膝关节损伤MRI表现与关节镜检查对照研究
摘要
目的 分析研究膝关节半月板及韧带损伤的MRI表现，并与关节镜诊断结果相对照，评价MRI的临床应用价值。材料和方法 选择48例膝关节外伤均行MRI和关节镜检查的患者作为研究对象。半月板损伤标准采用Kaplan的三级分类方法。韧带损伤参照Ruiz进行分级。膝关节MRI检查采用常规序列：T1WI/SE、T2WI/TES、STIR和GRE。关节镜由一名主任医师和一名主治医师共同完成。MRI检查后患者均于1-2周内行关节镜检查或手术。结果 以关节镜检查结果作为标准。半月板损伤MRI诊断的准确率为85.4%,敏感性为92.1%,特异性为81.0%,阳性预测值为76.1%,阴性预测值为94.0%。韧带损伤诊断的准确率为93.1%。滑膜皱襞综合征、剥脱性软骨炎及创伤性滑膜炎诊断价值较低。结论 MRI对膝关节半月板及韧带损伤诊断具有明显的临床应用价值，同时可作为关节镜术前的筛选工具，指导关节镜在临床中的合理运用。
Objective To study MRI findings of Semilunar lateral injuries and Ligament injuries in knees and compare imaging findings with the arthroscopic results，to evaluate value of MRI in diagnosing traumatic knees. Materials and Methods 48 cases with traumatic knees who were examined by MRI and arthroscopy were studied. Semilunar lateral injuries were classified three grades by Kaplan. Ligament injuries were classified by Ruiz MRI scanning ,including traditional T1WI/SE、T2WI/TSE、STIR、GRE was performed in all patients.arthroscopy operations were performed by a director doctor and a doctor .Patients with MRI findings were carried out by arthroscopy within one-two weeks after MRI scanning. Results The accuracy of semilunar lateral injuries in MRI diagnosis was 85.4%,the sensitivity and specificity of semilunar lateral injuries in MRI diagnosis was 92.1%、81.0%. positive predictive value was 76.1%,negative predictive value was 94.0%. The accuracy of ligament injuries was 93.1%.The diagnosis value of MRI findings in Synovial Plica Syndrome、Osteochondritis Dissecans and Traumatic Synovitis were lower. Conclusion The diagnosis value of MRI in traumatic knees has the clinical significance ,therefore,MRI imaging is an effective tool in the selection of patients for arthroscopy ,and it leads arthroscopy to appropriately apply in clinc.
Objective To study MRI findings of Semilunar lateral injuries and Ligament injuries in knees and compare imaging findings with the arthroscopic results，to evaluate value of MRI in diagnosing traumatic knees. Materials and Methods 48 cases with traumatic knees who were examined by MRI and arthroscopy were studied. Semilunar lateral injuries were classified three grades by Kaplan. Ligament injuries were classified by Ruiz MRI scanning ,including traditional T1WI/SE、T2WI/TSE、STIR、GRE was performed in all patients.arthroscopy operations were performed by a director doctor and a doctor .Patients with MRI findings were carried out by arthroscopy within one-two weeks after MRI scanning. Results The accuracy of semilunar lateral injuries in MRI diagnosis was 85.4%,the sensitivity and specificity of semilunar lateral injuries in MRI diagnosis was 92.1%、81.0%. positive predictive value was 76.1%,negative predictive value was 94.0%. The accuracy of ligament injuries was 93.1%.The diagnosis value of MRI findings in Synovial Plica Syndrome、Osteochondritis Dissecans and Traumatic Synovitis were lower. Conclusion The diagnosis value of MRI in traumatic knees has the clinical significance ,therefore,MRI imaging is an effective tool in the selection of patients for arthroscopy ,and it leads arthroscopy to appropriately apply in clinc.
