관절순 병변의 진단과 병변의 위치 평가에 대한 견관절 자기공명관절조영술의 진단적 정확도 및 일치도에 대한 연구 = Diagnostic Accuracy and Inter-Observer Agreement of Shoulder Magnetic Resonance Arthrography in the Detection of Labral Lesion and Assessment of Lesion Location

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the diagnostic accuracy and inter-observer agreement of magnetic resonance (MR) arthrography in the detection of labral lesions by location and to describe useful MR imaging findings of labral tears.
Materials and Methods: Sixty-eight patients who underwent both pre-operative MR arthrography and arthroscopy were included. The location of the labrum was classified into anterior (2-6 o’clock), superior (12-2 o’clock), and posterior (6-12 o’clock). Sensitivity, specificity, accuracy, and inter-observer agreement of MR arthrography for the diagnosis of labral lesions by location were calculated. Frequency of MR imaging findings such as detachment, high signal intensity cleft, contour change, absence, and signal change of the labrum by location were analyzed.
Results: 35 anterior, 44 superior and 15 posterior labral lesions were detected by arthroscopy. The corresponding sensitivities were 91.4%, 79.5%, and 40.0%, specificities were 90.9%, 20.8%, and 86.8%, accuracies were 91.2%, 58.8%, and 76.5%, and kappa values were 0.823, 0.252, and 0.394, for anterior, superior, posterior lesions, respectively. The most common MR imaging findings were detachment in 60.0% of anterior labrums, high signal intensity cleft in 52.3% of superior labrums, and normal in 60.0% of posterior labrums.
Conclusion: Diagnostic accuracy and inter-observer agreement of MR arthrography in the diagnosis of labral lesions are high in anterior labrums and low in superior or posterior labrums. The useful MR imaging findings of labral tears were different according to labral location.

국문 초록 (Abstract)

목적: 견관절의 관절순 병변을 진단하는데 자기공명관절조영술의 진단적 정확도 및 일치도를 병변의 위치별로 평가하고, 진단에 유용한 영상소견을 알아보고자 하였다.
대상과 방법: 수술 전 견관절 자기공명관절조영술을 시행하고, 관절경 수술을 받은 68명의 환자를 대상으로 하였다. 관절순의 위치를 전방(2~6시), 상방(10~2시), 후방(6~10시)으로 분류하였다. 자기공명관절조영술의 민감도, 특이도, 정확도 및 일치도를 관절순 병변의 위치별로 산출하였다. 자기공명관절조영영상에서 관절순의 박리, 고신호강도의 틈, 모양변형, 결손, 신호강도변화의 영상소견을 평가하고 위치별로 빈도를 분석하였다.
결과: 관절경 수술에서 관절순 병변은 전방 35명, 상방 44명, 후방 15명 있었다. 관절순 병변 진단에 대한 자기공명관절조영술의 민감도는 91.4%, 79.5%, 40.0%, 특이도는 90.9%, 20.8%, 86.8%, 정확도는 91.2%, 58.8%, 76.5%, 판독자간의 일치도는 kappa값이 0.823, 0.252, 0.394였다(전방, 상방, 후방). 가장 흔한 자기공명영상소견은 전방에서는 관절순의 박리(60.0%), 상방에서는 고신호강도의 틈(52.3%), 후방에서는 정상(60.0%)이었다.
결론: 관절순 병변을 진단하는 데 있어 자기공명관절조영술의 진단적 정확도 및 일치도는 전방에서는 높았지만, 상방, 후방에서는 낮았다. 진단에 유용한 영상소견은 병변의 위치별로 달랐다.

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