ARCO 2/3期股骨头坏死骨质吸收区MR影像评估  

Assessment of Bone Resorption in ONFH of ARCO Stage 2/3 with MR Imaging

作　　者：史珊[1] 罗萍[1] 杨学东[1] 范洋洋[1] 刘欢[1] 马云瑶[1] 张阔 于潼[2] SHI Shan;LU O Ping;YANG Xue-dong;FAN Yang-yang;LIU Huan;MA Yun-yao;ZHANG Kuo;YU Tong(Department of Radiology,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China;Department of Orthopaedics,Guang'anmen Hospital,China Academy of Chinese Medical Sciences,Beijing 100053,China)

机构地区：[1]中国中医科学院广安门医院放射科,北京100053 [2]中国中医科学院广安门医院骨科,北京100053

出　　处：《中国CT和MRI杂志》2023年第11期142-145,共4页Chinese Journal of CT and MRI

基　　金：北京联影智能影像技术研究院基金(CRIBJQY202109);中国中医科学院科技创新工程项目(CI2021A03302和CI2021A03320);中国中医科学院广安门医院护航工程——骨干人才培育项目(9323015)。

摘　　要：目的分析MR对ARCO2/3期股骨头坏死骨质吸收区的检出率及骨质吸收区MR特征,并探讨骨质吸收区不同MR信号可能的病理基础。方法回顾性分析2015年1月至2022年10月就诊于骨科并行MR检查的312例ARCO 2/3期股骨头坏死病例,最终纳入41例,男/女=29/12,其中5例为双侧股骨头坏死,共46例股骨头坏死。根据骨质吸收区T2WI信号特点将病例分为两组,组1-T2WIⅠ型信号(等、稍高信号),组2-T2WIⅡ型信号(高信号)。评估并比较两组间骨质吸收区及相关CT/MR征象。结果MR检出骨质吸收区的敏感性为70.6%,特异性为100%。组2骨质吸收区的数量、ADC值、骨髓水肿分级以及骨质吸收区是否与软骨下骨折相连的几率大于组1,组2骨质吸收区的密度低于组1。结论MR检出骨质吸收区有良好的敏感性和极高的特异性。骨质吸收区T2WIⅠ型信号可能混淆于骨髓水肿中,应仔细甄别;骨质吸收区T2WIⅡ型信号更常伴软骨下骨折和大范围骨髓水肿,可能提示破坏性修复,应密切随访、及时干预。Objective To analyze the detection rate and image characteristics of bone resorption lesion on MR in osteonecrosis of the femoral head(ONFH),and to explore the possible pathological basis of different MR signals in bone resorption lesion.Methods 312 cases in the department of orthopedics with ONFH staged as AR CO stage 2/3 from January 2015 to October 2022 were retrospectively analyzed,and 41 cases were included finally,M/F=29/12,of which 5 cases were bilateral femoral head necrosis,so a total of 46 cases.According to the signal characteristics of bone resorption lesion on T2WI,the cases were divided into two groups,group 1-T2WI TypeⅠsignal(equal or slightly high signal)and group 2-T2WI TypeⅡsignal(high signal).CT/MR signs of bone resorption and related were evaluated and compared between the two groups.Results The sensitivity of MR in detecting bone resorption was 70.6%,and the specificity was 100%.The number,ADC value of bone resorption,bone marrow edema,and the incidence of bone resorption connected to the subchondral fracture were significantly greater in group 2 than 1.The intensity of bone resorption was significantly lower in group 2 than 1.Conclusion MR Detection of bone resorption lesion in ONFH showed good sensitivity and high specificity.T2 TypeⅠsignal bone resorption lesions may be confused with bone marrow edema,which should be carefully detected.T2 TypeⅡsignal bone resorption lesions were more often associated with subchondral fractures and large scale of bone marrow edema,may indicate destructive repair type,should be followed up closely and intervened in time.

关 键 词：股骨头坏死 MR 骨质吸收 ARCO 2/3期 

分 类 号：R617[医药卫生—外科学]