Korean J Radiol.  2018 Feb;19(1):63-71. 10.3348/kjr.2018.19.1.63.

The Association between the Magnetic Resonance Imaging Findings of Adhesive Capsulitis and Shoulder Muscle Fat Quantification Using a Multi-Echo Dixon Method

Affiliations
  • 1Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea. hongsj@korea.ac.kr
  • 2Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea.
  • 3Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea.
  • 4Siemens Healthcare, Seoul 03737, Korea.

Abstract


OBJECTIVE
To investigate the association between the magnetic resonance imaging (MRI) findings of adhesive capsulitis and shoulder muscle fat percentages using a multi-echo Dixon method.
MATERIALS AND METHODS
Twenty-four patients with clinical diagnoses of adhesive capsulitis and either intact rotator cuffs or Ellman grade 1 partial tears as indicated by MRI scans were included. Two radiologists independently evaluated MRI scans of adhesive capsulitis as follows: presence or absence of axillary recess capsular and extracapsular hyperintensities; thickness of the coracohumeral ligament; thickness of abnormal rotator interval soft tissue; and thickness of glenoidal/humeral axillary recess capsules. Fat quantifications of the supraspinatus, infraspinatus, teres minor, subscapularis, teres major and posterior deltoid muscles were performed using multi-echo Dixon imaging at three locations. Inter-rater agreement was assessed. Differences in fat percentages were assessed and correlations between fat percentages and quantitative measurements were evaluated.
RESULTS
The fat percentage of the supraspinatus was significantly higher in patients with extracapsular hyperintensity (present, 3.00 ± 1.74%; absent, 1.81 ± 0.80%; p = 0.022). There were positive correlations between the fat percentage of the teres minor and the thicknesses of the abnormal rotator interval soft tissue (r = 0.494, p = 0.014) and the glenoidal axillary recess capsule (r = 0.475, p = 0.019). After controlling for the effects of age, sex and clinical stage, the relationship between the teres minor fat percentage and the thickness of the abnormal rotator interval soft tissue was statistically significant (r = 0.384, p = 0.048). Inter-rater agreement was almost perfect for fat quantification (intraclass correlation coefficients [ICC] > 0.9) and qualitative analyses (k = 0.824), but were variable for quantitative measurements (ICC, 0.170-0.606).
CONCLUSION
Several MRI findings of adhesive capsulitis were significantly related to higher fat percentages of shoulder muscles.

Keyword

Adhesive capsulitis; Fatty quantification; Shoulder; Rotator cuff; MRI

MeSH Terms

Adhesives*
Bursitis*
Capsules
Deltoid Muscle
Diagnosis
Humans
Ligaments
Magnetic Resonance Imaging*
Methods*
Muscles
Rotator Cuff
Shoulder*
Tears
Adhesives
Capsules

Figure

  • Fig. 1 46-year-old woman with clinical diagnosis of adhesive capsulitis.A. Presence of axillary recess capsular hyperintensity (solid arrow) and extracapsular hyperintensity (open arrows) was evaluated by coronal T2-weighted fat-suppressed imaging. B. Thickest portion of coracohumeral ligament (white line) was evaluated on oblique sagittal proton-density-weighted turbo spin-echo images. C. Thickest portion of abnormal soft tissue within rotator interval (white line) was measured at 1.5 cm lateral to base of coracoid process on oblique sagittal proton-density-weighted turbo spin-echo images. D. Thickness of axillary recess capsules on glenoidal (white line) and humeral (yellow line) sides were measured on oblique coronal images.

  • Fig. 2 Oblique sagittal proton-density-weighted turbo spin-echo images (A) with respective locations on axial images (small boxes in lower left corner) and corresponding fat percentage maps (B) with region-of-interest placement for fat quantification.Measurements were made at 3 cm and 1.5 cm medial to glenoid cartilage and at level of glenoid cartilage. Note heterogeneous fat distribution in shoulder musculature. DT = deltoid, IS = infraspinatus, SC = subscapularis, SS = supraspinatus, Tm = teres minor, TM = teres major


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