Ressonância magnética do músculo e tendão do peitoral maior em atletas com lesão unilateral: avaliação por imagem do lado não lesionado
Data
2023-03-23
Autores
Godoy, Ivan Rodrigues Barros 
Orientadores
Yamada, Andre Fukunishi
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: o presente estudo pretende avaliar as características de imagem de ressonância magnética (RM) do lado contralateral em atletas de levantamento de peso com rotura do peitoral maior (PM). As hipóteses são que a RM do lado não lesionado pode apresentar aumento do comprimento e espessura do tendão do peitoral maior (TPM) e volume do músculo peitoral maior (PMM-vol) e área de secção transversal (PMM-AST) quando comparados com o grupo controle. Objetivos específicos: avaliar os achados de imagem de ressonância magnética que possam estar relacionados com tendinopatia do lado não lesionado; analisar o desempenho dos estudos de Ressonância Magnética para avaliação da área e do volume do músculo peitoral maior no lado não lesionado; e avaliar características quantitativas e qualitativas de imagem dos exames de RM do tendão e músculo do peitoral maior em pacientes com lesão contralateral prévia. Metodologia: Identificou-se retrospectivamente casos de ressonância magnética com lesão unilateral do peitoral maior, além de serem revisados os achados de imagem do lado contralateral. O protocolo de ressonância magnética de ambos os grupos foi o mesmo e incluiu T1 FSE e T2 FATSAT axial, coronal, e imagens sagitais, um lado de cada vez. Outrossim, avaliou-se, como controle, a ressonância magnética de dez atletas assintomáticos de levantamento de peso com imagens de PM de ambos os lados. Dois radiologistas musculoesqueléticos revisaram separadamente a ressonância magnética e mediram o comprimento e a espessura do tendão do peitoral maior (TPM), o volume do músculo peitoral maior (PMM-vol) e a área de secção transversal de PMM (PMM-AST), bem como a área de secção transversal da diáfise umeral (UM-AST) e a razão entre PMM-AST e UM-AST (PMM-AST/UM-AST). Os dados foram comparados entre os indivíduos com lesão unilateral e aqueles indivíduos controles. Resultados: Identificaram-se 36 indivíduos do sexo masculino com lesão unilateral do peitoral maior (PM) e idade média de 35,7±8 anos, além de 10 controles pareados por idade (p=0,45). Um total de 36 ressonâncias magnéticas de peitoral maior, com lesão prévia do PM contralateral, e 20 ressonâncias magnéticas de controles sem lesão foram incluídas neste estudo. O comprimento e a espessura do tendão do peitoral maior foram significativamente maiores nos pacientes com antecedentes de lesão PM contralateral versus indivíduos controle (ambos P <0,001). Ademais, PM-AST e UM-AST foram maiores no grupo de lesão de PM contralateral (P=0,032 e P <0,001, respectivamente). A espessura do TPM >2,95 mm teve sensibilidade de 80,6% e especificidade de 90,0% para diferenciar o grupo PM não lesionado do grupo dos controles. Conclusão: A ressonância magnética do lado não lesionado de pacientes com rotura prévia de PM contralateral demonstra maior espessura e comprimento do tendão do peitoral maior, bem como maior PM-AST e UM-AST do que os do grupo de controles.
Introduction: The purpose of this study was to examine magnetic resonance (MR) imaging features of the PM tendon and muscle in patients with previous contralateral injury. The hypothesis is that the non-injured side have greater pectoralis major tendon (PMT) length and thickness, as well as higher pectoralis major muscle (PMM) cross-sectional area and volume than controls. Objective: To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. Methods: We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. Results: We identified 36 male subjects with unilateral PM injury with mean age 35.7 +/- 8 years and 10 age- and gender matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P<0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. Conclusion: Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.
Introduction: The purpose of this study was to examine magnetic resonance (MR) imaging features of the PM tendon and muscle in patients with previous contralateral injury. The hypothesis is that the non-injured side have greater pectoralis major tendon (PMT) length and thickness, as well as higher pectoralis major muscle (PMM) cross-sectional area and volume than controls. Objective: To evaluate magnetic resonance imaging (MRI) features of the contralateral side in weightlifting athletes with pectoralis major (PM) tears. We hypothesized that MRI of the non-injured side may present increased pectoralis major tendon (PMT) length and thickness and greater pectoralis major muscle (PMM) volume and cross-sectional area when compared with the control group. Methods: We retrospectively identified MRI cases with unilateral PM injury and reviewed imaging findings of the contralateral side. Also, we evaluated MRI from ten asymptomatic control weightlifting athletes, with PM imaging from both sides. Two musculoskeletal radiologists independently reviewed MRI and measured PMT length, PMT thickness, PMM volume (PMM-vol) and PMM cross-sectional area (PMM-CSA), as well as humeral shaft cross-sectional area (Hum-CSA) and the ratio between PMM-CSA and Hum-CSA (PMM-CSA/Hum-CSA). Data were compared between the non-injured side and controls. The MRI protocol from both groups was the same and included T1 FSE and T2 FATSAT axial, coronal, and sagittal images, one side at a time. Results: We identified 36 male subjects with unilateral PM injury with mean age 35.7 +/- 8 years and 10 age- and gender matched controls (p = 0.45). A total of 36 PM MRI with non-injured PM and 20 PM MRI studies were included in this study. PMT length and PMT thickness were significantly higher in contralateral PM injury versus control subjects (both P < 0.001). Also, PM-CSA and Hum-CSA were greater in the contralateral PM injury group (P = 0.032 and P<0.001, respectively). PMT thickness > 2.95 mm had 80.6% sensitivity and 90.0% specificity to differentiate the non-injured PM group from controls. Conclusion: Non-injured side MR imaging of patients with previous contralateral PM lesion demonstrates greater PMT thickness and length as well as PM-CSA and Hum-CSA than controls.
Descrição
Citação
GODOY, Ivan Rodrigues Barros. Ressonância magnética do músculo e tendão do peitoral maior em atletas com lesão unilateral: avaliação por imagem do lado não lesionado. 2023. 94 f. Tese (Doutorado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.