J Korean Orthop Assoc.  2014 Jun;49(3):223-230.

The Accuracy of Sonoelastography in a Fatty Degeneration of Supraspinatus: A Comparison with Magnetic Resonance Images through Quantitative Assessment

• Seo JB
• Yoo JS
• Ryu JW

Abstract

PURPOSE
Using magnetic resonance imaging (MRI) as the standard of reference, the purpose of this study was to evaluate the accuracy of sonoelastography (SE) for assessment of fatty degeneration of suprasupinatus (SSP).
MATERIALS AND METHODS
A retrospective analysis was conducted in 131 shoulders of 126 consecutive patients who underwent shoulder MRI, and SE. Oblique sagittal images of SSP were obtained using SE; the SE images were evaluated by two orthopedic surgeons using a 256 degree color map image.
RESULTS
When the supraspinatus fatty degenerations were based on MRI findings, the sensitivity of SE was 89.47%, specificity 92.85%, and accuracy 91.60%. The interobserver reliability of the SE findings was 'almost perfect agreement' with a weighted kappa coefficient of 0.81. By comparison of MRI with the SE findings, the grades of MRI and SE showed positive correlation (r=0.85, p< or =0.001). In addition, the occupation ratio and blue region area ratio also showed positive correlation (r=0.69, p< or =0.001).
CONCLUSION
SE is valuable in quantitative assessment of the severity of fatty atrophy of the supraspinatus and has excellent accuracy, excellent correlation with MRI and conventional ultrasonography, and excellent interobserver reliability.

Keyword

supraspinatus; fatty degeneration; ultrasonography; sonoelastography

MeSH Terms

Atrophy
Elasticity Imaging Techniques*
Humans
Magnetic Resonance Imaging
Occupations
Orthopedics
Retrospective Studies
Sensitivity and Specificity
Shoulder
Ultrasonography

Figure

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  Figure 1 T1-weighted oblique sagittal magnetic resonance image shows the method of calculation of the occupation ratio of supraspinatus muscle. Occupation ratio=actual occupied area (B)/estimated anatomical area (A) ×100. Solid lines indicate suprascapular fossa. Dotted lines indicate supraspinatus.

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  Figure 2 Photograph shows the investigation of the supraspinatus muscle belly. The transducer was perpendicular to the central tendon of the muscle belly of the supraspinatus muscle; this plane corresponded to the oblique sagittal magnetic resonance imaging plane.

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  Figure 3 Blue region area ratio=total surface area of blue regions (B)/total surface area in desired region (A) ×100. Solid lines indicate suprascapular fossa. Dotted lines indicate total surface area of blue regions. Subcu, subcutaneous tissue; TR, trapezius.

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  Figure 4 (A) T1-weighted oblique sagittal image of magnetic resonance images of grade 1 supraspinatus fatty degeneration shows some fatty streaks. (B) Oblique sagittal view of the sonoelasticography of grade 0 supraspinatus fatty degeneration shows an absolute dominant blue region (a few focal lesions) in the elasticity image. Solid lines indicate suprascapular fossa. Subcu, subcutaneous tissue; TR, trapezius; SSP, supraspinatus.

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  Figure 5 (A) T1-weighted oblique sagittal image of magnetic resonance images of grade 4 supraspinatus fatty degeneration shows that fat is more extensive than the muscle. (B) Oblique sagittal view of the sonoelasticography of grade 2 supraspinatus fatty degeneration shows a non-dominant blue region (≤1/2 of desired region) in the elasticity image. Solid lines indicate suprascapular fossa. Dotted lines indicate supraspinatus. Subcu, subcutaneous tissue; TR, trapezius; SSP, supraspinatus.

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  Figure 6 (A) T1-weighted oblique sagittal image of magnetic resonance images of grade 1 supraspinatus fatty degeneration shows some fatty streaks. (B) Oblique sagittal view of the sonoelasticography; arrows indicate posterior acoustic shadowing of the superior border and the spine of the scapula; arrowheads indicate a low echogenecity signal around the scapula by the reaction force of the scapula. TR, trapezius; SSP, supraspinatus; SU, superior border of scapula; SP, spine of scapula.

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