软骨的MR敏感序列在软骨类病变中的应用研究  

The application of cartilage sensitive MR sequences to detecting cartilaginous lesions

作　　者：富丽萍[1] 王绍武[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 [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12-17,共6页Chinese Journal of CT and MRI

摘　　要：目的评价软骨的MR敏感序列在软骨类病变中的诊断价值。方法分析76例急性关节软骨损伤患者,7例软骨类肿瘤的患者膝关节MRI所见,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(UnilateralT1-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。着重观察关节软骨、软骨下骨的改变,以及肿瘤软骨的信号特点,并与关节镜和手术结果对照分析。结果76例急性损伤膝关节中有32例经关节镜证实,其MRI表现异常,其中软骨局限性增厚信号异常5例,骨软骨压缩骨折3例,软骨部分或全层缺损18例,软骨连续性中断,断端瓣样掀起2例,骨软骨撕托、碎裂,原位或软骨体形成4例。经手术证实的7例软骨类肿瘤中6例T1WI为等肌肉信号T2WI稍高信号,FS-FSE-T2WI/PD和T2*GR明显高信号,FS-3D-T1*-FSPGR和UnilateralT1-Special-3D-FSPGR中高信号,DWI为均匀高信号。结论MR可以准确反映急性软骨创伤病变的范围、程度及形态信号特点,有助于治疗方案的选择、随访观察及判断预后;肿瘤软骨有较特异的MR信号特点,T2*GR是显示软骨类肿瘤的最有价值序列。DWI是诊断软骨类肿瘤的一种很有价值的成像方法。Objective To evaluate MR sensitive sequences of cartilage in detecting cartilaginous lesions. Methods Seventy-six patients with the history of acute injury and 7 patients with cartilaginous tumors were studied. MR scan protocol 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 threedimensional fast spoiled gradient echo （UnilateralT1-Special-3D-FSPGR）, Axial fatsuppressed fast spin-echo proton density （FS-FSE-PD）,another T1 weighted fast spin-echo （FSE-T1WI）, T2 weighted fast spin-echo （FSE-T2WI）,T2 weighted gradient echo （GR） and diffusion weighted imaging （DWI, b=300s/mm3） for cartilaginous tumor patients. The diagnosis of hyaline cartilage lesions and the signal characters of cartilaginous tumors were investigated. Results 32 of 76 patients underwent arthroscopy. MR appearances of chondral lesions included： cartilage thicken with abnormal signal （n=5）; osteochondral compression fracture （n=3）; partial or full-thick defection of cartilage with or without subcartilaginous bone abnormal signal （n=18）; abruption of chondral surface, flap-like free segment and fluid-like signal at the cartilage-bone junction （n=2）; osteochondral delamination, broken, in situ or out of place （n=4）. 6 of 7 cartilaginous tumors had similar signal characters： low signal on T1WI, slightly bright signal on T2WI, brilliant high signal on FS-FSE-T2WI/PD and GR, slightly high signal on FS-3D-T1＊- FSPGR and UnilateralT1-Special-3D-FSPGR, homogeneous high signal on DWI. Conclusion MR can reflect the area and degree of acute cartilage trauma accurately and provide significant information for the choice clinic of treatment plan and further following observation; cartilaginous tumors have specific MR appearances. The Heavy T2 weighted GR sequence is the most valuable MR sequence in the diagnosis of cartilaginous tumors; DWI is a potential method for cartilaginous tumor

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] R681.3[医药卫生—诊断学]