髌下脂肪垫损伤的MRI表现及临床分析

目的 :探讨髌下脂肪垫(infrapatellar fat pad,IFP)损伤的MRI成像特点及诊断价值。方法 :回顾性分析经临床综合诊断及随访明确诊断为IFP损伤患者105例,并分析其MRI成像特点。结果:105例中,右膝54例,左膝45例,双膝6例。共111个膝关节MRI表现与损伤程度相关,可表现为IFP的信号异常及形态改变,Ⅰ级51个(45.9%),Ⅱ级36个(32.4%),Ⅲ级21个(18.9%),Ⅳ级3个(2.7%),并常伴不同程度关节积液。结论:MRI能清晰显示IFP的形态、信号改变,准确评估其损伤的部位及严重程度,可为临床治疗提供影像学依据。     

MRI与关节镜诊断膝关节韧带损伤的比较研究

目的:探讨MRI对膝关节韧带损伤的诊断准确率及其对临床治疗的指导意义。方法:90例关节镜及手术患者术前行MRI检查,根据MRI诊断分为1~3级损伤,将MRI诊断结果与关节镜下及手术所见进行对比。结果:根据MRI表现,经关节镜及手术对照诊断准确率分别为CL 93.8%(76/81)、PCL 100%(32/32)、MCL 93.8(61/65)、LCL89.5(17/19),总诊断准确率为94.4%。结论:MRI是诊断膝关节韧带损伤的重要无创性检查方法,提高MRI诊断准确率对筛查韧带损伤及手术治疗有指导性意义。     

膝关节半月板损伤的MRI诊断

目的：探讨膝关节半月板损伤的MRI临床诊断价值。方法：回顾性分析108例膝关节半月板损伤的MRI表现。并按Mink和Fischer方法进行分级。结果：108例216个半月板中有159个损伤，其中I级损伤36个，Ⅱ级损伤78个。Ⅲ级损伤45个(经手术证实)。结论：MRI对膝关节半月板损伤具有很高的诊断价值及临床意义，可以清晰地显示半月板的形态、位置及其信号的变化，为临床治疗提供可靠的依据，是目前诊断半月板损伤最好的检查方法。     

高频超声膝关节前交叉韧带损伤分级诊断与关节镜对比研究

目的:探讨高频超声对膝关节前交叉韧带(ACL)损伤分级诊断的临床价值。方法:对85例临床拟诊为ACL损伤的患者行高频超声与关节镜检查,将2种检查结果进行对比,并对ACL损伤进行分级。结果:根据ACL损伤的程度及表现,将其分为3级,高频超声诊断符合率91.76%(78/85),假阴性率4.71%(4/85),假阳性率3.53%(3/85)。结论:高频超声分级诊断ACL损伤具有较高的准确性,可作为膝关节ACL损伤的常规检查方法。     

膝关节内侧副韧带损伤的MRI诊断价值

目的:探讨MRI对膝关节内侧副韧带损伤的诊断价值。方法:对59例临床拟诊膝关节内侧副韧带损伤的病例进行了MRI检查,分析其MRI表现,并与30例正常膝关节进行对比研究。结果:59例中,临床确诊为内侧副韧带损伤43例;MRI诊断为内侧副韧带损伤的共有37例,其中Ⅰ级损伤9例,Ⅱ级损伤15例,Ⅲ级损伤13例。MRI诊断膝关节内侧副韧带损伤的敏感度与特异性分别为81.4%和87.5%;对于手术治疗的20例Ⅱ、Ⅲ级的病例,MRI诊断的敏感度达100%。结论:MRI能够准确判断膝关节内侧副韧带有无损伤和损伤的程度及并发症,是较为理想的非创伤性检查方法。     

MRI对膝关节盘状半月板及其损伤的诊断价值

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,冠状面髁间棘层面半月板宽度>15mm。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。     

不同MRI序列对膝关节软骨损伤诊断敏感度及特异度分析

目的探讨分析不同MRI序列对膝关节软骨损伤诊断敏感度及特异度。方法选择我院收治的膝关节软骨损伤患者75例,对患者分别进行MRI常规序列以及T_2-mapping序列检查,关节镜检查结果作为金标准,分析不同MRI检查序列对膝关节软骨损伤诊断情况。结果 275例患者共375个关节软骨行常规MRI序列扫描以及关节镜诊断,常规RMI序列与关节镜分级一致性为0.638,表明MRI常规扫描与关节镜分级之间具有一定的一致性。T_2-mapping序列与关节镜分级一致性为0.816,表明MRI常规扫描与关节镜分级之间具有良好的一致性。MRI常规扫描诊断灵敏度为59.85%,诊断特异度为96.71%,T_2-mapping序列扫描诊断灵敏度为75.00%,诊断特异度为98.77%,T_2-mapping序列扫描诊断灵敏度显著高于MRI常规扫描(P0.05),T_2-mapping序列扫描与MRI常规扫描特异度无明显差异(P0.05)。结论 T_2-mapping序列扫描对膝关节软骨损伤诊断分级更为准确,且诊断敏感度较常规MRI更高。     

