MR诊断膝关节内、外侧半月板后根部撕裂的价值  

The value of MR in diagnosis of posterior root tear of the medial and lateral meniscus

作　　者：刘秀香[1] 郑卓肇 程钢[1] 李桂英[1] 

机构地区：[1]北京老年医院放射科,100095 [2]北京清华长庚医院放射科,102218

出　　处：《中华放射学杂志》2014年第11期919-922,共4页Chinese Journal of Radiology

摘　　要：目的 探讨MR诊断膝关节内、外侧半月板后根部撕裂的价值.方法 回顾性分析具有完整术前膝关节MRI资料,并经关节镜检查明确诊断,且MR检查前均无膝关节手术史的121例患者资料.所有患者均行患侧膝关节MR平扫.由1名放射科住院医师（医师1）和1名主任医师（医师2）采用双盲法独立回顾分析所有膝关节MR图像,根据后根部是否形态失常、消失或出现异常高信号,判断半月板后根部有无撕裂.以膝关节镜检查结果为金标准,计算2名医师MR诊断内、外侧半月板后根部撕裂的敏感度、特异度和准确度,并采用Kappa检验评价2名医师诊断结果的一致性.分析造成误诊和漏诊的原因.结果 121例中,膝关节镜手术证实33例半月板后根部撕裂,包括外侧撕裂14例,内侧撕裂19例.医师1诊断外侧半月板后根部撕裂的敏感度、特异度和准确度分别为71.4％（10/14）、82.2％（88/107）和81.0％（98/121）,医师2诊断上述部位撕裂的敏感度、特异度和准确度分别为71.4％（10/14）、86.0％（92/107）和84.3％（102/121）;医师1诊断内侧半月板后根部撕裂的敏感度、特异度和准确度分别为100.0％（19/19）、88.2％（90/102）和90.1％（109/121）,医师2诊断上述部位撕裂的敏感度、特异度和准确度分别为100.0％（19/19）、95.1％（97/102）和95.9％（116/121）.2名医师采用MR诊断内、外侧半月板后根部撕裂的一致性均好,Kappa值分别为0.81和0.67,P均＜0.05.医师1和医师2误诊内侧半月板后跟部撕裂分别为12例和5例,其中4例均误诊;2名医师均未漏诊;医师1和医师2误诊外侧半月板后跟部撕裂分别为19例和15例,其中11例均误诊;2名医师均漏诊4例.结论 膝关节MR诊断内、外侧半月板后跟部撕裂具有较大价值.Objective To determine the value of MR in the diagnosis of the medial and lateral meniscal posterior root tears.Methods One hundred and twenty one patients underwent arthroscopy and MR of knee examinations were retrospectively reviewed,and all of them did not have the history of knee surgery before the MR examination.MR images were double-blinded,independently,retrospectively scored by radiology residency （doctor 1） and attending radiologist （doctor 2）.The likelihood of the meniscus posterior root tear was scored on basis of arthroscopic findings constituted the gold standard.Sensitivity,specificity and accuracy of MR diagnosis of the lateral and medial meniscus posterior root tear by two physicians were calculated,and the consistency of diagnosis results by two physicians was evaluated using the Kappa statistics.Reasons leading to misdiagnosis or missed diagnosis were discussed.Results Thirty three of the 121 patients were diagnosed with meniscus posterior root tears by arthroscopy,including 14 cases of lateral tears and 19 cases of medial tears.The sensitivity,specificity and accuracy in the diagnosis of posterior lateral meniscus root tears （PLMRT） for doctor 1 were 71.4% （10/14）,82.2% （88/107） and 81.0% （98/121）,respectively,and for doctor 2 were 71.4% （10/14）,86.0% （92/107） and 84.3% （102/121）.The sensitivity,specificity and accuracy in the diagnosis of posterior medial meniscus root tears （PMMRT） for doctor 1 were 100.0% （19/19）,88.2% （90/102） and 90.1% （109/121）,respectively,and for doctor 2 were 100.0% （19/19）,95.1% （97/102） and 95.9% （116/121）,respectively.The Kappa statistics for PLMRT and PMMRT were 0.67 and 0.81,respectively,demonstrating a good interobserver agreement （P〈0.05）.The misdiagnosed cases of the PMMRT were 12 for doctor 1 and 5 for doctor 2.There were 4 cases being commonly misdiagnosed by the two doctors,and there were no any missed cases in this study.For the PLMRT,the misdiagnosed cases were 19 for doctor 1 and 15 for

关 键 词：磁共振成像 膝关节 半月板 胫骨 

分 类 号：R684[医药卫生—骨科学] R445.2[医药卫生—外科学]