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Balloufaud M, Hosni S, Bolivar J, Saguintaah M, Virassamy M, Laffont I, Coulet B, Lambert K, Delpont M. Subscapularis impairment on magnetic resonance imaging is correlated with functional limitations in neonatal brachial plexus palsy. INTERNATIONAL ORTHOPAEDICS 2024; 48:1635-1643. [PMID: 38167960 DOI: 10.1007/s00264-023-06081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The relationship between functional shoulder deficits in children with neonatal brachial plexus palsy (NBPP) and magnetic resonance imaging (MRI) shoulder abnormalities was evaluated. METHODS Shoulder function was assessed in 16 children (mean age: 5.8 years; range: 3-12 years) with NBPP based on shoulder rotator muscle strength, as measured using an isokinetic dynamometer and the modified Mallet score. The thickness and fatty infiltration of the subscapularis and infraspinatus muscles, and the morphology of the glenoid on MRI, were also determined. RESULTS The highest subscapularis fatty infiltration subgroup of NBPP patients promoted the highest alteration muscle thickness and modified Mallet score. CONCLUSIONS In NBPP children, subscapularis impairments play a major role in the functional limitations. This study of pediatric NBPP patients highlighted the value of adding an examination of the muscles to routine MRI assessment of bone parameters in the shoulders of NBPP children. TRIAL REGISTRATION NCT03440658.
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Affiliation(s)
- Maxime Balloufaud
- PhyMedExp, CNRS UMR 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - Sarah Hosni
- Orthopedic Pediatric Surgery Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Julie Bolivar
- Pediatric Radiology, Arnaud De Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Magali Saguintaah
- Pediatric Radiology, Arnaud De Villeneuve Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Maxime Virassamy
- Orthopedic Pediatric Surgery Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Isabelle Laffont
- Physical Medicine and Rehabilitation Department, CHU Montpellier, University of Montpellier, Montpellier, France
- Euromov, UFR STAPS, University of Montpellier, Montpellier, France
| | - Bertrand Coulet
- Euromov, UFR STAPS, University of Montpellier, Montpellier, France
- Orthopedic Surgery, Upper Extremity, Hand and Peripheral Nerve Surgery Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Karen Lambert
- PhyMedExp, CNRS UMR 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - Marion Delpont
- PhyMedExp, CNRS UMR 9214, INSERM U1046, University of Montpellier, Montpellier, France.
- Orthopedic Pediatric Surgery Department, Lapeyronie Hospital, CHU Montpellier, University of Montpellier, 191 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
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Mohajer B, Moradi K, Guermazi A, Dolatshahi M, Roemer FW, Ibad HA, Parastooei G, Conaghan PG, Zikria BA, Wan M, Cao X, Lima JAC, Demehri S. Statin use and longitudinal changes in quantitative MRI-based biomarkers of thigh muscle quality: data from Osteoarthritis Initiative. Skeletal Radiol 2024; 53:683-695. [PMID: 37840051 DOI: 10.1007/s00256-023-04473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To assess whether changes in MRI-based measures of thigh muscle quality associated with statin use in participants with and without/at-risk of knee osteoarthritis. METHODS This retrospective cohort study used data from the Osteoarthritis Initiative study. Statin users and non-users were matched for relevant covariates using 1:1 propensity-score matching. Participants were further stratified according to baseline radiographic knee osteoarthritis status. We used a validated deep-learning method for thigh muscle MRI segmentation and calculation of muscle quality biomarkers at baseline, 2nd, and 4th visits. Mean difference and 95% confidence intervals (CI) in longitudinal 4-year measurements of muscle quality biomarkers, including cross-sectional area, intramuscular adipose tissue, contractile percent, and knee extensors and flexors maximum and specific contractile force (force/muscle area) were the outcomes of interest. RESULTS After matching, 3772 thighs of 1910 participants were included (1886 thighs of statin-users: 1886 of non-users; age: 62 ± 9 years (average ± standard deviation), range: 45-79; female/male: 1). During 4 years, statin use was associated with a slight decrease in muscle quality, indicated by decreased knee extension maximum (mean-difference, 95% CI: - 1.85 N/year, - 3.23 to - 0.47) and specific contractile force (- 0.04 N/cm2/year, - 0.07 to - 0.01), decreased thigh muscle contractile percent (- 0.03%/year, - 0.06 to - 0.01), and increased thigh intramuscular adipose tissue (3.06 mm2/year, 0.53 to 5.59). Stratified analyses showed decreased muscle quality only in participants without/at-risk of knee osteoarthritis but not those with established knee osteoarthritis. CONCLUSIONS Statin use is associated with a slight decrease in MRI-based measures of thigh muscle quality over 4 years. However, considering statins' substantial cardiovascular benefits, these slight muscle changes may be relatively less important in overall patient care.
