MRI辅助征象对前交叉韧带撕裂的诊断价值  

Value of ancillary MR imaging signs in diagnosis of anterior cruciate ligament tears

作　　者：龚静山 陈蓟 刘特 朱进 饶梓彬 潘晓华 陈宇 黄国鑫 徐坚民 

机构地区：[1]深圳市人民医院,暨南大学第二临床学院放射科,广东深圳518020 [2]深圳市人民医院,暨南大学第二临床学院骨科,广东深圳518020

出　　处：《中国医学影像技术》2009年第2期286-289,共4页Chinese Journal of Medical Imaging Technology

基　　金：深圳市医学重点学科建设基金(2001B07)。

摘　　要：目的观察ACL撕裂MRI辅助征象的发生率,探讨其对ACL撕裂的诊断价值。方法回顾性分析209例膝关节关节镜检查和(或)治疗且有MRI资料患者中,胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105度和半月板外周部垂直撕裂四个辅助征象,计算其对ACL撕裂检出的敏感性、特异性和阳性预测值,比较其在ACL撕裂和ACL完整患者中的发生率的差别。结果209例患者中,关节镜检查ACL撕裂36例,完整173例。胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105。和半月板外周部垂直撕裂对ACL撕裂检出的敏感性分别为0.72、0.64、0.31和0.67,特异性为0.91、0.93、0.97和0.88.PPV为0.62、0.66、0.64和0.34;在ACL撕裂患者中发生率高于ACL完整患者,差异有统计学意义。结论胫骨平台后外侧或股骨外侧髁挫伤、外侧半月板后角向后移位、后交叉韧带夹角小于105度和半月板外周部垂直撕裂等征象与ACL撕裂相伴发生,认识这些征象有助于ACL撕裂的检出,特别是在ACL撕裂直接征象模棱两可时。Objective To describe the prevalence of ancillary MR imaging signs in anterior cruciate ligment（ACL）of the knees and their diagnostic value.Methods MR images of 209 patients were retrospectively reviewed by two radiologists in consensus on whose status of ACL were assessed by arthroscopy,and contusions on the lateral femoral condyle or posterior lateral tibial plateau,posterior displacement of the posterior horn of the lateral meniscus,a posterior cruciate ligament （PCL）angle less than 105°and peripheral vertical meniscal tears in the posterior horn were focused.The sensitivity,specificity and positive predictive value（PPV）of each sign were calculated.The prevalence of these MRI signs in patients with and without ACL tear was statistically analyzed.Results Contusions on the lateral femoral condyle or posterior lateral tibial plateau,posterior displacement of the posterior horn of the lateral meniscus,a posterior cruciate ligament（PCL）angle less than 105°and peripheral vertical meniscal tears in the posterior horn had sensitivities of 0.72,0.64,0.31 and 0.67,specificities of 0.91,0.93,0.97 and 0.88,and PPVs of 0.62,0.66,0.64 and 0.34,respectively,in detection of ACL tears. The prevalence of these signs in knees with ACL tears was higher than that in knees with intact ACL,and the difference was statistically significant.Conclusion Contusions on the lateral femoral condyle or posterior lateral tibial plateau,posterior displacement of the posterior horn of the lateral meniscus,PCL angle less than 105°and peripheral vertical meniscal tears in the posterior horn occur in association with ACL tear,and are helpful to the detection of ACL tear,especially when the direct signs of ACL tear are equivocal.

关 键 词：膝关节 前交叉韧带 撕裂 辅助征象 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R686.5[医药卫生—诊断学]