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Contrast‐Enhanced Sonographic Characterization of the Vascularity of the Repaired Rotator Cuff
Author(s) -
Adler Ronald S.,
Johnson Kevin M.,
Fealy Stephen,
Maderazo Alex,
Gallo Robert A.,
Gamradt Seth C.,
Warren Russell F.
Publication year - 2011
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/jum.2011.30.8.1103
Subject(s) - vascularity , medicine , rotator cuff , tendon , shoulders , nuclear medicine , contrast (vision) , fibrous joint , ultrasound , radiology , surgery , artificial intelligence , computer science
Objectives To characterize the distribution of vascularity of the postoperative rotator cuff tendon using a maximum intensity projection technique after contrast‐enhanced sonography. Methods We retrospectively evaluated image data on 23 patients (11 male and 12 female) with intact rotator cuff repairs who had previously undergone contrast‐enhanced sonography of their shoulders using lipid microspheres before and after a standardized exercise protocol. The patients were on average 3 months out from their surgery. Using offline image analysis software, a maximum intensity projection image was obtained for each patient, reflecting the regional vascular distribution within the repair and adjacent soft tissue. Subjective analysis was performed in 4 regions of interest: peribursal, articular medial, articular lateral, and suture anchor, independently by 2 musculoskeletal radiologists using a semiquantitative scale ranging from 0 to 4 for each region (0, no enhancement; 1, 1%–25% enhancement; 2, 26%–50%; 3, 51%–75%; and 4, 76%–100%). A combined vascularity score (0–8) was produced for each region and formed the basis for the subjective analysis. Results Using a Mann‐Whitney nonparametric test, the data showed significantly higher regional enhancement in the peribursal and suture anchor regions compared to the tendon ( P < .001). Exercise resulted in a statistically significant increase in the extent of enhancement in all regions ( P < .002). Inter‐rater reliability analysis using a weighted κ statistic showed strong agreement (0.63–0.64) for the suture anchor site and moderate agreement for the others (peribursal, 0.35–0.39; articular medial, 0.45–0.55; and articular lateral 0.32–0.33). Conclusions The maximum intensity projection technique after contrast‐enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone‐tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.