磁共振平扫和间接法磁共振关节造影对肩峰下撞击综合征的诊断价值  

Diagnostic value of unenhanced magnetic resonance and indirect magnetic resonance arthrography in subacromial impingement syndrome

作　　者：张薇[1] 过哲[1] 梁伟[1] 张玉[2] 程晓光[1] 

机构地区：[1]北京积水潭医院放射科,北京市100035 [2]中国石油天然气集团公司中心医院放射科,廊坊市065000

出　　处：《广西医学》2016年第3期358-361,共4页Guangxi Medical Journal

摘　　要：目的比较磁共振(MR)平扫和间接磁共振关节造影(I-MRAR)对肩峰下撞击综合征(SAIS)的诊断价值。方法 74例SAIS患者均行MR平扫和I-MRAR检查,以关节镜检查作为诊断"金标准",计算两种方法诊断SAIS直接征象(肌腱炎、冈上肌肌腱部分撕裂、冈上肌肌腱全层撕裂)及继发征象(关节盂唇撕裂、冈上肌萎缩、三角肌萎缩)的敏感性、特异性、准确性。结果 I-MRAR诊断冈上肌肌腱部分撕裂的敏感性、特异性和准确性分别为90.9%、98.1%及95.9%,MR平扫分别为31.8%、96.2%、77.3%,I-MRAR的敏感性及准确性较高。I-MRAR诊断关节盂唇撕裂的敏感性、特异性和准确性分别为90.0%、100.0%以及98.6%,MR平扫分别为30.0%、100.0%及90.5%,I-MRAR的敏感性更高。对于肌腱炎、肌腱全层撕裂以及冈上肌、三角肌萎缩,MR平扫及I-MRAR两种方法诊断的敏感性、特异性以及准确性均相似且较高。结论在诊断SAIS时,I-MRAR具有无创、危险系数低以及重复性高等优点,是MR平扫的有效补充,在临床上值得推广使用。Objective To compare the diagnostic value in subacromial impingement syndrome（SAIS） between unenhanced magnetic resonance（MR） and indirect magnetic resonance arthrography （I-MRAR）. Methods Seventy-four patients with SAIS underwent the examinations of unenhanced MR and I-MRAR. The diagnostic sensitivity, specificity and accuracy of direct signs （ including tendinitis, partial supraspinatus tendon tear and fall-thickness supraspinatus tendon tear） and secondary signs（including glenoid labral tear,supraspinatus muscle atrophy and deltoid muscle atrophy） were compared between two approaches with the gold standard of arthroscopy. Results For the diagnosis of partial supraspinatus tendon tear,the sensitivity, specificity and accuracy of I-MRAR were 90. 9% ,98.1% and 95.9% respectively, which were significantly higher than those （31.8 % ,96.2% and 77.3 % respectively） of unenhanced MR. I-MRAR had higher sensitivity and accuracy compared to unenhanced MR. For the diagnosis of glenoid labral tear, the sensitivity, specificity and accuracy of I-MRAR were 90.0% , 100.0% and 98.6% ,respectively, and the sensitivity, specificity and accuracy of unenhanced MR were 30.0% , 100.0% and 90.5% , respectively. For the diagnosis of tendinitis, full-thickness supraspinatus tendon tear, supraspinatus muscle and deltoid muscle atrophy, the sensitivity,specificity and accuracy of unenhanced MRI and I-MRAR were similar and quite high. Conclusion With the advantages of noninvasive,low risk and good repeatability, I-MRAR is an effective complement to unenhanced MR for diagnosis of SAIS, and deserves the clinical promotion and application.

关 键 词：肩峰下撞击综合征 磁共振 平扫 间接 关节造影 

分 类 号：R445.2[医药卫生—影像医学与核医学]