软骨MRI敏感序列比较及与关节镜、病理结果对照研究  

Study of comparing MRI sequences in de-tecting cartilaginous lesions with arthroscopy and pathology

作　　者：王绍武[1] 富丽萍[1] 宋清伟[1] 康健蕴[1] 王福生[2] 王立德[2] 

机构地区：[1]大连医科大学附属第一医院放射科,116011 [2]大连医科大学附属第一医院骨科

出　　处：《中国CT和MRI杂志》2007年第4期1-6,共6页Chinese Journal of CT and MRI

摘　　要：目的评价人体软骨的MRI序列,寻找其敏感序列并探讨其在关节软骨急性创伤及软骨类肿瘤病变中的应用价值。方法76例急性膝关节软骨损伤患者,7例软骨类肿瘤的患者,采用抑制脂肪的快速自旋双回波质子和T2加权像(FS-FSE-T2WI/PD)、抑制脂肪的三维快速扰相梯度回波(FS-3D-T1*-FSPGR)、反相位T1加权三维快速扰相梯度回波(Unilateral-T1-Special-3D-FSPGR),对软骨类肿瘤病变,加用快速自旋回波T1加权像(FSE-T1WI)、快速自旋回波T2加权像(FSE-T2WI)、T2*梯度回波(GR)和弥散加权成像(DWI,b=300)进行扫描。前瞻性分析456个关节软骨面及7个肿瘤实体,进行病变分级诊断和肿瘤信号特点分析,分别与关节镜及病理检查结果对照分析,采用双盲法计算各序列信噪比(signalnoiseratio,SNR),对比噪声比(contrastnoiseratio,CNR)以及诊断软骨病变的敏感度、特异度、准确度、阴性预测值、阳性预测值和Kappa值。结果76例膝关节中MRI诊断软骨损伤45例,其中31人做了关节镜检查,7例软骨类肿瘤均经病理证实。FS-FSE-T2WI、FS-FSE-PD、FS-3D-T1*-FSPGR及Unilateral-T1-Special-3D-FSPGR序列的SNR分别为5.75±0.47、51.57±2.28、43.96±5.23和45.00±10.18。将矢状面和横断面的FS-FSE-T2WI/PD结合分析,其诊断的敏感度为91%、特异度为99%、准确度为97%、阳性预测值为98%、阴性预测值为94%,Kappa值为0.80;FS-3D-T1*-FSPGR和Unilateral-T1-Special-3D-FSPGR诊断的敏感度为81%、特异度为97%、准确度为95%、阳性预测值为96%、阴性预测值为87%,Kappa值为0.71。结论FS-FSE-T2WI/PD是诊断关节软骨病变的最敏感序列;Unilateral-T1-Special-3D-FSPGR和FS-3D-T1*-FSPGR序列对关节软骨病变具有相同病变检出力,但是前者SNR优于后者,且扫描时间明显缩短,完全可以替代前者用于临床;首次将软骨敏感的FS-FSE-T2WI/PD,FS-3D-T1*-FSPGR,Unilateral-T1-Special-3D-FSPGR和T2*GR序列应用于软骨类肿瘤的诊断,其中T2*GR是显示软骨�Objective To evaluate MR sequences of human cartilage and search for the most valuable sequence and explore its clinical application to the acute chondral trauma and cartilaginous tumors. Methods Seventy-six patients with the history of acute injury and 7 patients with cartilaginous tumors were studied. 31 of 76 patients underwent arthroscopy and all 7 patients had pathological results. MR protocol included： Sagittal dual-echo fast spin-echo with fat-suppressed （FS-FSE-T2WI/PD）,fat-saturation three-dimensional fast spoiled gradient echo （FS-3D-T1＊-FSPGR）,out phase T1 weighed three-dimensional fast spoiled gradient echo （Unilateral-T1-Special-3D- FSPGR）, axial fat-suppressed fast spin-echo proton density （FS-FSE-PD）,another T1 weighted fast spin-echo （FSE-TIWI）, T2 weighted fast spin-echo （FSE-T2WI）,T2 weighted gradient echo （GR） and diffusion weighted imaging （DWI, b=300s/mm3） for the patients with cartilaginous tumor. The staging diagnosis of hyaline cartilage lesions and the signal characters of cartilaginous tumors were investigated. Results The SNR of FS-FSE-T2WI, FS-FSE-PD, FS-3D-T1＊-FSPGR, unilateral-T1-Special-3D- FSPGR were 5.75 ±0.47,51.57 ± 2.28,43.96 ± 5.23 and 45.00±10.18; the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of combined sagittal and axial FS-FSE-T2WI/PD were 91%, 99%, 97%, 98%, 94%, 0.80, respectively; 81%, 97%, 95%, 96% ,87% ,0.71 with FS-3D-T1＊-FSPGR and Unilateral-T1-Special-3D-FSPGR, Conclusion FS-FSE-T2WI/PD is the most sensitive sequence for articular cartilage lesions; unilateral-T1-Special-3D-FSPGR sequence has the same diagnostic capability as FS-3D-T1＊-FSPGR, but higher SNR and fewer acquisition time than FS-3D-T1＊-FSPGR sequence; the Heavy T2 weighted GR sequence is the most valuable MR sequence of diagnosis in cartilaginous tumors. DWI is a potential method.

关 键 词：膝关节 软骨损伤 软骨类肿瘤 磁共振成像 

分 类 号：R445[医药卫生—影像医学与核医学]