Arthroscintigraphy in Suspected Rotator Cuff Rupture

Abstract

Summary Aim: In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. Methods: After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBURES 400 μCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. Results: In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistant. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Conclusion: Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

The effectiveness of diagnostic tests for the assessment of shoulder pain due to soft tissue disorders: a systematic review

“…Although frequencies of >10 MHz are common in practice today, most studies used only 5 MHz (six studies) or 7 MHz (19 studies) or a combination of the two (six studies); only three studies exclusively employed transducers of 10 MHz or over. [40][41][42] The techniques used were described in some detail (in all except three studies [43][44][45], and were largely based on those of Mack and colleagues, 46,47 Middleton and colleagues 41,48 and Crass and colleagues. 40,49 Outcomes Studies generally concentrated on the detection of 'any' RCT (27 studies), although 17 studies also attempted to differentiate full or partial tears using the technique (see Appendix 7).…”

“…This is also reflected in the prevalence of RCTs in the study samples as mentioned above; only nine studies had prevalences of <40%. 41,43,52,64,65,68,71,73,74…”

“…One-third of the studies used only arthrography as the reference test and were judged not to have employed a suitable reference standard. 41,43,45,47,50,57,59,65,68,[71][72][73]75 In a further four, 67,70,74,76 arthrography was used as the reference standard in at least some of the patients enrolled -the reference test in these studies was scored as unclear. In all of the remaining studies except one using MRI, 60 the reference standard used was likely to have correctly classified the target condition.…”

“…Sufficient details to allow replication of the reference tests was provided in only 16. 41,43,44,54,56,[59][60][61][62][63]69,71,74,75,77,78 Partial verification bias was also a problem, being clearly present in 10 studies 40,45,52,58,66,67,70,74,76,79 where only a subset of those undergoing ultrasound actually underwent the reference test, and clearly not present in only nine. 47,51,57,60,64,[71][72][73]78 In the other 19 studies, this item was scored as unclear as it appeared that only those who underwent the reference test were included in the study; others who may have undergone ultrasound or been eligible to undergo ultrasound were not reported.…”

“…The criteria used to interpret the ultrasound scans also tended to be a combination of those proposed in the early studies of Middleton and colleagues, 41,48 Mack and colleagues 46,47 and Crass and colleagues. 49,80 Almost all studies included non-visualisation of the RC as a criterion, 12 36,47,51,55,58,60,64,66,[71][72][73][74] reported using loss of convexity of the RC as per Mack and colleagues 46 and 13 included focal discontinuity 41,45,53,54,60,62,63,69,70,73,75,77,78 and 18 focal thinning [41][42][43][44]54,57,59,61,64,[67][68][69][70]72,73,75,…”