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与关节镜诊断半月板损伤价值的对照研究

目的 分析MRI诊断半月板损伤的价值,为临床诊断和治疗半月板损伤提供依据.资料与方法 符合纳入标准的168例患者(均为单膝半月板受损),共336个半月板.对膝关节进行术前MRI检查,并于MRI检查后8周内行关节镜术.半月板损伤的MRI分级标准参考Fischer分级法,分为Ⅰ级损伤、Ⅱ级损伤、Ⅲ级损伤;关节镜分级,分为正常、纤毛化和撕裂.结果 与关节镜结果对照,MRI诊断半月板Ⅰ、Ⅱ级损伤的准确性分别为100%、92.9%.诊断半月板撕裂的敏感性、特异性、阳性似然比、准确性、Kappa值分别为93.1%、89.3%、8.7、91.1%、0.82.对半月板撕裂类型诊断总的灵敏性、特异性、阳性似然比、准确性、Kappa值分别为92.0%、79.8%、4.6、84.8%和0.70.结论 MRI不仅能够准确评价半月板损伤程度,而且还能对半月板撕裂进行准确分型.因此,MRI可广泛应用于半月板损伤性疾病的诊断,并进一步指导临床治疗方案的选择.     

MRI检查和CT检查诊断膝关节损伤的临床效果分析

目的探讨对比MRI和CT检查诊断膝关节损伤的临床效果。方法选取膝关节损伤患者40例,均采用CT和MRI对患者的膝关节损伤进行诊断,分析两者的诊断结果和诊断的准确率。结果对比CT诊断,MRI对隐匿性骨折、少量关节腔积液及韧带损伤检出率高,比较差异(P0.05),具有统计学意义;MRI诊断准确率为95.0%,CT诊断准确率为80.0%,两组之间比较差异(P0.05)有统计学意义。结论 MRI对膝关节损伤检查诊断中具有较高的检出率,与CT诊断比较,MRI的诊断效果更好。     

The infrapatellar fat pad: anatomy and clinical correlations

This study examined the anatomy of the infrapatellar fat pad (IFP) in relation to knee pathology and surgical approaches. Eight embalmed knees were dissected via semicircular parapatellar incisions and each IFP was examined. Their volume, shape and constituent features were recorded. They were found in all knees and were constant in shape, consisting of a central body with medial and lateral extensions. The ligamentum mucosum was found inferior to the central body in all eight knees, while a fat tag was located superior to the central body in seven cases. Two clefts were consistently found on the posterior aspect of the IFP, a horizontal cleft below the ligamentum mucosum in six knees and a vertical cleft above, in seven cases. Our study found that the IFP is a constant structure in the knee joint, which may play a number of roles in knee joint function and pathology. Its significance in knee surgery is discussed.     

MR imaging of the posterolateral aspect of the knee

The structures of the posterolateral aspect of the knee were evaluated with axial MR images. One hundred twelve knees of clinical cases without posterolateral injury were retrospectively reviewed, and 30 knees of 15 volunteers with no history of knee injury or pain were evaluated. The amount of joint effusion and visualization of the lateral collateral ligament (LCL) and popliteal tendon were classified according to three grades. The LCL and popliteal tendon were identified in 111 clinical cases (99%) and 28 volunteer knees (93%). Visualization of the LCL and popliteal tendon was facilitated in the presence of both joint effusion and fluid collection between the LCL and popliteal tendon. Fluid collection posterior to the femoral attachment of the popliteal tendon was seen in 79 clinical cases (71%) and 20 volunteer knees (67%). Based on cadaveric study, this was considered to be a potential fluid space for communication to the joint space.     

