MRI诊断膝关节半月板桶柄状撕裂

目的:总结分析半月板桶柄状撕裂的MRI征象和诊断价值.方法:回顾性分析146个经关节镜证实的膝关节MR图像,其中28个膝关节存在半月板桶柄状撕裂,记录如下5种MRI征象:碎块内移征、外周残半月板征、双PCL征、空领结征及双前角征,并分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、准确度、阳性预测值和阴性预测值.结...     

半月板根部放射状撕裂MR表现

目的 探讨半月板根部放射状撕裂的MRI表现.方法 回顾性分析17例经关节镜证实半月板根部放射状撕裂MRI表现.结果 17例半月板根部放射状撕裂中,16例位于内侧半月板后角,1例位于外侧半月板后角.MRI表现为根部横断位和冠状位后角条状高信号和矢状位表现为后角弥漫性高信号.同时检出继发征象,包括半月板膨出11例,关节面下骨挫伤13例.17例患者均伴有膝关节退行性改变.结论 膝关节半月板根部放射状撕裂主要发生在内侧半月板后角,MRI可以依据多方位成像显示其多种征象,熟悉这些征象可以帮助放射诊断医师作出正确诊断指导临床治疗方案的实施.     

MRI评价膝关节半月板的桶柄状撕裂

目的 明确5种MRI征象对膝关节半月板桶柄状撕裂的诊断价值。方法 回顾135例患者139个经关节镜证实的膝关节MR图像，其中19个存在半月板桶柄状撕裂。在均不告知关节镜结果的条件下，由2名有经验的放射医生对所有图像进行独立读片，差异协商解决。每个膝关节均记录如下5种MRI征象：双后交叉韧带征(双PCL征)、半月板翻转征、空领结征、碎块内移征和外周残半月板征。分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果 5种征象的诊断敏感度分布于52．6％和89．5％之间，特异度分布于83．3％和98．3％之间，阳性预测值分布于42．9％和88．2％之间，阴性预测值分布：于92．7％和98．3％之间，准确度分布于82．7％和96．4％之间。“碎块内移征”和“外周残半月板征”的诊断敏感度最高，“双PCL征”的诊断特异度和阳性预测值最高，而“碎块内移征”具有最高的阴性预测值和诊断准确度。结论 半月板桶柄状撕裂在MRI上可以有多种表现，各种征象对诊断的能力有所不同。     

MR与关节镜诊断半月板损伤的临床价值研究

目的探讨MR与关节镜诊断半月板损伤的临床价值。方法本组72例患者检查86个膝关节,共172例半月板,入院后进行MRI检查评价半月板损伤情况,2周内进行膝关节镜检查,MRI检查结果按Fischer分级标准分I级信号、II级信号、III级信号,关节镜检查结果分正常、退变、撕裂。结果 MRI与关节镜检查诊断半月板损伤结果比较,X~2=1.432,P=0.698,κ=0.694;MRI与关节镜检查诊断半月板撕裂结果比较,X~2=0.529,P=0.629,κ=0.767,MRI诊断半月板撕裂的敏感度86.27%、特异度91.73%、阳性预测值81.48%、阴性预测值94.07%、阳性似然比10.43、阴性似然比0.15、准确度90.12%、假阳性率8.27%、假阴性率13.73%。结论 MRI能够较好的诊断半月板损伤的程度,特别是对半月板撕裂的诊断,MRI的Ⅲ级信号可作为临床选择关节镜检查和手术治疗的一个重要指征。     

