前足肌腱韧带3.0T高分辨磁共振成像技术及临床应用效果  

High-resolution 3.0T magnetic resonance imaging in diagnosis of ligament and tendon injuries of the forefoot

作　　者：李亚雄[1] 张恒[1] 白荣杰[1] 王金娥 曹宇鹏[1] 詹惠荔 钱占华[1] Li Yaxiong;Zhang Heng;Bai Rongjie;Wang Jine;Cao Yupeng;Zhan Huili;Qian Zhanhua(Department of Radiology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院放射科,100035

出　　处：《中华全科医师杂志》2021年第6期676-681,共6页Chinese Journal of General Practitioners

基　　金：国家自然科学基金面上项目(81771809);北京市自然科学基金(7202063)。

摘　　要：目的探讨前足肌腱韧带的3.0T高分辨磁共振成像(MRI)技术及其应用效果。方法回顾性分析2014年9月至2020年8月北京积水潭医院20名健康志愿者(40侧足)、40例经手术/随访证实前足肌腱韧带损伤早期(损伤后1周内)患者(前足损伤患者)的前足MRI检查资料。20名健康志者中男性13名、女性7名,平均年龄36(22~58)岁;40例前足损伤患者中,男性21例、女性19例,平均年龄39(19~63)岁。3.0T高分辨MRI检查时被检查者取仰卧位,分别进行T1加权像(T1WI)和质子脂肪抑制(PD-FS)序列检查,并分别采用冠状位(短轴位)、矢状位和轴位(长轴位)扫描。分析足肌腱韧带的MR表现特点,将肌腱损伤的MRI表现与手术或随访结果进行对照,采用双盲法分析确认。结果20名健康志愿者前足肌腱韧带在T1WI和PD-FS序列均表现为线形均匀低信号。40例前足损伤患者经手术证实诊断者18例、随访证实者22例,侧韧带损伤者8例,其中完全断裂2例,单纯损伤无撕裂和部分撕裂各3例;伸肌腱部分撕裂2例;屈肌腱损伤者8例,其中完全断裂3例,部分撕裂3例和单纯损伤无撕裂2例;外展肌腱部分撕裂3例;跖板损伤者13例;Lisfranc韧带损伤6例,其中完全断裂5例,部分撕裂1例。损伤的肌腱、韧带T1WI序列表现为纤维不连续,纤维增粗、模糊,PD-FS序列表现为肌腱走行区内信号不均匀增高,腱鞘积液。部分撕裂表现为纤维不连续、纤维增粗;完全断裂表现为纤维中断、回缩,断端纤维结构消失被液体充填,其周围软组织水肿。结论前足高分辨MR成像技术可精确显示前足肌腱、韧带的精细解剖结构和损伤的MRI表现,对损伤的早期诊断和精准治疗具有诊断意义。Objective To evaluate the application high-resolution 3.0-T magnetic resonance imaging(MRI)in diagnosis of ligament and tendon injuries of the forefeet.Methods From September 2014 to August 2020,40 patients with forefeet injury(40 forefoot)and 20 healthy subjects(40 forefoot)meeting the including and excluding criteria were enrolled into this retrospective study.All subjects underwent MRI T1-weighted image(T1WI)and fat suppression proton density-weighted imaging(PD-FS)scan on coronal planes,sagittal planes and axial planes,respectively.Then the MRI characteristics of tendons in forefoot of healthy subjects and patients with forefoot injuries were compared.In patients the MR features of ligament and tendons injury were compared with the surgical findings or follow-up results.Results In 20 normal subjects the tendons and ligament of the forefoot showed homogeneous low-signal-intensity on T1WI and PD-FS images.In the 40 patients with forefoot injuries,22 cases were confirmed by surgical findings and 18 cases were confirmed by follow-up results.There were 8 cases of collateral ligament injuries,including 2 cases with complete tear,3 cases with partial tear and 3 cases with sprain;2 cases of extensor tendon with partial tear;8 cases of flexor tendon injuries,including 3 cases with complete tear,3 cases with partial tear and 2 cases with sprain;3 cases of abductor tendon with partial tear;13 cases of plantar plate injuries;and 6 cases of Lisfranc ligament injuries including 5 cases with complete tear and 1 case with partial tear.The injured ligament and tendons presented thicker and discontinuity in T1WI;and demonstrated heterogeneously increased signal intensity with edema in the surrounding soft tissues in PD-FS.The partially torn ligament and tendons showed discontinuity and thickening;and the completely torn ligament and tendons showed that they were interrupted and retracted,fiber structure disappeared and was filled with liquid,and edema in the surrounding soft tissue.Conclusion High resolution magnetic resonance

关 键 词：足前段 人 肌腱病 韧带 足损伤 磁共振成像 

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