9 of 31 were diagnosed as PRCT with 3 grade.11 were diagnosed as PRCT with 3 grade mingled with 1 grade.1 PRCT with elastography of 3 grade with 4 grade at its border.2 were diagnosed as intact rotator cuffs.Conclusions.High frequency ultrasound examinations have high sensitivity, specificity, accuracy, positive predictive value and negative predictive value in diagnosis of RCT.17MHz ultrasound examinations don't have a higher sensitivity and specificity in diagnosis of RCT.Elastography can make a clear map of RCIt could help make a definite diagnosis of small tears, distinguish RCT and intact RC, FRCT and PRCT and give an additional information of the edge of RCT.
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