MRI检查膝关节半月板桶柄样撕裂的临床价值分析

目的探讨MRI在膝关节半月板桶柄样撕裂诊断中的临床应用价值。方法对我院经关节镜证实为膝关节半月板损伤患者62例进行MRI检查。结果双前角征、髁间碎片征、双后交叉韧带征、领结消失征等四个征象对内侧半月板桶柄样撕裂的诊断敏感性分别为61.54%、92.31%、38.46%、76.92%,特异性均为100.00%。双前角征、髁间碎片征、双后交叉韧带征、领结消失征等四个征象对外侧半月板桶柄样撕裂的诊断敏感性分别为23.53%、47.06%、0.00%、70.59%。在28例膝关节半月板桶柄样撕裂中,有22例在MRI上出现了两种以上的征象,总体诊断敏感性为78.57%。对比分析发现内侧半月板桶柄样撕裂在双前角征、髁间碎片征、双后交叉韧带征等征象下诊断敏感性明显高于外侧半月板,且差异具有统计学意义。髁间碎片征是诊断内侧半月板桶柄样撕裂敏感性最高的征象(92.31%),特异性达100.00%。结论 MRI是诊断膝关节半月板桶柄样撕裂的有效方法,其对内侧半月板桶柄样撕裂的敏感性及特异性较外侧高,髁间碎片征对诊断内侧半月板桶柄样撕裂的来说最具价值,而外侧半月板桶柄样撕裂则很难利用该征象进行确诊。双前角征在诊断外侧半月板桶柄样撕裂时敏感性低,特异性高,而领结消失征则是敏感性高,特异性低,仅能作为诊断参考。     

膝关节外侧半月板后根部撕裂的MRI评价

目的:评价MRI对膝关节外侧半月板后根部撕裂的诊断价值,以提高对该病的认识,为临床诊疗提供帮助。方法:回顾性分析16例经关节镜或手术证实的外侧半月板后根部撕裂患者的MRI资料;在MRI冠状位、矢状位及横断位上评价外侧半月板后根部撕裂的直接征象及伴随征象;对冠状位"裂隙征"、矢状位"幽灵征"及横断位"裂隙征"的发生率行Fisher确切概率法检验,以P0.05为差异有统计学意义。结果:外侧半月板后根部撕裂冠状位"裂隙征"15例,矢状位"幽灵征"14例,横断位"裂隙征"4例;冠状位"裂隙征"与矢状位"幽灵征"发生率比较差异无统计学意义(P 0.05),冠状位"裂隙征"与横断位"裂隙征"显示率比较差异有统计学意义(P0.05),矢状位"幽灵征"与横断位"裂隙征"发生率比较差异有统计学意义(P0.05)。伴随征象中外侧半月板突出5例(5/16);外侧半月板后根部附着处软骨下骨水肿3例(3/16);胫骨外侧关节软骨损伤4例(4/16);合并外侧半月板其他节段撕裂4例(4/16);合并前交叉韧带撕裂6例(6/16),后交叉韧带撕裂1例(1/16),板股韧带缺失7例(7/16),其中外侧半月板突出5例中,4例板股韧带缺失或显示不清;合并胫骨平台骨折6例。结论:外侧半月板后根部撕裂MRI表现具有特征性;MRI对评价外侧半月板后根部撕裂具有重要价值。     

膝关节损伤的前瞻性研究:MRI诊断与关节镜对照

目的:探讨MRI诊断膝关节损伤的有效性.材料和方法:对2002年10月至2003年8月共126例临床高度怀疑膝关节损伤的患者,行MRI和关节镜检查,以关节镜结果为金标准,前瞻性分析MRI的敏感性和特异性.结果:111例MRI提示膝关节损伤的患者进行了关节镜检查或治疗,其中有107例证明关节镜检查是必要的;15例MRI提示膝关节无明显病变的患者进行了关节镜检查或治疗,4例表明关节镜检查是必要的.MRI的总体敏感性和特异性分别为96.4%、73.3%,准确度93.7%,其中内侧半月板撕裂敏感性和特异性分别为90.6%、96.8%,准确度95.2%,外侧半月板撕裂敏感性和特异性分别为90.3%、93.8%,准确度92.1%,前交叉韧带完全撕裂的敏感性和特异性分别为85.7%、99.1%,准确度97.6%.结论:MRI是诊断膝关节损伤的可靠的工具,能有效地鉴别出临床高度怀疑膝关节损伤的患者中需要关节镜检查及治疗的患者.     

