成人股骨头缺血性坏死的综合影像学分期研究
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摘要
目的研究非创伤性成人股骨头缺血性坏死(ANFH)的影像学分期及不同分期影像学(MRI、C T及X线平片)表现及对应关系,评价各种影像学检查技术在缺血性股骨头坏死早期的诊断价值,探讨磁共振弥散加权成像在股骨头坏死早期诊断中的应用前景。分析骨坏死的可能病因,并探讨不同病因所致的非创伤性股骨头坏死的影像学及病理学表现是否相似。
方法
1、选择我院2008年4月至2012年5月25例37髋关节经随访或病理证实的股骨头缺血性坏死病例,由两位高年资放射科医师对所有病例的X片、CT、MRI征象进行双盲法分析并进行分期对照,比较不同分期X线平片、CT及MRI的影像表现。对9髋行磁共振弥散加权成像检查,根据公式ADC=ln(SI低/SI高)/(b高-b低)计算出股骨头负重区的表观弥散系数(ADC)值,并与正常组对照。
2、25例骨坏死患者静脉血化验凝血、纤溶指标(活化部分凝血活酶时间(APTT)、抗凝血酶-Ⅲ(AT_Ⅲ)、血浆凝血酶原时间(PT)与正常对照组比较。
3、37髋中8髋行全髋置换术,对置换所得的股骨头参照CT、MRI图像,同时按照股骨头①负重区软骨面；②软骨下坏死中心；③修复区；④周围正常区,四个分区进行取材,行大体切片及组织病理学检查。
结果1、37个缺血性坏死股骨头中,0期0髋,I期5髋,其中IA3髋,Ⅱ期10髋,其中ⅡA4髋,ⅡB3髋,ⅡC3髋；Ⅲ期14髋,其中ⅢA5髋,ⅢB5髋,ⅢC4髋；Ⅳ期8髋。X线诊断27个,其中早期(Ⅰ-Ⅱ期)病变诊断率5/15(33.3%)；CT诊断32髋,其中早期病变诊断率为10/15(66.6%)；MRI诊断37个,其中早期病变诊断率为15/15(100%);MRI组与X线平片、CT组早期病变诊断数据比较有显著性差异(P<0.05)。
2、统计结果显示9髋(ⅠA1例,ⅡA2例,ⅡB4例,ⅢA2例)股骨头坏死病例经磁共振弥散加权成像检查,根据ADC=ln(SI低/SI高)/(b高-b低)公式计算得出的股骨头坏死区的ADC值为5.3±0.3×10-3mm2/s；正常组股骨头对应区域的ADC值为3.2±0.5×10-3mm2/s,P<0.05,两者有显著差异性。
3、25例骨坏死患者静脉血化验凝血、纤溶指标(活化部分凝血酶时间(APTT)、抗凝血酶-Ⅲ(AT_Ⅳ)、血浆凝血酶原时间(PT)与对照组比较,均有不同程度的减低,P<0.05,二者具有显著性差异。
4、不同病因的股骨头坏死标本剖面有着极其相似表现：由外向内分为4层：软骨、坏死区、增生反应区、病灶外骨正常区。软骨色泽正常或增白,软骨表面可光滑或有不同程度的磨损；坏死区呈黄色不规则楔形,软骨下骨折发生于该区;增生反应区呈不规则棕褐色带包绕坏死区,将坏死区与正常骨髓组织分隔开。
结论
1、与其它影像检查方法相比,MRI在早期诊断ANFH的敏感性和准确率明显高于CT和X线平片,通过STIR序列结合MRI常规检查可提高早期检出率,DWI测得的股骨头负重区表观弥散系数值的升高具有一定的意义,对股骨头坏死的早期诊断具有潜在的应用前景。
2、高凝、低纤溶可能是激素性及酒精性股骨头坏死的病因。
3、不同病因的非创伤性股骨头坏死有着相似的影像学和病理学表现。
Objective Comparative analysis adult nontraumatic avascular necrosis of the femoral head (ANFH) radiological staging and different stages of imaging (MRI, CT and X-ray) and corresponding relation, evaluation of various imaging techniques in the diagnosis of early avascular necrosis of femoral, dispersion of application of weighted magnetic resonance imaging in the early diagnosis of bone necrosis of femoral. Analysis may cause bone necrosis, and discusses the different causes of nontraumatic osteonecrosis of the femoral head of the imaging and pathological manifestations are similar.
Methods
1、From April to2012in our hospital in2008May25cases of37hips with avascular necrosis of the femoral head were follow-up or pathological, by two senior radiologists X tablets, in all cases, the CT and MRI findings were analyzed in double blind method and stage control, comparison of different stages of X-film, imaging findings of CT and MRI. On9hips underwent diffusion-weighted magnetic resonance imaging, according to equation ADC=In (SI L/SIH)/(bH-bL) to calculate the Apparent diffusion coefficient of the femoral head (ADC), and compared with the normal group.