引文
1 逢利博，冯宏君，崔冯。急性膝关节外伤的MRI、X平片、CT对照。中国临床医学影像杂志。2002；13（2）：147-149
2 李松柏，何翠菊，吴振华，等。膝关节软骨缺损性病变的MRI成像序列研究。中华放射学杂志。2003；37（11）：967-972
3 Vander Graafm M,Van den Boogert HT,Jagger GJ,et al.Human prostate:multisection proton MR spectroscopic imaging with a
single spin-echosequence-prelimiary experience.Radiology.1999;213:919-925
4 Kaplan PA,Nalson NL,Garrin KL,et al.MRI of the Knee;The Significance of high signal in the meniscus that dose not clearly extend to the Surface.AJR1991;156:333-3361
5 Ruiz ME,Erickson SJ.Medial and lateral supporting structures of the knee:Normal MR imaging anatomy and pathologic findings.MRI Clin North AM,1994;2(3):381-399
6 Reicher MA,Hartzman S,Duckweiler GR,et al.Meniscal injuries:detection using
Mr imaging.Radiology,1986,1959:753
7 徐爱德，主编。骨关节CT与MRI诊断学。济南：山东科学技术出版社，2002；465-482
Stoller DW. Menisldtear:pathological come lation with MRI Mag MRinaging[J], Radiology,1987,163(5):452-453
9 倪磊，主译。磁共振成像—关节镜对照图谱。北京：科学出版社，2002，25—30
10 高元桂，主编。磁共振成像诊断学。北京：人民军医出版社，1993，680
11 王仁贵，高玉洁，蒋学祥，等。膝关节半月板损伤的MRI诊断。中华放射学杂志。1997；31（7）：459-462
12 韩鸿宾，赵海艳，刘洪东，等。MRI诊断膝关节半月板撕裂的假阳性与假阴性病例分析。中华放射学杂志。2003；37：175-178
13 Otani T, Matsumoto H,Suda Y, et al. Proper use of Mrimaging in internal derangement of the keen (orthopedic surgen'sview).Semin Musculoskelet Radio 2001 JUN; 5(2);143-5
14 Brown TR，Quimn SF，Wensel JP，et al.Diagnosis of popliteus injuries with MR imaging. Skeletal Radiol，1995，24：511—4
15 丁晓峰,陆勇,江浩等.盘状半月板MRI分型初探.中国临床医学影像杂志,200;11(1):46-47
16 雷新玮，伊建忠，祁吉。膝关节软骨退变的MRI检查与关节镜对照研究。临床放射学杂志。2003；22（159）：865—868
17谢敬霞,主编.核磁共振新技术研究与临床应用.北京：北京医科大学出版社，2001，392—396
18 Steenbngge F, Corteel J, Verdonk R,etal .Long-term assessmont of arthroscopic moniscus repail! Rearssi orthop Reparatrice Appar mot. 2003Dec;89(8):699-706.
19 Rongam FA,,Grarssi Bulgheroni P,Arthroscopic alltolyous schsndrocyte inplantation forthetneatnnone of a chondral defect in the tibial plateall of thekeom. Arthoslopy.2004Jan;20(1)79-8
2 李松柏，何翠菊，吴振华，等。膝关节软骨缺损性病变的MRI成像序列研究。中华放射学杂志。2003；37（11）：967-972
3 Vander Graafm M,Van den Boogert HT,Jagger GJ,et al.Human prostate:multisection proton MR spectroscopic imaging with a
single spin-echosequence-prelimiary experience.Radiology.1999;213:919-925
4 Kaplan PA,Nalson NL,Garrin KL,et al.MRI of the Knee;The Significance of high signal in the meniscus that dose not clearly extend to the Surface.AJR1991;156:333-3361
5 Ruiz ME,Erickson SJ.Medial and lateral supporting structures of the knee:Normal MR imaging anatomy and pathologic findings.MRI Clin North AM,1994;2(3):381-399
6 Reicher MA,Hartzman S,Duckweiler GR,et al.Meniscal injuries:detection using
Mr imaging.Radiology,1986,1959:753
7 徐爱德，主编。骨关节CT与MRI诊断学。济南：山东科学技术出版社，2002；465-482
Stoller DW. Menisldtear:pathological come lation with MRI Mag MRinaging[J], Radiology,1987,163(5):452-453
9 倪磊，主译。磁共振成像—关节镜对照图谱。北京：科学出版社，2002，25—30
10 高元桂，主编。磁共振成像诊断学。北京：人民军医出版社，1993，680
11 王仁贵，高玉洁，蒋学祥，等。膝关节半月板损伤的MRI诊断。中华放射学杂志。1997；31（7）：459-462
12 韩鸿宾，赵海艳，刘洪东，等。MRI诊断膝关节半月板撕裂的假阳性与假阴性病例分析。中华放射学杂志。2003；37：175-178
13 Otani T, Matsumoto H,Suda Y, et al. Proper use of Mrimaging in internal derangement of the keen (orthopedic surgen'sview).Semin Musculoskelet Radio 2001 JUN; 5(2);143-5
14 Brown TR，Quimn SF，Wensel JP，et al.Diagnosis of popliteus injuries with MR imaging. Skeletal Radiol，1995，24：511—4
15 丁晓峰,陆勇,江浩等.盘状半月板MRI分型初探.中国临床医学影像杂志,200;11(1):46-47
16 雷新玮，伊建忠，祁吉。膝关节软骨退变的MRI检查与关节镜对照研究。临床放射学杂志。2003；22（159）：865—868
17谢敬霞,主编.核磁共振新技术研究与临床应用.北京：北京医科大学出版社，2001，392—396
18 Steenbngge F, Corteel J, Verdonk R,etal .Long-term assessmont of arthroscopic moniscus repail! Rearssi orthop Reparatrice Appar mot. 2003Dec;89(8):699-706.
19 Rongam FA,,Grarssi Bulgheroni P,Arthroscopic alltolyous schsndrocyte inplantation forthetneatnnone of a chondral defect in the tibial plateall of thekeom. Arthoslopy.2004Jan;20(1)79-8