The Effect Of Ultrasound-guided Subacromial Bursography For Assessment Of Rotator Cuff Lesions

Objective:We performed a new ultrasound technique — ultrasound-guided subacromail bursography(USB) for the first time in our hospital. The purpose of this study was to detect the value and to summarize the features of USB for assessing of rotator cuff lesions, in which arthroscopy was used as a gold standard.Method:There were 263 patients that suspected of rotator cuff lesions had performed ultrasound examination of the affected shoulder at Sichuan Provincial People’s Hospital between March 2014 and June 2015. One hundred and five of 263 patients had then undergone USB examination. Finally, 40 patients confirmed as rotator cuff lesions by arthroscopy were recruited in this study. All diagnosis of ultrasound, USB and arthroscopy was categorized as tendinosis(intact rotator cuff), partial-thickness and full-thickness rotator cuff tears. The features of USB for assessment of different kinds of rotator cuff lesions were analyzed and summarized. The sensitivity, specificity, accuracy, positive predictive value(PPV), negative predictive value(NPV) and Youden Index of both ultrasound and USB was calculated respectively for assessing partial-thickness and full-thickness rotator cuff tears.Result:There was no severe complication and adverse reactions occurred either during or in a month after the USB procedure. As confirmed by arthroscopy, US and USB detected 17 and 24 out of 25 full-thickness rotator cuff tears cases respectively with significant difference(P = 0.039). The sensitivity, specificity and accuracy of US was 68%, 100% and 80% respectively, and that of USB was 96%, 100% and 97.5% respectively for assessment of full-thickness tears. Among those 10 patients confirmed as partial-thickness rotator cuff tears by arthroscopy, US and USB accurately detected 6 and 8 cases respectively, with no significant difference(P = 0.05). However, US and USB detected 3 and 4 out of 5 intact rotator cuffs respectively.Conclusion:1、Ultrasound-guided Subacromial bursography was a novel and safe imaging modality, which has made a new clinical application of extravascular contrast-enhanced ultrasound and offered a new form of bursography.2、USB could be used to assess rotator cuff lesions. Whether there were contrast agents leaking into rotator cuff tendon from the bursa or not was a criteria to differentiate a rotator cuff tear(bursal side partial-thickness tear or full-thickness tear) or an intact cuff. Whether the contrast agents was distributed in the whole layer of tendon that the hyperecho reached at the surface of humerus or entered into the glenohumeral joint was useful to judge if the tear was full-thickness or partial-thickness. In addition, we could measure the area of contrast agents that entered into the tendon to evaluate the area of rotator cuff tear, which was of great importance for surgeons to make a therapeutic plan. But USB was not sensitive to intrasubstance and articular side partial-thickness rotator cuff tears, because contrast agents was injected into the subacromial bursa not the glenohumeral joint.3、The sensitivity and specificity of USB was significantly greater than that of ultrasound for full-thickness rotator cuff tears. USB expands the value of ultrasound in evaluating rotator cuff pathology, which is worth to populate and apply in our clinical work.