2、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the normal control group.
3、37hips of8hip hip replacement, the replacement of the femoral head with reference to CT, the MRI image, and according to the loading area of femoral head cartilage;②subchondral necrotic center; the repair area (including zone and the new bone granulation tissue); the normal peripheral zone, four zones were drawn, general biopsy and histopathology.
Results
1、37of avascular necrosis of the femoral head in0hips,0, stage I in5hips, including IA3hip,IB2hip; II10hip, IIA4、IIB3hip, IIC3hip;Ⅲ14hips, including ⅢA5、ⅢB5 hip、ⅢC4,hip, IV were8stage. X-ray diagnosis of27, wherein the early (stage Ⅰ-Ⅱ) the diagnosis rate of5/15(33.3%); CT diagnosis in32hips, the early diagnosis rate of10/15(66.6%); MRI diagnosis37, early diagnosis rate of15/15(100%); group MRI and X-ray plain film, CT data early diagnosis there was significant difference (P<0.05).
2、the statistical results showed9hips (IA1cases, IIA2cases, IIB4cases, IIIA2cases) of avascular necrosis of the femoral head were treated with diffusion weighted imaging ADC=ln (SI L/SIH)/(bH-bL), calculated from the femoral head necrosis area of the ADC value was5.3±0.3×10-3mm2/s; normal femoral head corresponding regions of the ADC value was3.2±0.5×10-3mm2/s, P<0.05, there are significant differences.
3、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the control group, decreased in varying degrees, P<0.05, significant difference between the two.
4、avascular necrosis of the femoral head specimens of different etiologies have very similar performance:from the outside to the inside is divided into4layers:the cartilage, necrosis, hyperplasia reaction region, normal region of lesion of bone. Cartilage normal color or whitening, cartilage surface may be smooth or have varying degrees of wear and tear; necrotic yellow irregular wedge, occurred in the fracture under cartilage hyperplasia reaction zone; irregular Brown ribbon wrapped around the necrosis area, the area of necrosis and normal bone marrow separated.
Conclusion
1、Compared with other imaging methods in the early diagnosis of MRI, the sensitivity and accuracy of ANFH was higher than that of CT and X-ray plain film, STIR sequences with routine MRI examination can improve the early detection rate, has a certain significance of increased apparent diffusion head weight-bearing area coefficient DWI measured, which has potential application prospect in early diagnosis of avascular necrosis of the femoral head.
2、coagulation, fibrinolysis may be the cause of low hormone and alcoholic avascular necrosis of the femoral head.
3、different causes of nontraumatic osteonecrosis of the femoral head is similar to the imaging and pathological manifestations.
方法
1、选择我院2008年4月至2012年5月25例37髋关节经随访或病理证实的股骨头缺血性坏死病例,由两位高年资放射科医师对所有病例的X片、CT、MRI征象进行双盲法分析并进行分期对照,比较不同分期X线平片、CT及MRI的影像表现。对9髋行磁共振弥散加权成像检查,根据公式ADC=ln(SI低/SI高)/(b高-b低)计算出股骨头负重区的表观弥散系数(ADC)值,并与正常组对照。
2、25例骨坏死患者静脉血化验凝血、纤溶指标(活化部分凝血活酶时间(APTT)、抗凝血酶-Ⅲ(AT_Ⅲ)、血浆凝血酶原时间(PT)与正常对照组比较。
3、37髋中8髋行全髋置换术,对置换所得的股骨头参照CT、MRI图像,同时按照股骨头①负重区软骨面；②软骨下坏死中心；③修复区；④周围正常区,四个分区进行取材,行大体切片及组织病理学检查。
结果1、37个缺血性坏死股骨头中,0期0髋,I期5髋,其中IA3髋,Ⅱ期10髋,其中ⅡA4髋,ⅡB3髋,ⅡC3髋；Ⅲ期14髋,其中ⅢA5髋,ⅢB5髋,ⅢC4髋；Ⅳ期8髋。X线诊断27个,其中早期(Ⅰ-Ⅱ期)病变诊断率5/15(33.3%)；CT诊断32髋,其中早期病变诊断率为10/15(66.6%)；MRI诊断37个,其中早期病变诊断率为15/15(100%);MRI组与X线平片、CT组早期病变诊断数据比较有显著性差异(P<0.05)。
2、统计结果显示9髋(ⅠA1例,ⅡA2例,ⅡB4例,ⅢA2例)股骨头坏死病例经磁共振弥散加权成像检查,根据ADC=ln(SI低/SI高)/(b高-b低)公式计算得出的股骨头坏死区的ADC值为5.3±0.3×10-3mm2/s；正常组股骨头对应区域的ADC值为3.2±0.5×10-3mm2/s,P<0.05,两者有显著差异性。
3、25例骨坏死患者静脉血化验凝血、纤溶指标(活化部分凝血酶时间(APTT)、抗凝血酶-Ⅲ(AT_Ⅳ)、血浆凝血酶原时间(PT)与对照组比较,均有不同程度的减低,P<0.05,二者具有显著性差异。
4、不同病因的股骨头坏死标本剖面有着极其相似表现：由外向内分为4层：软骨、坏死区、增生反应区、病灶外骨正常区。软骨色泽正常或增白,软骨表面可光滑或有不同程度的磨损；坏死区呈黄色不规则楔形,软骨下骨折发生于该区;增生反应区呈不规则棕褐色带包绕坏死区,将坏死区与正常骨髓组织分隔开。
结论
1、与其它影像检查方法相比,MRI在早期诊断ANFH的敏感性和准确率明显高于CT和X线平片,通过STIR序列结合MRI常规检查可提高早期检出率,DWI测得的股骨头负重区表观弥散系数值的升高具有一定的意义,对股骨头坏死的早期诊断具有潜在的应用前景。
2、高凝、低纤溶可能是激素性及酒精性股骨头坏死的病因。
3、不同病因的非创伤性股骨头坏死有着相似的影像学和病理学表现。