前交叉韧带损伤的MRI相关征象分析

目的：分析膝关节多种MRI征象对诊断前交叉韧带（ACL）损伤的价值.方法：经关节镜证实的194例患者（包括前ACL正常膝97例、ACL损伤膝97例）,对ACL损伤的相关MRI直接征象和间接征象进行评价.结果：在评价的4个直接征g（ACI,连续性中断、信号缺失、形态异常及走行异常）中,除ACL信号缺失外,其余直接征象对诊断ACL损伤均具有统计学意义,其中韧带连续性中断具有较高的诊断敏感度（83.5%）、特异度（97.9%）及阳性似然比（39.8）.大多数间接征象具有较高的特异性和相对低的敏感性,其中Notch征、骨挫伤、外侧半月板后角裸露征及胫骨前移等征象具有较高的阳性似然比,分别为：＋∞、9.0、55.70和8.0.结论：前交叉韧带损伤的MRI直接征象是其诊断的主要依据;由于其间接征象具有较高的特异性和＋LR,因此可作为前交叉韧带损伤的辅助诊断依据,尤其是直接征象难以确诊的可疑ACL损伤者.     

膝关节半月板及股骨髁软骨损伤关节镜下标准化分区法及其临床应用

目的 制定膝关节半月板及股骨髁软骨损伤标准化分区图，探讨其对膝关节镜手术病人病情评估和术后疗效评价的作用。方法 通过对186例膝关节镜手术患者术中膝关节分区图记录资料汇总分类，统计分析半月板及股骨髁软骨损伤部位。结果 186例病人中，膝关节损伤总数242膝，其中左膝关节损伤110膝（45．4％），右膝损伤132膝（54．5％）。在192膝半月板损伤中，外侧半月板损伤116膝（60．4％），内侧半月板损伤76膝（39．6％）。股骨髁软骨损伤75膝，内侧髁软骨损伤45膝（60％），外侧髁软骨损伤30膝（40％）。半月板损伤的好发部位为6区（38膝）和2区（37膝），股骨髁软骨损伤的多发部位为4区（20膝）、5区（21膝）。结论 外侧半月板损伤多于内侧半月板，其体部和后角为损伤好发部位。股骨髁内侧区软骨损伤多见。膝关节标准化分区图对膝关节镜手术中病情的评估和术后疗效评价具有重要辅助作用。     

膝关节损伤的MRI对临床诊治的作用

目的　探讨膝关节损伤的MRI表现、病理基础、诊断价值及其临床意义。方法　对 3 1例膝关节损伤的MRI征象进行回顾性分析 ,并与临床和手术结果进行比较。结果　膝关节损伤的MRI征象可分为 :(1)膝关节周围软组织肿胀 2 3例 (74% ) ;(2 )关节韧带损伤 18例 (58% ) ,关节脱位 2例 (6% ) ;(3 )骨折 12例 (3 9% ) ,骨挫伤 4例 (13 % ) ,隐匿性骨折 1例 (3 % ) ,关节面软骨损伤 1例(3 % ) ;(4)半月板损伤 15例 (48% ) ,半月板囊肿 2例 (6% ) ;(5)股四头肌和髌韧带损伤各 1例 (3 % ) ;(6)不同程度的关节积液 2 9例(9 3 % )。结论　MRI能反映膝关节损伤的各种病理改变 ,对临床的处理和预后判断具有重要价值     

膝关节骨挫伤的低场MRI诊断价值探讨

目的探讨低场MRI对膝关节骨挫伤的诊断价值。方法回顾性分析72例膝关节骨挫伤的低场MRI表现。结果本组72例X线平片均未见异常。MRI检查72例骨挫伤在T1WI呈低信号、T2WI呈高信号或混杂高信号,境界不清,在STIR像上呈显著高信号,境界清晰;其中51例合并半月板损伤,43例合并韧带损伤,19例合并关节软骨损伤,3例合并骺板损伤,64例合并关节积液。结论低场MRI能清楚显示骨挫伤的病变特点及严重程度,准确判断关节其它结构的损伤,可为临床治疗及愈后的评估提供依据。     

