外展外旋位肩关节MR造影对Perthes病变的价值  

The importance of the abduction and external rotation of shoulder in MR arthrography for perthes lesions diagnosis

作　　者：田春艳[1] 郑卓肇[1] 

机构地区：[1]北京大学第三医院放射科,100191

出　　处：《中华关节外科杂志（电子版）》2012年第1期4-6,共3页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：北京市科委基金项目(Z111107058811091)

摘　　要：目的比较肩关节MR造影处于外展外旋位(ABER位)与中立位对Perthes病变的诊断价值。方法由两名影像诊断医师独立回顾分析206例肩关节MR造影图像,每例患者均行中立位与ABER位检查,分析结果与肩关节镜手术相比较。计算肩关节MR造影中立位与ABER位评价Perthes病变的诊断敏感性和特异性,并采用McNemar检验进行统计分析。采用Kappa统计计算两名影像诊断医师评价的一致性。结果 206例患者中,35例证实为Perthes病变,60例前下盂肱韧带复合体正常。对于这95例,肩关节MR造影中立位评估Perthes病变的敏感性和特异性分别为65.71%～68.57%和95%～96.67%,ABER位则为88.57%～91.43%和91.67%～93.33%。肩关节MR造影ABER位的敏感性显著高于中立位检查(P<0.05)。2名影像诊断医师的评价一致性极好(Kappa>0.75)。结论肩关节MR造影ABER位可以明显提高Perthes病变的诊断敏感性。Objective To compare abduction and external rotation （ABER） position with conventional neutral position in MR arthrography for the detection of Perthes lesions. Methods A retrospective study was carried out in 206 cases of shoulder MR arthrography. Two radiologists analyzed the ABER position images and neutral position images independently, and the results were compared with those of arthroscopy. Paired McNemar test was used to evaluate the sensitivity and specificity of these two positions in MR arthrography for Perthes lesions diagnosis. K values were calculated to assess the inter-observer reliability. Results 35 cases with Perthes lesions and 60 with intact anteroinferior labrum were arthroscopically diagnosed. For these 95 patients, the sensitivity of ABER position was significantly higher than it of neutral position in MR arthrography （88.57%-91.43% versus 65.71%-68.57%, P〈0.05）, but no statistical differences were detected negarding specificity （91.67%-93.33% versus 95%-96.67%）. The inter-observer reliability was very good （kappa values〉 0.75） for both positions. Conclusions ABER position of shoulder MR arthrography can improve the sensitivity of Perthes lesions diagnosis.

关 键 词：肩关节 损伤 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684[医药卫生—诊断学]