膝关节半月板桶柄样撕裂的MRI表现

目的 探讨膝关节半月板桶柄样撕裂的MRI特征.方法 搜集经手术或关节镜证实的膝关节半月板桶柄样撕裂56例,回顾性分析其MRI表现,总结MRI特征.结果 56例半月板桶柄样撕裂中,内侧半月板34例,外侧半月板22例,半月板碎块移位征42例,阳性率75%(42/56);双前(后)交叉韧带征36例,阳性率64.3%(36/56);半月板翻转征30例,阳性率53.6%(30/56);半月板双前角征24例,阳性率42.9%(24/56);领结缺如征39例,阳性率69.6%(39/56);外周残半月板征41例,阳性率73.2%(41/56).结论 膝关节半月板桶柄样撕裂具有典型的MRI特征,MRI对其诊断具有重要价值.     

The value of MRI in the diagnosis of injury of discoid meniscus

目的:探讨MRI对膝关节盘状半月板及其损伤的诊断价值.方法:回顾性分析89例(151个膝关节)盘状半月板及其损伤的MRI、关节镜及手术资料.结果:89例盘状半月板中,88例(150个膝关节)为外侧盘状半月板,1例(1个膝关节)为内侧盘状半月板,表现为半月板增大、增宽、增厚,矢状面上可见≥3个层面前后角相连,冠状面髁闻棘层面半月板宽度>15 mm.本组中81例(138个膝关节)伴半月板损伤,发生率为91.40%,MRI表现为半月板不同程度变性或撕裂.与膝关节镜及手术对照,MRI图像对半月板损伤诊断的特异度为92.31%、敏感度为99.28%,对I～Ⅱ级半月板损伤诊断的符合率为95.00%;对Ⅲ级半月板损伤诊断的符合率为98.98%.结论:MRI能准确判断盘状半月板类型及其损伤的范围和程度,是诊断盘状半月板及其损伤的最佳检查方法.     

MRI对军事训练致盘状半月板损伤的临床应用价值

目的:探讨MRI对军事训练致膝关节盘状半月板损伤的临床应用价值。方法:回顾性分析36例武警部队军人盘状半月板资料,其中33例经关节镜证实盘状半月板撕裂,33例撕裂病例均有明确的军事训练致伤史,观察盘状半月板形态、大小及信号改变,判断盘状半月板及其损伤分型。结果:36例盘状半月板,均发生在外侧。36例中,板型21例,楔型9例,肥角型6例。33例盘状半月板发生撕裂,以关节镜为诊断标准,MRI诊断膝关节盘状半月板准确率为100%,MRI诊断盘状半月板水平撕裂、斜行撕裂、纵行撕裂、放射状撕裂、桶柄状撕裂及复杂撕裂的准确性分别为91.7%、94.4%、100%、97.2%、91.7%、94.4%。结论:MRI对军事训练致盘状半月板撕裂能清晰显示、准确分型,对临床治疗方案的制定有重要的指导作用,具有较高的临床应用价值。     