外伤性膝关节前外侧韧带损伤的MR影像特征及相关性分析

目的探讨外伤所致膝关节前外侧韧带损伤病人的MR影像特征,并分析其与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性,为深入研究前外侧韧带对膝关节稳定性的作用提供可靠依据。方法回顾性分析2016年1月—2017年2月间因外伤进行膝关节MRI检查的320例病人(共321膝)的影像资料。采用美国GE公司生产的Signa HDe 1.5 T MR扫描设备,分别行膝关节斜矢状面T1WI、质子密度加权成像(PDWI)和冠状面、横断面PDWI扫描。根据前外侧韧带的完整性和损伤部位对所有病人进行分类统计。采用独立性卡方检验对前外侧韧带撕裂与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性进行分析。结果全部病人膝关节MR影像均可显示前外侧韧带,显示率为100%。151/321膝(47.0%;95%CI为41.6%~52.5%)存在前外侧韧带损伤,其中累及胫骨部、股骨部及半月板部的分别为97膝、96膝及65膝。前交叉韧带撕裂158膝,外侧半月板撕裂98膝,股骨外侧髁挫伤58膝,外侧胫骨平台挫伤71膝,分别与前外侧韧带撕裂具有相关性(均P0.001)。结论 MRI检查可以很好地显示前外侧韧带解剖及其损伤情况。膝关节前外侧韧带损伤与前交叉韧带撕裂、外侧半月板撕裂及膝外侧骨挫伤具有相关性。     

T2 relaxometry of the infrapatellar fat pad after arthroscopic surgery

Objective

To investigate the T2 relaxation values of the infrapatellar fat pad (IFP) after arthroscopic surgery.

Materials and methods

This study was approved by the institutional review board; all individuals signed informed consent. We performed MRI in 16 knees from 8 subjects. Prior to imaging, each subject had unilateral arthroscopic knee surgery and an asymptomatic non-operated contralateral knee. We used a 10-echo multiple-TE fast-spin echo pulse sequence for creation of T2 relaxation time maps. Two musculoskeletal radiologists independently placed regions of interest in the IFP, suprapatellar subcutaneous and deep intermuscular adipose tissue. Qualitative assessments were performed to assess fibrotic changes affecting patellar retinaculum and IFP. Statistical analyses of T2 values determined differences between groups, correlation with time after surgery, and cut-off values to differentiate groups.

Results

The average time between arthroscopy and imaging was 3.5?±?0.4 years. IFP of knees with prior surgery had significantly shorter mean T2 values (133?±?14 ms) compared with control knees (147?±?8 ms, P?=?0.03). There was no significant difference between operated and control knees regarding T2 values of suprapatellar subcutaneous (P?=?0.3) or deep intermuscular adipose tissue (P?=?0.2). There was no correlation between IFP T2 values and time after surgery (P?>?0.2). IFP T2 values?≤?139 ms had 75 % sensitivity and 88 % specificity in identifying prior arthroscopy.

Conclusion

Shortening of T2 relaxation values is present in IFP chronically after arthroscopic surgery and may be an indicator of adipose tissue fibrosis.     

Anterior rim tibial plateau fractures and posterolateral corner knee injury

The aim of this study was to review MRI findings of clinically suspected posterolateral corner knee injuries and their associated internal derangements. Sixteen knees in 15 patients who had evidence of a posterolateral corner knee injury on the physical exam underwent MRI to evaluate the posterolateral corner of the knee and to look for associated injuries. Two musculoskeletal radiologists reviewed the scans. Surgery was performed on 10 of the knees. Tibial plateau fractures were present in 6 knees; 5 of the fractures were anteromedial rim tibial plateau fractures. The popliteus muscle was injured in 13 knees and the biceps femoris in 6 knees. The lateral collateral ligament was ruptured in 12 knees. The posterior cruciate ligament was completely ruptured in 7 knees and avulsed from its tibial attachment in 1 knee. Eleven knees had a complete anterior cruciate ligament rupture. The anterior cruciate ligament was edematous without complete disruption of all fibers in 3 knees. There was excellent correlation between the MRI results and operative results in regard to the presence of a posterolateral corner injury of the knee (9 of the 10 knees had a posterolateral corner injury). In our study MRI readily detected posterolateral corner injuries. Posterolateral corner injuries of the knee are frequently associated with a variety of significant injuries, including cruciate ligament tears, meniscus tears, and fractures. Fractures of the peripheral anteromedial tibial plateau are not common; however, given their relatively common occurrence in this study, they may be an indicator of a posterolateral corner injury to the knee.     

低场MRI对膝关节痛风的诊断价值

目的:探讨低场MRI对膝关节痛风性关节炎的诊断价值。方法:回顾性分析21例(28膝)经病理或临床随访证实的膝关节痛风的低场MRI资料,并进行总结。结果:21例(28膝)均有不同程度的关节腔积液和滑膜增生。痛风结节累及韧带24膝,累及肌腱24膝;发生骨质侵蚀21膝;单纯骨髓水肿7膝;小囊变影3膝;弧形压迹18膝;发生在髌下脂肪垫内8膝。结论:膝关节痛风性关节炎的低场MRI表现多样。痛风结节形成后,其特征性的低场MRI表现可为该病的及时诊治提供可靠、有价值的影像学依据。