Thickening of the axillary recess capsule on ultrasound correlates with magnetic resonance imaging signs of adhesive capsulitis.

OBJECTIVE: To correlate the thickness of the axillary recess capsule measured by ultrasound with magnetic resonance imaging signs of adhesive capsulitis in patients with shoulder pain. MATERIALS AND METHODS: We prospectively evaluated 193 consecutive patients (141 women and 52 men, aged 40-69 years) with shoulder pain lasting 1-9 months from January 2015 to December 2016 who underwent shoulder ultrasound. All participants had routine shoulder ultrasound with additional measurement of axillary recess capsule thickness. After examinations, two groups were formed: negative ultrasound group, composed of patients with a capsule thickness of 2.0 mm or less, and positive ultrasound group, composed of individuals with a capsule thickness greater than 2.0 mm. All patients from the positive ultrasound group and 27 randomly chosen patients from the negative ultrasound group underwent shoulder magnetic resonance imaging. RESULTS: In all, 169/193 patients (88%) had an axillary recess capsule thickness of 2.0 mm or less (negative ultrasound group) and 24/193 patients (12%) had a capsule thickness greater than 2.0 mm (positive ultrasound group). Twenty-seven patients from negative ultrasound group (27/169) were randomly selected to undergo shoulder magnetic resonance imaging. None of them had magnetic resonance imaging criteria for adhesive capsulitis. All patients from positive ultrasound group (24/24) underwent shoulder magnetic resonance imaging and 23 of them (23/24) had magnetic resonance imaging signs of adhesive capsulitis, with a sensitivity of 100% and a specificity of 96%. CONCLUSION: In patients with shoulder pain, a thickness greater than 2.0 mm of the axillary recess capsule measured by ultrasound correlates to magnetic resonance imaging signs of adhesive capsulitis with good sensitivity and specificity.

Ultrasound features of carpal tunnel syndrome: a prospective case-control study.

PURPOSE: The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). MATERIAL AND METHODS: Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29-78) in the symptomatic and 45.1 years (range 24-82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. RESULTS: In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm(2) (DT) and 9 mm(2) (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. CONCLUSION: Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm(2) (DT) and 9 mm(2) (IT) and several additional findings.

Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis.

OBJECTIVE: To evaluate the inter- and intrareader variability for interpretation of a modified Larsen's radiographic classification system for juvenile rheumatoid arthritis (JRA) focused on osteochondral lesions and a conventional Larsen's classification system, compared to a reference MR scoring system of corresponding images. MATERIALS AND METHODS: Seventy-five radiographs of 60 children with JRA, performed within a short interval of time from the MR examinations, were independently evaluated by three experienced radiologists, three diagnostic imaging residents and three rheumatologists, in two separate sessions, according to the two different classification methods, blinded to the corresponding MR images. RESULTS: The inter- and intrareader concordance rates between the two radiographic classification systems and the MR-related radiographs were respectively poor and poor/moderate. The interobserver range of weighted kappa values for the conventional and the modified Larsen's system respectively was 0.25-0.37 vs 0.19-0.39 for radiologists, 0.25-0.37 vs 0.18-0.30 for residents and 0.19-0.51 vs 0.17-0.29 for rheumatologists. The intrareader rate ranged from 0.17-0.55 for radiologists, 0.2-0.56 for residents, and 0.14-0.59 for rheumatologists. CONCLUSION: Although the proposal of a new radiographic classification system for JRA focused on osteochondral abnormalities sounds promising, the low inter- and intrareader concordance rates with an MR-related radiographic system makes the clinical applicability of such a radiographic system less suitable.