الفهرس 
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Abstract
Being the only CT technique that could highlight the rotator cuff tendons at their articular and bursal surfaces; This study was aiming to evaluate the use of combined multi-detector CTA of the shoulder and sub-acromial bursography in characterization of rotator cuff tear with an emphasis on partial thickness ones regarding theirs extent and the percentage of affected thickness.
This study was conducted during April 2018 through November 2018. Forty seven patients, clinically suspected to have rotator cuff tear, were referred from orthopedic and rheumatology clinics, Minia University Hospital, for targeted shoulder ultrasonography and CT arthrography and bursography using 16-detector CT scanners; (Bright-Speed 16; GE Healthcare-America: Milwaukee, USA) and Philips 16-detector row CT machine. Seventeen patients were excluded from participating in the study after ultrasonographic evaluation which demonstrated absence of rotator cuff tendon tear, whereas the rest of the patients (thirty patients) participated in the next step of the study.
Informed written consent was obtained prior to participation in the study from all patients.
All recruited patients were submitted to targeted ultrasonography and ultrasonographic guided contrast injection into the GH joint and SA-SD bursa.
The utilized contrast medium was non-ionic iodinated contrast medium (Iohexol; Omnipaque® 300); it was diluted 1:1 with lidocaine HCL 1%.
Aspiration of joint effusion or bursal fluid was done under direct sonographic visualization and careful sterile technique prior to contrast injection.
Overview of the entire shoulder joint on CTA was done through the axial plane. Supraspinatus tendon was assessed on coronal and sagittal planes, subscapularis and infraspinatus tendons were assessed on axial and sagittal planes. Tendon tear was diagnosed when contrast medium enters within the substance of the tendon from any surface.
Tendon tear was classified according to direction of contrast passage into simple tear and complex or multi-directional. Measurement of normal tendon thickness and tear thickness was done in order to obtain the percentage of tear-thickness in relation to normal thickness. Medial extension of the supraspinatus and infraspinatus tendon tears was classified into distal, intermediate or medial, as follow: distal when the tear is limited by the upper edge of the anatomical neck of the humerus, medial when the tear extends beyond the lower edge of the anatomical neck, and intermediate when the tear is located between the two extremes.
Results of CTA showed that twelve cases had supraspinatus full-thickness tendon tear, and four cases had subscapularis full-thickness tendon tear (all of which had concurrent supraspinatus tendon tear), there was no infraspinatus full-thickness tear in the current study. Depending on the percentage of thickness affected in each rotator cuff tendon, the partial-thickness tear was graded into four grades.
Rotator cuff tear were classified into articular surface, bursal surface and interstitial tears, the last one was detected as an extension adjacent tendon tear (from its interstitial component) with no violation of either bursal or articular surfaces.
Depending on the mediolateral extension of the tear within the affected tendon, the most common location of partial-thickness supraspinatus tear was the intermediate location; then the distal one. Whereas in cases demonstrating partial-thickness infraspinatus tendon tears, the most frequent location was the medial location then the intermediate one.
Most of rotator cuff tears in the study were complex rather than simple ones; complex tear was defined as a tear that had multiple direction (more than two directions).
There were some minor complications happened post-arthrography, fourteen patients had extra-articular contrast extension; ten of them happened at sites rather than the injection path with lack of increased pressure needed for injection, whereas four patients showed extra-articular extension posteriorly at the injection site and didn’t affect the diagnostic yield of CTA. No major complication was encountered.