Hasan ERDOĞAN, Mehmet Sedat DURMAZ, Ali Yavuz KARAHAN, Serdar ARSLAN, İsmet TOLU

Omuz Ultrasonografi İncelemesi Manyetik Rezonans Görüntüleme’nin Yerini Alabilir Mi?

Amaç: Omuz patolojilerinin incelenmesinde manyetik rezonans görüntüleme (MRG) altın standart tetkiktir, ancak statik bir yöntemdir, maliyeti yüksektir ve inceleme zamanı uzundur. Ultrasonografi (US) ise hızlı sonuç veren, kolay uygulanan, ucuz ve yaygın bir görüntüleme yöntemidir, fakat MRG’ye göre daha subjektiftir ve tecrübeye oldukça bağımlıdır. Biz bu çalışmada omuz eklemi patolojilerinin tanısında, artan tecrübe ile birlikte US’nin tanısal doğruluğunu MRG ile karşılaştırmayı amaçladık.Yöntemler: Yeterli düzeyde omuz US tecrübesi olmayan bir radyolog, omuz US ile ilgili mevcut literatürü okudu. Daha sonra 2 hafta boyunca, MRG bulguları bilinen 100 hastaya eğitim amaçlı olarak US incelemesi yapıldı. Sonraki 5 hafta boyunca ise, her hafta 50 hasta olmak üzere, çalışmaya dahil edilen toplam 250 hastaya önce US, sonra MRG tetkiki yapılarak, artan US tecrübesi ile birlikte, US ve MRG bulguları arasındaki uyumun artıp artmadığı araştırıldı.Bulgular: Hastaların 160'ı (%64) kadın, 90'ı (%36) erkekti. Hastaların yaş ortalaması 54±11,7 olarak saptandı. Her hafta incelenen hastalar ayrı bir grup olacak şekilde, toplam 5 grup şeklinde değerlendirme yapıldı. İlerleyen haftalara göre artan US tecrübesi ile birlikte elde edilen sensitivite, spesifite, pozitif prediktif değer ve negatif prediktif değerler hesaplandı.Sonuç: Omuz eklemi patolojilerinde yeterince tecrübe kazanıldığında US’de tanısal doğruluk belirgin düzeyde artmaktadır. Parsiyel yırtıklarda US’nin başarısı MRG’nin gerisindedir. Eklem aralığında efüzyonu göstermede US, MRG’ye göre geride kalırken, subakromial-subdeltoid efüzyonu göstermede sensitivite ve spesifite MRG’ye yakındır. US’nintotal yırtıkları, biceps tenosinovitini ve akromioklaviküler eklem dejenerasyonunu saptama oranları MRG ile benzer düzeydedir. Kalsifik tendinitleri, biceps subluksasyonu-dislokasyonunu ve impingementi göstermede ise US’nin MRG’den daha başarılı olduğu görülmüştür.

Can Shoulder Ultrasonography Review Replace Magnetic Resonance Imaging?

Objective: Magnetic resonance imaging (MRI) is the gold standard examination in the evaluation of shoulder pathologies, but it is a static method, expensive and examination time is long. Ultrasonography (US) is a fast, easy-to-apply, cheap and common imaging method, but it is more subjective and dependent on experience. In this study, we aimed to compare the diagnostic accuracy of US with MRI in the diagnosis of shoulder joint pathologies, with increasing experience. Methods: A radiologist without sufficient shoulder US experience read the literature on shoulder US. Then, for 2 weeks, US was performed for training in 100 patients whose MRI findings were known. Subsequently, for 5 weeks, firstly US, then MRI were performed a total of 250 patients, including 50 patients every week. With increased US experience, it was investigated whether the consistency between US and MRI findings increased. Results: One hundred and sixty (64%) of the patients were female and 90 (36%) were male. The mean age of the patients was 54±11.7. Each week, patients were evaluated as a separate group, with a total of 5 groups. Sensitivity, specificity, positive and negative predictive values were calculated which were achieved with increasing US experience. Conclusion: When sufficient experience is gained in shoulder pathologies, diagnostic accuracy increases significantly in US. The success of US in partial tears is behind MRI. US lags behind MRI in showing joint effusion. The sensitivity and specificities in the subacromial-subdeltoid effusion are close to MRI. The rates of US to detect total tears, biceps tenosynovitis and acromioclavicular joint degeneration are similar to MRI. US is successful than MRI in showing calcific tendinitis, biceps subluxation-dislocation and impingement.

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