Prevalence of meniscal radial tears of the knee revealed by MRI after surgery

OBJECTIVE: Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. These forces are oriented centrifugally on the meniscus by normal weight-bearing and are distributed by circumferentially oriented fibers. This alteration may predispose the knee to radial tears after surgery. SUBJECTS AND METHODS: One of three musculoskeletal radiologists prospectively interpreted 100 consecutive postoperative MRI examinations of the knee. A prospective MRI report was generated for the referring orthopedic surgeon, and prospective MRI interpretations were correlated with arthroscopic findings (n = 63). MRI examinations on those patients who underwent second-look arthroscopy were retrospectively reviewed by three musculoskeletal radiologists who reached a consensus on the prevalence of new postoperative meniscal radial tears. MRI criteria for radial tear diagnosis were used as outlined by Tuckman et al.: truncation, abnormal morphology, lack of continuity, absence of the meniscus, or any combination of those criteria on one or more MR images. An additional criterion used was abnormal increased signal in that area on T2-weighted images. RESULTS: Thirty-two of the 100 patients had meniscal radial tears on prospective MRI interpretations. In 29 of these 32 patients, second-look arthroscopy confirmed meniscal radial tears in the areas described on the MRI examinations. Five additional radial tears were shown on second-look arthroscopy that were not seen on prospective MRI interpretations. Two of those additional five radial tears were seen on consensus retrospective MRI review. CONCLUSION: In this study, a 32% prevalence of meniscal radial tears in the postoperative knee was present on prospective MRI interpretations as opposed to a reported 14% prevalence in the nonoperated knee. Meniscal resection decreases the ability of the meniscus to evenly distribute forces placed on it. This circumstance may increase the prevalence of meniscal radial tears in the postoperative knee. New meniscal radial tears are common in patients presenting with pain after knee surgery.     

Radial meniscal tears: significance, incidence, and MR appearance

OBJECTIVE: The purpose of this study was to assess the prevalence of radial meniscal tears at arthroscopy and the ability of MRI to detect radial tears preoperatively. In addition, the ability of four radiologic signs to detect radial tears was assessed. Those signs are the truncated triangle, cleft, marching cleft, and ghost meniscus signs. MATERIALS AND METHODS: Arthroscopy of the knee was performed by a single orthopedic surgeon on 196 consecutive patients. The surgeon noted each radial tear he encountered. The MR images that were obtained at our institution were reviewed, whereas those patients who were imaged elsewhere were excluded. The preoperative MRI reports were reviewed to assess the ability to prospectively identify radial meniscal tears. In addition, a retrospective analysis of the MRI studies was performed by two radiologists in which four radiologic signs were applied to detect radial tears. RESULTS: Twenty-nine patients (15%) had radial tears at arthroscopy. Eighteen of the 29 patients had their imaging performed at our institution and were selected for review. There were 19 radial tears found at surgery. Seven (37%) of the 19 tears were identified as radial prospectively. Retrospectively, using the four signs for radial tears, reviewers identified 17 (89%) of 19 radial tears. CONCLUSION: A more accurate preoperative diagnosis may be rendered using the four described signs to detect radial tears, thus allowing informative preoperative counseling and consideration of new therapies that are available for radial meniscal repair.     

MRI of meniscal bucket-handle tears

Objective. A meniscal bucket-handle tear is a tear with an attached fragment displaced from the meniscus of the knee joint. Low sensitivity of MRI for detection of bucket-handle tears (64% as compared with arthroscopy) has been reported previously. We report increased sensitivity for detecting bucket-handle tears with the use of coronal short tau inversion recovery (STIR) images. Design and patients. Three hundred and twenty-seven patients who had MRI of the knee between October 1994 and December 1996 and subsequently underwent arthroscopy were included in the study. We prospectively and retrospectively reviewed the MR examinations of the 30 patients with arthroscopically proven bucket-handle tears. Each of two observers examined each scan for the three traditional findings of bucket-handle tears: a double posterior cruciate ligament sign, a flipped meniscus sign and/or a fragment in the intercondylar notch. We also assessed STIR images in the coronal plane through the menisci looking for an area of increased signal within either meniscus with a displaced meniscal fragment. Results. By using four criteria for diagnosis of meniscal bucket-handle tears, our overall sensitivity compared with arthroscopy was 93% (28 of 30 meniscal bucket-handle tears seen at arthroscopy were detected by MRI). The meniscal fragment was well visualized in all 28 cases on coronal STIR images. The double posterior cruciate ligament sign was seen in 8 of 30 cases, the flipped meniscus was seen in 10 of 30 cases and a fragment in the intercondylar notch was seen in 18 of 30 cases. Conclusion. By using four criteria for diagnosis of bucket-handle tears, overall diagnostic sensitivity of MRI compared with arthroscopy increased from the previously reported 64% to 93%. Coronal STIR images are useful for detecting small meniscal bucket-handle tears.     

Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities

OBJECTIVE: To evaluate magnetic resonance imaging (MRI) findings of medial meniscal root tear and the correlation of medial meniscal root tear with other associated knee abnormalities. METHODS: We retrospectively assessed preoperative magnetic resonance images of 39 patients with arthroscopically confirmed medial meniscal root tear. Magnetic resonance imaging findings were retrospectively reviewed by 2 experienced musculoskeletal radiologists for consensus. We evaluated the configuration of meniscal root tear and the other associated knee abnormalities on MRI for direct correlation with arthroscopic findings. RESULTS: At arthroscopy, there were 36 radial tears and 3 complex tears involving the medial meniscal posterior horn roots. All 36 radial tears could be correctly diagnosed by MRI, with findings showing ghost sign on sagittal images in 100% (36/36), vertical linear defect on coronal images in 100% (36/36), and radial linear defect on axial image in 94% (34/36). However, all 3 complex tears were misdiagnosed as radial tears on MRI. Medial meniscal root tears displayed a strong association with degenerative joint disease in 97% (38/39). Medial meniscal root tears were also found in association with cartilage defects of the medial femoral condyle and medial meniscal extrusions (> or =3 mm) in 89% (34/38) and 67% (26/39), respectively. CONCLUSIONS: Medial meniscal root tears were usually posterior horn root radial tear. A high association with degenerative joint disease, cartilage defects of the medial femoral condyle, and medial meniscal extrusions (>/=3 mm) were also noted.     

Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI

In this study, we aim to evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Thirty-six patients who had a diagnosis of bucket handle tear in arthroscopy, in either medial or lateral meniscus, were included in our study (32 males and 4 females). Meniscal tears were evaluated in arthroscopy according to Dandys classification. The MRIs were retrospectively analyzed regarding the following findings: absence of bow tie sign, presence of double posterior cruciate ligament (PCL) sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign, and fragment within the intercondylar region. Locked types I and II fragment of medial meniscus and half-length, whole-width and whole length–half-width fragment of lateral meniscus in arthroscopy were basically correlated with fragment within the intercondylar notch and absent bow tie signs in MRI. We did not find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear. The most common signs in MR images of meniscal bucket handle tears were the fragment in the notch sign and the absent bow tie sign. They were observed with equal frequency of 88.8%. The presence of double PCL sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign were less common (41.66, 33, 25, and 27.7%, respectively). We conclude that the presence of at least two of the six MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.     

MRI对膝关节半月板桶柄样撕裂的诊断价值

目的　评价MRI诊断膝关节半月板桶柄样撕裂的应用价值。方法　经关节镜证实的 2 1例的桶柄样撕裂患者及 11例非桶柄样撕裂患者。采用百胜公司的关节专用磁共振成像系统进行扫描。观察以下 4种MRI征象 ,双前角征 ,双后交叉韧带征 ,髁间碎片征及领结消失征。结果　 3 2例患者中 ,出现双前角征的有 10例 ,双后交叉韧带征 5例 ,髁间碎片征 2 0例 ,领结消失征 2 5例。结论　MRI是诊断半月板桶柄样撕裂的有效手段 ,内侧半月板桶柄样撕裂的敏感性及特异性较外侧高 ,髁间碎片征是诊断内侧半月板桶柄样撕裂最有价值的征象     