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Affiliation(s)
- Bahram Mohajer
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3142, Baltimore, MD, 21287, USA.
| | - Kamyar Moradi
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, USA, Baltimore
| | - Ali Guermazi
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, MA, USA
| | - Mahsa Dolatshahi
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, USA, Baltimore
| | - Frank W Roemer
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Hamza A Ibad
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3142, Baltimore, MD, 21287, USA
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Bashir A Zikria
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Musculoskeletal Radiology, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 3142, Baltimore, MD, 21287, USA
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Rajabzadeh-Oghaz H, Kumar V, Berry DB, Singh A, Schoch BS, Aibinder WR, Gobbato B, Polakovic S, Elwell J, Roche CP. Impact of Deltoid Computer Tomography Image Data on the Accuracy of Machine Learning Predictions of Clinical Outcomes after Anatomic and Reverse Total Shoulder Arthroplasty. J Clin Med 2024; 13:1273. [PMID: 38592118 PMCID: PMC10931952 DOI: 10.3390/jcm13051273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Despite the importance of the deltoid to shoulder biomechanics, very few studies have quantified the three-dimensional shape, size, or quality of the deltoid muscle, and no studies have correlated these measurements to clinical outcomes after anatomic (aTSA) and/or reverse (rTSA) total shoulder arthroplasty in any statistically/scientifically relevant manner. Methods: Preoperative computer tomography (CT) images from 1057 patients (585 female, 469 male; 799 primary rTSA and 258 primary aTSA) of a single platform shoulder arthroplasty prosthesis (Equinoxe; Exactech, Inc., Gainesville, FL) were analyzed in this study. A machine learning (ML) framework was used to segment the deltoid muscle for 1057 patients and quantify 15 different muscle characteristics, including volumetric (size, shape, etc.) and intensity-based Hounsfield (HU) measurements. These deltoid measurements were correlated to postoperative clinical outcomes and utilized as inputs to train/test ML algorithms used to predict postoperative outcomes at multiple postoperative timepoints (1 year, 2-3 years, and 3-5 years) for aTSA and rTSA. Results: Numerous deltoid muscle measurements were demonstrated to significantly vary with age, gender, prosthesis type, and CT image kernel; notably, normalized deltoid volume and deltoid fatty infiltration were demonstrated to be relevant to preoperative and postoperative clinical outcomes after aTSA and rTSA. Incorporating deltoid image data into the ML models improved clinical outcome prediction accuracy relative to ML algorithms without image data, particularly for the prediction of abduction and forward elevation after aTSA and rTSA. Analyzing ML feature importance facilitated rank-ordering of the deltoid image measurements relevant to aTSA and rTSA clinical outcomes. Specifically, we identified that deltoid shape flatness, normalized deltoid volume, deltoid voxel skewness, and deltoid shape sphericity were the most predictive image-based features used to predict clinical outcomes after aTSA and rTSA. Many of these deltoid measurements were found to be more predictive of aTSA and rTSA postoperative outcomes than patient demographic data, comorbidity data, and diagnosis data. Conclusions: While future work is required to further refine the ML models, which include additional shoulder muscles, like the rotator cuff, our results show promise that the developed ML framework can be used to evolve traditional CT-based preoperative planning software into an evidence-based ML clinical decision support tool.
