膝关节软骨损伤的MR诊断及与关节镜结果对照  

MR diagnosis of articular cartilage injury in the knee: compared with arthroscopy

作　　者：张敏[1] 李石玲[1] 郭智萍[1] 张伟[2] 马晓晖[1] 蔡朋利[1] 魏培建[1] 彭志刚[1] 孙英彩[1] 张泽坤[2] 

机构地区：[1]河北医科大学第三医院CT/MR室,石家庄050051 [2]河北医科大学第三医院放射科,石家庄050051

出　　处：《中华放射学杂志》2005年第7期731-735,共5页Chinese Journal of Radiology

基　　金：河北省科学技术研究与发展计划项目(04276145)

摘　　要：目的分析不同MR扫描序列对关节软骨损伤的诊断能力,为关节软骨损伤的临床诊断和治疗提供可靠的影像学依据。方法对临床拟行膝关节镜检查的膝关节疼痛患者进行术前MR成像,对MR图像进行二维和三维重建处理。结果与关节镜对照,34例膝关节软骨损伤患者的MR检查结果:脂肪抑制三维稳态进动快速成像序列(fat-saturatedthree-dimensionalfastimagingwithsteady-stateprocession,FS-3D-FISP)敏感度为91·4%、特异度为97%、Kappa值为0·818,脂肪抑制二维快速小角度激发成像序列(fat-saturatedtow-dimensionalfastlowangleshot,FS-2D-FLASH)敏感度为77·1%、特异度为98%、Kappa值为0·531,SE-T1WI序列敏感度为70%、特异度为99%、Kappa值为0·518。本组无明确急性外伤史的关节软骨损伤病例中有77·6%在病变部位出现与损伤软骨区相对应的软骨下骨及骨髓内片状T1WI低信号影,FS-3D-FISP及FS-2D-FLASH序列呈高信号。结论FS-3D-FISP序列对关节软骨损伤病变的准确性明显优于FS-2D-FLASH和SE-T1WI,与关节镜诊断结果之间具有良好的一致性。软骨下骨及骨髓内的异常信号是关节软骨损伤重要的间接征象。关节软骨损伤的三维成像有利于临床术前对重度膝关节软骨损伤进行立体定位诊断。Objective To assess the efficacy of FS-3D-FISP, FS-2D-FLASH and SE-T1WI sequences in the detection of articular cartilage injury of the knee. Methods 34 consecutive patients with persistent symptoms of knee pain who were scheduled for arthroscopy underwent MR examination of the knee on a 1.5 T MR unit prior to arthroscopy. The 2D MR images were transferred to a workstation and processed tow-dimensional and three-dimensional reconstruction. Results Compared with the arthroscopy, the sensitivity, specificity, and Kappa were 91.4%,97%, and 0.818, respectively with FS-3D-FISP sequence, 77.1%, 98%, and 0.531, respectively with FS-2D-FLASH sequence, 70%, 99%, and 0.518, respectively with SE-T1WI sequence. In the cases that had no acute trauma, 77.6% lesions were shown lower SI on T1- WI in the region of the subchondral bone and marrow near the lesions, and higher SI on FS-3D-FISP and FS-2D-FLASH sequences. Conclusion Comparing with arthroscopy, the diagnosis accuracy of FS-3D-FISP sequence is obviously better than that of FS-2D-FLASH and SE-T1WI sequences. Correlation between FS-3D-FISP sequence and arthroscopy in detecting articular cartilage injury is remarkeble. Abnormal signal in the subchondral bone and marrow is an important indirect sign of articular cartilage injury. Three-dimensional reconstruction of articular cartilage is helpful for localization of the lesions after injury.

关 键 词：膝关节软骨损伤 MR诊断 对照 KAPPA值 FLASH序列 膝关节镜检查 成像序列 脂肪抑制 fast 软骨下骨 诊断和治疗 angle 敏感度 特异度 诊断能力 扫描序列 MR成像 疼痛患者 三维重建 MR图像 检查结果 T1WI 病变部位 损伤病例 

分 类 号：R684[医药卫生—骨科学]