Ultrasound Microflow Imaging Technology for Diagnosis of Adhesive Capsulitis of the Shoulder

Abstract

Objectives-To assess the diagnostic accuracy of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) at the subcoracoid triangle for adhesive capsulitis of the shoulder, to compare the diagnostic value of SMI with that of conventional ultrasound (US) and power Doppler ultrasound (PDUS) findings, and to investigate the correlation between vascular flow on SMI with clinical features.Methods-Our study included 39 patients with a diagnosis of adhesive capsulitis and 35 healthy patients as a control group. The echogenicity in the rotator interval and coracohumeral ligament thickness were assessed with conventional US. Vascular flow in the subcoracoid fat triangle was evaluated with SMI and PDUS (SMI and PDUS areas). A receiver operating characteristic curve analysis was performed to evaluate diagnostic accuracy. The correlation between US findings and the range of motion, pain intensity, and duration of symptoms was also evaluated.Results-The SMI area was higher in the adhesive capsulitis group than in the control group (2.95 versus 0 mm 2 ; P < .01). The visualization of vascular flow at the subcoracoid fat triangle was superior with SMI compared with PDUS (P < .01). In the receiver operating characteristic analysis, the SMI area showed higher diagnostic performance, with an area under the curve of 0.90 compared with other US findings. The area of SMI vascular flow was also negatively correlated with external rotation and forward flexion (P < .05) in the adhesive capsulitis group.Conclusions-Measurement of vascular flow at the subcoracoid fat triangle using SMI facilitated the diagnosis of adhesive capsulitis. Superb Microvascular Imaging was superior to PDUS in diagnostic performance. Vascular flow was negatively correlated with the range of motion of external rotation and forward flexion.

Evaluation of hypervascularity in synovitis of the shoulder using ultrasound: comparison of preoperative ultrasound findings and intraoperative arthroscopic findings

“…Recent US imaging technologies have been shown to be more accurate and sensitive for micro blood flows in connective tissues. In previous reports, contrast-enhanced US 8 , 9 , 21 and superb microvascular imaging 17 , 19 have been used to evaluate hypervascularity via US. Conventional PDUS imaging suffers from technical limitations associated with the visualization and quantitative evaluation of fine vessels or low-velocity blood flow.…”

“…The landmarks in the RI were the guides between the supraspinatus and subscapularis tendons of the coracoid process, humeral head, and acromion based on previous studies. 17 , 19 , 28 For the observation of RI 1, the coracoacromial ligament was used as a landmark. In RI 2, the US probe was moved downward from RI 1 to the area where the long head of the biceps tendon was drawn on the short axis.…”

Shear Wave Elastography of the Coracohumeral Ligament With Frozen Shoulder in Different Stages

“…[19][20][21] Stage I frozen shoulder is mainly an inflammatory reaction with exudation. Kim et al 22 found that the blood supply of the rotator cuff space in early frozen shoulder was abundant, indicating the existence of inflammation; inflammatory exudation leads to ligament thickening, oedema, and reduced stiffness, while the release of a large number of inflammatory cytokines aggravates pain. 16 In stage I, we also found that when the SWE of the CHL decreased, the VAS score increased, resulting in a low negative correlation.…”

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound – Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures

“…The diagnosis of adhesive capsulitis (AC) of the shoulder is based on clinical findings but imaging modalities can be used to confirm the diagnosis [19]. US may help identify several morphological and functional alterations at the level of the GHJ capsule, rotator interval [19][20][21][22], and supraspinatus and subscapularis tendon gliding [23]. The coraco-humeral ligament (CHL) and inferior GHJ capsule were reported to be significantly thickened in AC when compared to other shoulder pathologies and asymptomatic shoulders [20,23,24] and correlated with MRI measurements [19].…”