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Affiliation(s)
| | - Vikas Kumar
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
| | - David B. Berry
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA 92093, USA; (D.B.B.); (A.S.)
| | - Anshu Singh
- Department of Orthopedic Surgery, University of California San Diego, San Diego, CA 92093, USA; (D.B.B.); (A.S.)
| | | | - William R. Aibinder
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Bruno Gobbato
- R. José Emmendoerfer, 1449—Nova Brasília, Jaraguá do Sul 89252-278, SC, Brazil;
| | - Sandrine Polakovic
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
| | - Josie Elwell
- Exactech, Inc., Gainesville, FL 32653, USA; (H.R.-O.); (V.K.); (S.P.); (J.E.)
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Yang Z, Zhang M, Liu T, Zhang B, Wang X, Liang J, Jiang J, Yun X. Does the Fatty Infiltration Influence the Re-tear Rate and Functional Outcome After Rotator Cuff Repair? A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:227-237. [PMID: 36777118 PMCID: PMC9880084 DOI: 10.1007/s43465-022-00807-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/18/2022] [Indexed: 01/11/2023]
Abstract
Purpose Fatty infiltration (FI) of the rotator cuff muscles occurs after rotator cuff tears (RCTs), which may affect the outcome of the repair procedure. This study aimed to determine the relationship between preoperative FI and the rate of re-tear and functional outcomes after rotator cuff repair. Methods Computerized databases, including PubMed, EMBASE, Web of Science, and Cochrane Library database were searched for studies published from the inception date to January 2022. Two reviewers independently screened the titles and abstracts using prespecified criteria. Articles were included if they clearly stated the effect of varying degrees of FI on the outcome after shoulder cuff repair. Comparison was performed by different degrees of FI analysis: no FI is grade 0-1, FI is grade 2 and above. Statistical analysis was performed using Review Manager 5.4.1 software. Results A total of 16 articles involving 1383 patients from 8 countries were included. The follow-up period ranged from 8 to 121 months. In terms of re-tear rate: patients with preoperative FI had significantly higher rates of re-tear compared with patients without FI (OR 4.60, 95% CI 2.22-9.54, p < 0.0001), supraspinatus FI VS no FI (OR 2.06, 95% CI 1.00-4.24, p = 0.05), infraspinatus FI VS no FI (OR 2.42, 95% CI 1.19-4.91, p = 0.01). In terms of functional scoring: patients without FI had higher postoperative Constant-Murley (Constant) scores than those with FI (MD - 5.06, 95% CI - 9.40 to - 0.72, p = 0.02), there was no clear evidence that preoperative FI was related to postoperative American Society of shoulder and elbow physicians scores and the University of California at Los Angeles scores and range of motion. Conclusion FI after RCTs significantly increases the risk of postoperative re-tear and leads to worse functional scores, especially FI of the infraspinatus muscle. However, FI does not seem to reduce postoperative range of motion. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00807-0.
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Affiliation(s)
- Zhitao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Tao Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Borong Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Xihao Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Junwen Liang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
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Wang TY, Nie P, Zhao X, Wang HX, Wan GY, Zhou RZ, Zhong X, Zhang Y, Yu TB, Hao DP. Proton density fat fraction measurements of rotator cuff muscles: Accuracy, repeatability, and reproducibility across readers and scanners. Magn Reson Imaging 2022; 92:260-267. [PMID: 35623416 DOI: 10.1016/j.mri.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the accuracy, repeatability, and reproducibility of magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) measurements of rotator cuff muscles between two readers and three different scanners. METHODS Thirty-one volunteers underwent serial shoulder MRI examinations of both left and right sides on one 1.5-T MRI scanner and two 3.0-T MRI scanners. Two independent readers measured muscular PDFF of the supraspinatus, infraspinatus/teres minor muscle, and subscapularis. MR spectroscopy-based proton density fat fraction (MRS-PDFF) was regarded as the reference standard for assessing accuracy. A "coffee break" examination method was used to test the repeatability of each scanner. Bland-Altman plots, Pearson correlation, and linear regression analysis were used to assess bias and linearity. The Wilcoxon signed-rank test and Friedman test were applied to evaluate repeatability and reproducibility. RESULTS MRI-PDFF measurements indicated strong linearity (R2 = 0.749) and small bias (-0.18%) in comparison with the MRS-PDFF measurements. A very strong positive Pearson correlation (r = 0.955-0.986) between the PDFF estimates of the two repeat scans indicated excellent repeatability. The PDFF measurements showed high reproducibility, with a strong positive Pearson correlation (r = 0.668-0.698) and a small mean bias (-0.04 to -0.10%) across different scanners. CONCLUSION MRI-PDFF measurements of rotator cuff muscles were highly accurate, repeatable, and reproducible across different readers and scanners, leading us to the conclusion that PDFF can be a reliable and robust quantitative imaging biomarker for longitudinal or multi-center studies.
