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Dynamic enhanced MRI of the subacromial bursa: correlation with arthroscopic and histological findings

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Abstract

Objective

To assess dynamic MRI with Gd-DTPA enhancement for evaluating inflammatory changes in the subacromial bursa.

Design and patients

We detected the signal intensity changes in dynamic MRI of the subacromial bursa, and confirmed these macroscopically by arthroscopy and histologically. The signal intensity was measured using built-in software, and the enhancement ratio (E ratio) was calculated from dynamic MR images. In addition, as a parameter of the rate of the increase in the signal intensity from 0 to 80 s, the mean increase per second in the E ratio was obtained as the coefficient of enhancement (CE). The correlation was studied of the E ratio and CE with the arthroscopic findings (redness, villous formation, thickening and adhesion), and of the E ratio and CE with the histological findings (capillary proliferation, papillary hyperplasia, fibrosis and inflammatory cell infiltration) of the subacromial bursa. Of patients with shoulder pain, this study included those with rotator cuff injury; patients with rheumatoid arthritis or pitching shoulder disorders were excluded. There were 27 patients (15 men, 12 women) ranging in age from 25 to 73 years (mean 49.1 years). Dynamic MRI of the shoulder was also performed on the healthy side of 10 patients and in five normal young volunteers.

Results and conclusions

Changes in signal intensity on dynamic MRI were measured in the subacromial bursa. The E ratio (80 s) and CE (0–80 s) were significantly correlated with redness and villous formation as arthroscopic findings, positively correlated with capillary proliferation and papillary hyperplasia as histological findings (p < 0.05), and negatively correlated with fibrosis as a histological finding (p < 0.05) in the subacromial bursa. The patterns of dynamic curves were well correlated with the bursoscopic and histological findings of the synovium of the subacromial bursa. Dynamic MRI appears to correlate with inflammatory activity of synovium of the subacromial bursa. Clarifying the state of the synovium of the subacromial bursa may be useful in determining therapeutic strategies (e.g., indicating topical infusion of hyaluronic acid or steroids for preservative treatment and selecting the site). Furthermore, the evaluation may be useful for indicating surgery, selecting the technique, and evaluating preoperative and postoperative inflammatory changes.

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Acknowledgements

We are grateful to Atsushi Hirooka, M.D., director of Sekime Hospital, and Kiyofumi Iida, chief RT of Sekime Hospital, for their cooperation in image processing. We are also grateful to Yuichi Inoue M.D., Chairman, Department of Radiology, Osaka City Medical School, for reviewing the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Osaka Kosei-nenkin Hospital, Osaka, Japan

    Saeko Matsuzaki

  2. Shoulder and Sports Medicine Service, Osaka Kosei-nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, 553-0003, Osaka City, Osaka, Japan

    Minoru Yoneda

  3. Department of Pathology, Osaka Kosei-nenkin Hospital, Osaka, Japan

    Yasushi Kobayashi

  4. Department of Orthopaedic Surgery, Sapporo Tokeidai Hospital, Osaka, Japan

    Sunao Fukushima

  5. Department of Orthopaedic Surgery, Shinsyu University, Matsumato, Japan

    Shigeyuki Wakitani

Authors
  1. Saeko Matsuzaki
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  2. Minoru Yoneda
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  3. Yasushi Kobayashi
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  4. Sunao Fukushima
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  5. Shigeyuki Wakitani
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Corresponding author

Correspondence to Minoru Yoneda.

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Matsuzaki, S., Yoneda, M., Kobayashi, Y. et al. Dynamic enhanced MRI of the subacromial bursa: correlation with arthroscopic and histological findings. Skeletal Radiol 32, 510–520 (2003). https://doi.org/10.1007/s00256-003-0655-8

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  • DOI: https://doi.org/10.1007/s00256-003-0655-8

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