Objective Comparative analysis adult nontraumatic avascular necrosis of the femoral head (ANFH) radiological staging and different stages of imaging (MRI, CT and X-ray) and corresponding relation, evaluation of various imaging techniques in the diagnosis of early avascular necrosis of femoral, dispersion of application of weighted magnetic resonance imaging in the early diagnosis of bone necrosis of femoral. Analysis may cause bone necrosis, and discusses the different causes of nontraumatic osteonecrosis of the femoral head of the imaging and pathological manifestations are similar.
Methods
1、From April to2012in our hospital in2008May25cases of37hips with avascular necrosis of the femoral head were follow-up or pathological, by two senior radiologists X tablets, in all cases, the CT and MRI findings were analyzed in double blind method and stage control, comparison of different stages of X-film, imaging findings of CT and MRI. On9hips underwent diffusion-weighted magnetic resonance imaging, according to equation ADC=In (SI L/SIH)/(bH-bL) to calculate the Apparent diffusion coefficient of the femoral head (ADC), and compared with the normal group.
2、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the normal control group.
3、37hips of8hip hip replacement, the replacement of the femoral head with reference to CT, the MRI image, and according to the loading area of femoral head cartilage;②subchondral necrotic center; the repair area (including zone and the new bone granulation tissue); the normal peripheral zone, four zones were drawn, general biopsy and histopathology.
Results
1、37of avascular necrosis of the femoral head in0hips,0, stage I in5hips, including IA3hip,IB2hip; II10hip, IIA4、IIB3hip, IIC3hip;Ⅲ14hips, including ⅢA5、ⅢB5 hip、ⅢC4,hip, IV were8stage. X-ray diagnosis of27, wherein the early (stage Ⅰ-Ⅱ) the diagnosis rate of5/15(33.3%); CT diagnosis in32hips, the early diagnosis rate of10/15(66.6%); MRI diagnosis37, early diagnosis rate of15/15(100%); group MRI and X-ray plain film, CT data early diagnosis there was significant difference (P<0.05).
2、the statistical results showed9hips (IA1cases, IIA2cases, IIB4cases, IIIA2cases) of avascular necrosis of the femoral head were treated with diffusion weighted imaging ADC=ln (SI L/SIH)/(bH-bL), calculated from the femoral head necrosis area of the ADC value was5.3±0.3×10-3mm2/s; normal femoral head corresponding regions of the ADC value was3.2±0.5×10-3mm2/s, P<0.05, there are significant differences.
3、25cases of venous blood of patients with osteonecrosis laboratory coagulation, fibrinolysis (activated partial thromboplastin time (APTT), antithrombin-Ⅲ (AT_Ⅲ), plasma prothrombin time (PT) compared with the control group, decreased in varying degrees, P<0.05, significant difference between the two.
4、avascular necrosis of the femoral head specimens of different etiologies have very similar performance:from the outside to the inside is divided into4layers:the cartilage, necrosis, hyperplasia reaction region, normal region of lesion of bone. Cartilage normal color or whitening, cartilage surface may be smooth or have varying degrees of wear and tear; necrotic yellow irregular wedge, occurred in the fracture under cartilage hyperplasia reaction zone; irregular Brown ribbon wrapped around the necrosis area, the area of necrosis and normal bone marrow separated.
Conclusion
1、Compared with other imaging methods in the early diagnosis of MRI, the sensitivity and accuracy of ANFH was higher than that of CT and X-ray plain film, STIR sequences with routine MRI examination can improve the early detection rate, has a certain significance of increased apparent diffusion head weight-bearing area coefficient DWI measured, which has potential application prospect in early diagnosis of avascular necrosis of the femoral head.
2、coagulation, fibrinolysis may be the cause of low hormone and alcoholic avascular necrosis of the femoral head.
3、different causes of nontraumatic osteonecrosis of the femoral head is similar to the imaging and pathological manifestations.
引文
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