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Affiliation(s)
- Tong-Yu Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Xia Zhao
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - He-Xiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Guang-Yao Wan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Rui-Zhi Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Xin Zhong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Yi Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
| | - Teng-Bo Yu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China.
| | - Da-Peng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China.
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Liu B, Xu J, Jin Y, Su W, Zhang X, Qiao Y, Yu W, Cheng L, Zhao J, Li Y. Advantages of 3-dimensional Measurements for Supraspinatus Intramuscular Fatty Evaluation in Patients With Medium to Massive Rotator Cuff Tears: Comparison With a Single Sagittal Slice. Am J Sports Med 2022; 50:699-707. [PMID: 35044262 DOI: 10.1177/03635465211068854] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fatty infiltration of the rotator cuff muscles is highly related to poor outcomes after rotator cuff tears. Fat fraction (FF) based on traditional 2-dimensional measurements (2D-FF) from a single sagittal Y-view slice cannot determine intramuscular FF in the rotator cuff muscles; the newly developed 3-dimensional method (3D-FF) is supposed to precede 2D measurements for intramuscular FF evaluation in accuracy and reliability. PURPOSE (1) To measure 3D-FF and (2) to compare 3D-FF and 2D-FF in terms of quantitative values and intra- and interobserver agreement. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Six-point Dixon magnetic resonance imaging was performed in patients with full-thickness supraspinatus tears. 2D-FF was calculated on a single sagittal Y-view. Semiautomatic segmentation software (ITK-SNAP) was used to reconstruct 3D volumes of the supraspinatus muscle and fat. 3D-FF was obtained by dividing the fat volume by the total volume of the supraspinatus muscle. A paired t test was used to compare the individual differences between 2D-FF and 3D-FF results. Linear regression and Bland-Altman analyses were performed to determine the agreement between 2D-FF and 3D-FF. Intraclass correlation coefficients (ICCs) were calculated to determine intra- and interobserver agreement. RESULTS The 3D muscular and fatty models presented an inhomogeneous distribution of intramuscular fat in the supraspinatus, indicating the superiority of 3D-FF over 2D-FF in capturing all muscle morphologic information. 2D-FF was significantly higher than 3D-FF in the supraspinatus with large (19.5% ± 5.9% vs 16.2% ± 3.7%; P = .002) and massive (34.8% ± 13.3% vs 26.2% ± 9.4%; P < .001) rotator cuff tears. 2D-FF overestimated the FF compared with 3D-FF by >50% in 14.7% of all patients and by >15% in 67.6% of patients with large or massive RCTs. The discrepancy between 2D-FF and 3D-FF increased with increasing mean FF. The intra- and interobserver agreement of 3D-FF (ICCs, 0.89-0.99 and 0.89-0.95) was superior to that of 2D-FF (ICCs, 0.71-0.95 and 0.64-0.79). CONCLUSION 3D-FF indicated an inhomogeneous distribution of intramuscular fat by capturing all muscle and fat morphologic information. In patients with large and massive rotator cuff tears, 2D-FF of the supraspinatus was significantly higher than 3D-FF. 3D-FF was more reliable than 2D-FF for estimating fatty infiltration in the supraspinatus, with better intra- and interobserver agreement.
