Abstract

Purpose

Frozen shoulder is characterized by pain and reduced passive movement capability, and the diagnose is made clinically. However, pain is the major symptom in the first stage before stiffness occurs, and the condition can be mistaken for subacromial impingement. This study explored the possibility to use positron emission tomography/computed tomography (PET/CT) with a ¹⁸F Flour-Deoxy-Glucose (FDG) tracer in the diagnostic process.

Methods

Eleven patients with frozen shoulder and 9 patients with subacromial impingement received a ¹⁸F-FDG PET/CT scan before being treated surgically. During arthroscopy, the diagnoses were confirmed. Images were blindly analyzed visually by two nuclear medicine physicians. Also, semi-quantified analysis applying a set of standard regions was performed, and standard uptake value in both shoulder regions was recorded.

Results

Both the visual description of the pictures and the semi-quantified analysis generally showed increased FDG uptake in the affected shoulder regions of patients that had frozen shoulder and no uptake in patients with subacromial impingement. Kappa for interobserver agreement in the visual assessments was 0.74. Sensitivity was 92% and specificity 93% of the visual assessment, 77% and 93%, respectively, of the semi-quantified analyses, and by combining the two types of analyses sensitivity was 100% and specificity was 93% for the distinction between frozen shoulders and subacromial impingement/unaffected shoulders.

Conclusion

¹⁸F-FDG PET/CT seems to be a valid method to diagnose frozen shoulder. This is clinically relevant in diagnostically challenging cases, for instance in the first phase of frozen shoulder, which can be difficult to distinguish from subacromial impingement.

Level of evidence

II.

中文翻译：

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18 F-FDG PET / CT在肩周炎诊断中的作用

摘要

目的

肩周炎的特点是疼痛和被动运动能力下降，并且诊断是在临床上进行的。但是，疼痛是刚度发生之前的第一阶段的主要症状，并且该状况可能被误认为是肩峰以下撞击。这项研究探索了在诊断过程中使用正电子发射断层扫描/计算机断层扫描（PET / CT）和¹⁸ F面粉-脱氧葡萄糖（FDG）示踪剂的可能性。

方法

11例肩周炎患者和9例肩峰以下冲击患者在接受手术治疗之前接受了¹⁸ F-FDG PET / CT扫描。在关节镜检查期间，诊断得到确认。两名核医学医师对图像进行了盲目分析。此外，进行了应用一组标准区域的半定量分析，并记录了两个肩部区域的标准摄取值。

结果

图片的视觉描述和半定量分析通常都显示，肩周炎患者的患病肩部区域的FDG摄取增加，而肩峰以下撞击的患者则没有摄取。视觉评估中观察者之间的共识的Kappa为0.74。视觉评估的敏感性为92％，特异性为93％，半定量分析的特异性分别为77％和93％，并且通过将两种分析结合起来，冷冻分离的敏感性为100％，特异性为93％肩膀和肩峰以下/未受影响的肩膀。

结论

¹⁸ F-FDG PET / CT似乎是诊断肩周炎的有效方法。这在诊断上具有挑战性的情况下具有临床意义，例如在肩周炎的第一阶段，这可能很难与肩峰以下撞击区分开。

证据水平

二。