SLAP Lezyonlarının MRG ve Artroskopik karşılaştırması

Öz

Superior labrum anterior-posterior (SLAP) yırtıkları ortopedi hastalarında omuz ağrısı kaynaklarındandır. Manyetik rezonans görüntüleme (MRG) bu hastalarda teşhis için gereklidir. Bu çalışmanın amacı SLAP lezyonlarının MRG ve artroskopi değerlendirmeleri arasındaki uyumu göstermektir. Çalışma Nisan 2019- Mayıs 2020 tarihleri arasında varolan omuz patolojisi için omuz artroskopi cerrahisine giden yaş ortalamsı 50.40 (aralık: 19-74 yaş) olan, 32 kadın ve 20 erkek içeren toplam 52 hastadan oluşmaktadır. 34 hastada (%65) sağ, 18’ nde (%35) sol omuz etkilenmişti. Hastalarda ameliyat öncesi teşhis; rotator kaf sendromu (n:34), impingement sendromu (n:7), donuk omuz (n:2) ve bankart lezyonu (n:9) idi. MRG yapıldıktan sonra omuz artroskopisi yapıldı. Sadece artroskopik değerlendirmede SLAP tip sınıflaması tespit edildi ve 13 Tip 1 (%33), 23 Tip 2 (%58), bir Tip 3 (%3), bir Tip 4 (%3) ve 1 Tip 5 (%3) lezyon mevcut idi. Oniki hastada hem MRG hemde artroskopi de SLAP lezyonları saptandı. MRG de SLAP lezyon olmasına rağmen 3 hastada artroskopik olarak lezyon saptanmadı. 10 hastada hem artroskopi hem de MRG de SLAP lezyonu yoktu. 27 hastada MRG de lezyon yok iken, artroskopi de lezyon saptandı. SLAP lezyonlarının teşhisinde, MRG %31 duyarlılık, %77 özgüllük, %80 pozitif öngörme değeri ve %27 negatif öngörme değeri gösterdi. MRG’ nin doğruluğu %42 olarak bulundu. MRG ve artroskopi arasında anlaşmanın güvenilirliği (Fleiss kappa) 0.048 (p=0.596) olarak bulundu. MRG diğer omuz patolojilerini teşhis etmekte yararlı bir araç olmasına ragmen, altın standart olan omuz artroskopisine kıyasla SLAP lezyonlarını tespit etmekte yeterli değildir.

Anahtar Kelimeler

• Omuz
• SLAP lezyon
• Artroskopi
• MRG
• Teşhis
• Duyarlılık
• Özgüllük

Comparison of SLAP Lesions on MRI and Arthroscopy

Öz

Superior labrum anterior-posterior (SLAP) tears are a source of shoulder pain in orthopaedic patients. Magnetic resonance imaging (MRI) is a necessary tool for diagnosis in these patients. The aim of this study was to show correlation between MRI and arthroscopy evaluations of SLAP lesions. The study included a total of 52 patients, comprising 32 females and 20 males with a mean age of 50.40 years (range: 19-74 years) who underwent shoulder arthroscopy surgery for an existing shoulder pathology between April 2019- May 2020. The right shoulder was affected in 34 (65%) patients and the left in 18 (35%). The pre-operative diagnoses were rotator cuff syndrome (n:34), impingement syndrome (n:7), frozen shoulder (n:2) and Bankart lesion (n:9). MRI of the shoulder joint was applied followed by shoulder arthroscopy. Only SLAP type classifications were detected on arthroscopic examination and there were 13 Type 1 (33%), 23 (58%) Type 2, one (3%) Type 3, one (3%) Type 4, and one (3%) Type 5 lesion. SLAP lesions were detected on both MRI and arthroscopy in 12 patients. The lesion could not be detected arthroscopically in 3 patients although MRI reported a SLAP lesion. SLAP lesions were negative on both MRI and arthroscopy in 10 patients. In 27 patients, MRI was negative, but the SLAP lesions were detected in arthroscopy. In the diagnosis of SLAP lesions, MRI showed 31% sensitivity, 77% specificity, 80% positive predictive value, and 27% negative predictive value. The accuracy of MRI was found to be 42%. Reliability of agreement (Fleiss kappa) between MRI and arthroscopy was found to be 0.048 (p=0.596). Although MRI is a useful tool for diagnosing other shoulder pathologies, it is not sufficient for the detection of SLAP lesions compared to gold standard shoulder arthroscopy.

Anahtar Kelimeler

• Shoulder
• SLAP lesion
• Arthroscopy
• MRI
• Diagnosis
• Sensitivity
• Specificity

Kaynakça

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