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@ARTICLE{Fischer:131575,
      author       = {C. Fischer and D. Krammer and A. Hug and M.-A. Weber$^*$
                      and H.-U. Kauczor$^*$ and M. Krix and T. Bruckner and P.
                      Kunz and G. Schmidmaier and F. Zeifang},
      title        = {{D}ynamic contrast-enhanced ultrasound and elastography
                      assess deltoid muscle integrity after reverse shoulder
                      arthroplasty.},
      journal      = {Journal of shoulder and elbow surgery},
      volume       = {26},
      number       = {1},
      issn         = {1058-2746},
      address      = {St. Louis, Mo.},
      publisher    = {Mosby},
      reportid     = {DKFZ-2017-06207},
      pages        = {108 - 117},
      year         = {2017},
      abstract     = {The outcome after reverse shoulder arthroplasty (RSA)
                      depends on the condition of the deltoid muscle, which we
                      assessed with new ultrasound modalities and electromyography
                      (EMG). Contrast-enhanced ultrasound (CEUS) and acoustic
                      radiation force impulse (ARFI) were applied to assess
                      perfusion and elasticity of the deltoid muscle compared with
                      the clinical and functional outcome.The study recruited 64
                      patients (mean age, 72.9 years) treated with RSA between
                      2004 and 2013. The deltoid muscle was examined with EMG and
                      ultrasound imaging. Functional scores such as Constant score
                      and American Shoulder and Elbow Surgeons Standardized
                      Shoulder Assessment Form score were assessed. Among other
                      CEUS parameters, the wash-in perfusion index, time to peak,
                      and rise time were compared between the operated-on and
                      contralateral shoulders as well as between patients with
                      above-average and below-average outcome. The stiffness of
                      the deltoid muscle was analyzed with ARFI.After RSA, deltoid
                      perfusion (wash-in perfusion index,
                      $Δ = -12\% ± 22\%,$ P = .0001) and shoulder
                      function (Constant score, Δ = -14 ± 24,
                      P < .0001) were both inferior compared with the
                      contralateral side. This perfusion deficit was associated
                      with a limited range of motion (time to peak and
                      anteversion: r = -0.290, P = .022). Deltoid
                      perfusion was higher in patients with above-average outcome
                      (rise time, $Δ = 33\% ± 13\%,$ P = .038). The
                      operated-on deltoid muscles showed higher stiffness than the
                      contralateral muscles (ARFI, Δ = 0.2 ± 0.9 m/s,
                      P = .0545). EMG excluded functionally relevant axillary
                      nerve injuries in the study population.CEUS revealed reduced
                      mean perfusion of the deltoid muscle after RSA. Reduced
                      perfusion was associated with limited range of motion and
                      below-average outcome. Functional shoulder impairment after
                      RSA might be predicted by noninvasive CEUS as a surrogate
                      parameter for the integrity of the deltoid muscle.},
      cin          = {E010 / E015},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)E015-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27374234},
      doi          = {10.1016/j.jse.2016.04.012},
      url          = {https://inrepo02.dkfz.de/record/131575},
}