激素治疗SARS患者中期随访的髋部MRI表现  

Midterm follow-up of SARS patients treated with corticosteroid with MR imaging

作　　者：赵凤朝[1] 李子荣[1] 张念非[1] 程立明[1] 刘朝晖[1] 孙伟[1] 王冉东[1] 王佰亮[1] 石少辉[1] 

机构地区：[1]中日友好医院骨科,北京100029

出　　处：《中华骨科杂志》2009年第6期548-553,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（30672117）;卫生部属（管）临床单位重点课题（2007-2009）

摘　　要：目的 对应用激素治疗的严重急性呼吸综合征（severe acute respiratory syndrome，SARS）患者进行中期髋部MRI随访，探讨早期股骨头坏死和未发生股骨头坏死即正常股骨头的MRI特征。方法 2003年6月至2004年1月对539例（1078髋）应用激素治疗的SARS患者行MR及X线检查，诊断股骨头坏死210髋，无股骨头坏死868髋。2007年2至11月对510例（1020髋）SARS患者再行MR及X线复查。观察早期股骨头坏死和未发生股骨头坏死股骨头的MRI表现及其变化。结果 末次随访时无新发股骨头坏死病例，应用激素冲击治疗的SARS患者MRI影像上的股骨头坏死均出现在激素治疗后的6个月内。股骨头塌陷或手术后，股骨头坏死的信号类型发生改变，表现为T1加权像低信号，对应STIR序列上高信号。3髋出现坏死范围减小。正常股骨头在T1加权像上有四种MRI影像类型。24髋初次诊断无股骨头坏死者T1加权像出现异常表现，但STIR序列均无异常高信号。这些信号类型在随访的MRI上发生了改变。结论 应用激素冲击治疗的SARS患者，MRI影像上出现股骨头坏死均发生在激素治疗后的6个月内，少数早期坏死股骨头的坏死范围会减小。正常股骨头的MRI影像存在变异。T1加权像上低信号带、对应STIR序列上高信号可作为股骨头坏死的诊断标准。Objective To observe the MRI differences between normal adult femoral head and osteonecrosis of the femoral head in severe acute respiratory syndrome （SARS） patients treated with corticosteroid. Methods From Jun. 2003 to Jan. 2004, 539 SARS patients （1078 hips） treated with corticosteroid were examined by radiography and MRI. 130 cases （210 hips） developed osteonecrosis of the femoral head （ONFH）, 459 cases （868 hips） without ONFH. Patients with ONFH were followed up by MRI annually. From February to November in 2007, 510 SARS patients （1020 hips） were examined by radiographs and MRI again. All MRI examinations were performed with same protocol. The images of femoral head with or without necrosis were compared. Results No ONFH was found at the second examination. Necrotic lesions were detected on MRI in 6 months since the administration of corticosteroid. The signal types of ONFH changed after collapse or operation. Low signal intensity on T1 weighted image and high signal intensity on corresponding short time inversion recovery image （STIR） was still observed in all necrotic femoral head, Three necrotic femoral heads showed lesion size reduction on MRI. Four types of MRI were observed in normal femoral head. 24 hips with abnormal signal on T1 weighted image and normal signal on the corresponding STIR were diagnosed as normal. Conclusion Necrotic lesions can be detected on MRI within 6 months since the administration of corticosteroid. There is signal variability in normal femoral head. Band form with low signal intensity on T1 weighted image and high signal intensity on corresponding STIR can be used as diagnostic standards of ONFH. Only little necrotic femoral heads showed lesion size reduction on MRI.

关 键 词：磁共振成像 股骨头坏死 严重急性呼吸综合征 

分 类 号：R686[医药卫生—骨科学]