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Affiliation(s)
- Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuchen Jin
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Human Oncology and Pathogenesis, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiuyuan Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weibin Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lude Cheng
- Siemens Medical Systems Co, Ltd, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Bogdanov J, Lan R, Chu TN, Bolia IK, Weber AE, Petrigliano FA. Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:301-308. [PMID: 37588720 PMCID: PMC10426606 DOI: 10.1016/j.xrrt.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Chronic rotator cuff pathology is often complicated by fatty degeneration of the rotator cuff (FDRC) muscles, an insidious process associated with poor prognosis with or without surgical intervention. Currently there is no treatment for FDRC, and many studies have described a natural course for this disease almost always resulting in further degeneration and morbidity. Recapitulating FDRC using animal injury models, and using imaging-based studies of human FDRC, the pathophysiology of this disease continues to be further characterized. Researchers studying mesenchymal stem cell-derived progenitor cells and known fibrogenic and adipogenic signaling pathways implicated in FDRC seek to clarify the underlying processes driving these changes. While new cell- and molecular-based therapies are being developed, currently the strongest available avenue for improved management of FDRC is the use of novel imaging techniques which allow for more accurate and personalized staging of fatty degeneration. This narrative review summarizes the evidence on the molecular and pathophysiologic mechanisms of FDRC and provides a clinical update on the diagnosis and management of this condition based on the existing knowledge. We also sought to examine the role of newer biologic therapies in the management of RC fatty degeneration and to identify areas of future research.
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Affiliation(s)
- Jacob Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Timothy N. Chu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K. Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E. Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Ro K, Kim JY, Park H, Cho BH, Kim IY, Shim SB, Choi IY, Yoo JC. Deep-learning framework and computer assisted fatty infiltration analysis for the supraspinatus muscle in MRI. Sci Rep 2021; 11:15065. [PMID: 34301978 PMCID: PMC8302634 DOI: 10.1038/s41598-021-93026-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Occupation ratio and fatty infiltration are important parameters for evaluating patients with rotator cuff tears. We analyzed the occupation ratio using a deep-learning framework and studied the fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. To calculate the amount of fatty infiltration of the supraspinatus muscle using an automated region-based Otsu thresholding technique. The mean Dice similarity coefficient, accuracy, sensitivity, specificity, and relative area difference for the segmented lesion, measuring the similarity of clinician assessment and that of a deep neural network, were 0.97, 99.84, 96.89, 99.92, and 0.07, respectively, for the supraspinatus fossa and 0.94, 99.89, 93.34, 99.95, and 2.03, respectively, for the supraspinatus muscle. The fatty infiltration measure using the Otsu thresholding method significantly differed among the Goutallier grades (Grade 0; 0.06, Grade 1; 4.68, Grade 2; 20.10, Grade 3; 42.86, Grade 4; 55.79, p < 0.0001). The occupation ratio and fatty infiltration using Otsu thresholding demonstrated a moderate negative correlation (ρ = - 0.75, p < 0.0001). This study included 240 randomly selected patients who underwent shoulder magnetic resonance imaging (MRI) from January 2015 to December 2016. We used a fully convolutional deep-learning algorithm to quantitatively detect the fossa and muscle regions by measuring the occupation ratio of the supraspinatus muscle. Fatty infiltration was objectively evaluated using the Otsu thresholding method. The proposed convolutional neural network exhibited fast and accurate segmentation of the supraspinatus muscle and fossa from shoulder MRI, allowing automatic calculation of the occupation ratio. Quantitative evaluation using a modified Otsu thresholding method can be used to calculate the proportion of fatty infiltration in the supraspinatus muscle. We expect that this will improve the efficiency and objectivity of diagnoses by quantifying the index used for shoulder MRI.
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Affiliation(s)
- Kyunghan Ro
- Gangnambon Research Institute, Gangnambon Orthopaedic Cinic, Seoul, Republic of Korea
| | - Joo Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Heeseol Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Baek Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Medical Device Management and Research, SAIHST, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - In Young Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Seung Bo Shim
- Department of Orthopaedic Surgery, Yonsei Thebaro Hospital, Seoul, Republic of Korea
| | - In Young Choi
- Department of Radiology, Korea University Ansan Hospital, Korea University, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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