Significance of the arthroscopic meniscal flounce sign: a prospective study

BACKGROUND: The meniscal flounce sign is a fold in the free, nonanchored inner edge of the medial meniscus that can be noted during routine arthroscopy of the knee. HYPOTHESIS: The meniscal flounce sign can be a significant indicator of the presence or absence of medial meniscus injury. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 4. METHODS: One hundred sixty-eight patients were prospectively evaluated at the time of the arthroscopy for the presence or absence of the arthroscopic meniscal flounce sign. These results were then correlated with the presence of medial meniscus tears. RESULTS: The presence of the meniscal flounce sign has a positive predictive value of a normal meniscus of 0.97 (63/65). The absence of the meniscal flounce sign has a positive predictive value of an abnormal meniscus of 0.98 (101/103). Specificity is 98%, and sensitivity is 97%. CONCLUSION: The absence of the arthroscopic meniscal flounce sign is a sensitive and specific predictor of the presence of medial meniscus tears that should alert the surgeon to probe carefully for an occult medial meniscus tear.     

Magnetic resonance diagnosis of meniscal tears in patients with acute anterior cruciate ligament tears

OBJECTIVE: To evaluate the accuracy of magnetic resonance imaging in the diagnosis of meniscal tear in patients with acute anterior cruciate ligament tears. METHODS: Magnetic resonance images obtained from 41 patients imaged within 6 weeks of injury who had acute anterior cruciate ligament tears identified at arthroscopy were retrospectively reviewed for meniscal tear. RESULTS: With MR imaging the sensitivity, specificity and accuracy for diagnosing meniscal tears in the presence of acute anterior cruciate ligament tears were 71%, 93%, and 88%; for the lateral meniscal tears were 57%, 100% and 85%; and for the medial meniscal tears were 100%, 88%, 90%. All false negative cases (n = 6) involved the posterior horn of the lateral meniscus. CONCLUSION: In the presence of acute anterior cruciate ligament tears, MRI imaging has relatively low sensitivity for detecting meniscal tears due to missed tears in the lateral meniscus.     

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy

Objective To evaluate the diagnostic efficacy of thin-slice (1 mm) axial proton density-weighted (PDW) MRI of the knee for meniscal tear detection and classification. Methods We prospectively assessed pre-operative MR images of 58 patients (41 males, 17 females; age range 18-62 years) with arthroscopically confirmed meniscal tear. First, we evaluated the performance of the sagittal and thin-slice axial MR images for the diagnosis of meniscal tears. Second, we compared the correlation of tear types presumed from sagittal and axial MRI with arthroscopy and tear classification from axial MRI. Tears were classified on the sagittal plane and the axial plane separately. The diagnostic performance and tear classification were compared statistically with arthroscopy results, which is accepted as the standard of reference. Results 8 of 58 patients were removed from the study group because they had complex or degenerative tears. A total of 62 tears were detected with arthroscopy in 50 patients. On the sagittal images, sensitivity and specificity values were 90.62% and 70.37%, respectively, for medial meniscus tears and 72.73% and 77.14%, respectively, for lateral meniscus tears. The corresponding values for axial images were 97.30% and 84.00%, respectively, for medial meniscus tears and 95.65% and 80.50%, respectively, for lateral meniscus tears. There was no significant difference in tear classification between the arthroscopy results and the thin-slice axial PDW MRI results (p>0.05). Conclusion thin-slice axial PDW MRI increases the sensitivity and specificity of meniscal tear detection and especially classification, which is important for surgical procedure decisions.     

膝关节半月板撕裂磁共振成像与关节镜对照研究

目的分析磁共振成像（MRI）在膝关节半月板撕裂诊断中的价值。方法分析168例（共计336个半月板）临床疑诊半月板损伤患者,依次在1周内行磁共振（MR）和关节镜检查,对比MR和关节镜检查结果,探讨MRI对膝关节半月板撕裂诊断符合率。结果以关节镜为参考标准,168例（共计336个半月板）中MRI诊断半月板撕裂敏感性96．9％,特异性为87．5％,准确性为92．5％,假阳性率为12．5％,假阴性率3．1％,MRI具有术前诊断价值。结论MRI诊断半月板撕裂具有很高准确性,但仍有一定的假阳性与假阴性。