外伤性肩袖撕裂的MR关节造影诊断

评价ＭＲ关节造影在外伤性肩袖撕裂中的诊断价值。材料和方法：对照分析了２１例外伤性肩袖撕裂的ＭＲ关节造影和关节镜的表现。在透视下穿刺肩关节腔,注入１５￣２０ｍｌ ２２％ Ｏｍｎｉｐａｑｕｅ和３ｍｍｏｌ／Ｌ Ｍａｇｎｅｖｉｓｔ的混合性造影剂,然后在４５分钟内完成ＳＥ序列Ｔ１加权（ＴＲ／ＴＥ＝５００／２０ｍｓ）的斜冠状面、斜矢状面和横 断面ＭＲ成像。结果：９例肩袖完全撕裂的ＭＲ关节造影表现为：（１）肌腱     

常规MRI及MRI肩关节造影在肩袖撕裂中的应用

目的:探讨常规MRI及MRI肩关节造影在肩袖撕裂诊断中的价值。方法:226例肩关节损伤的患者,分别行常规MRI及MRI肩关节造影检查,以近期肩关节镜检查为金标准,对比2种检查方法的敏感性及特异性。结果:常规MRI对肩袖撕裂诊断的敏感性为70.8%(17/24),特异性100%(2/2),准确性65.4%(17/26);MRI肩关节造影对肩袖撕裂的敏感性为95.8%(23/24),特异性100%(2/2),准确性88.5%(23/26)。两者的诊断敏感性差异有统计学意义(P=0.016)。结论:MRI肩关节造影可以显著提高肩袖撕裂诊断的敏感性。     

MRI和MR关节腔造影诊断肩袖撕裂的实验研究

目的 :探讨常规MRI和MR肩关节腔造影诊断肩袖撕裂的价值。方法 :采用 2 0个人离体肩关节标本 ,将常规MRI和追加MR肩关节腔造影检查结果与大体解剖、组织病理学结果进行比较。结果 :常规MRI检出肩袖部分撕裂的敏感度约为 61.9% ,追加MR肩关节腔造影后敏感度提高到 90 .5 %。常规MRI和MR关节腔造影检出肩袖完全撕裂的敏感度和特异度均为 10 0 %和 97.1%。结论 :在常规MRI检查的基础上追加MRI关节腔造影能提高检出肩袖部分撕裂的敏感度。     

肩袖损伤的MRI诊断比较研究

目的:比较常规MRI和MRI间接关节造影检查对肩袖撕裂伤的诊断价值.方法:搜集2002年11月～2006年8月共40例肩袖损伤病例,20例行常规MRI检查,20例行MRI间接关节造影检查.以肩关节镜作为诊断标准,比较两种影像学方法诊断肩袖损伤的敏感性和特异性.结果:肩袖完全撕裂中,常规MRI检查的敏感度为45.5%,特异度为66.7%,准确度为55%;MRI间接关节造影的敏感度为92.3%,特异度为85.7%,准确度为90%.肩袖不全撕裂中,常规MRI检查敏感度为57.1%,特异度为53.8%,准确度为55%;而间接关节造影敏感度为83.3%,特异度为92.8%,准确度则为90%.经Fisher确切概率统计法统计,MRI间接关节造影诊断肩袖全层撕裂敏感性及准确性明显高于常规MRI(P＜0.05),在诊断肩袖部分撕裂时,MRI间接关节造影的特异性及准确性明显高于MRI(P＜0.05).结论:MRI间接关节造影较常规MRI诊断肩袖撕裂准确性较高.同时对盂唇等其它病变诊断有帮助.     

肩袖撕裂的肩关节MR造影评价

目的 评价肩关节MR造影对肩袖撕裂的诊断价值。方法 分析32例病人的肩关节MR造影图像,评价内容包括肩袖肌腱、盂唇、肱二头肌长头腱,结果与肩关节镜及肩部开放手术比较。结果 以肩关节镜和手术结果为标准,32例病人包括14例全层撕裂,6例下表面部分撕裂,12例无撕裂。肩关节MR造影判定有无肩袖撕裂的敏感性、特异性和准确性都为100％;诊断全层撕裂的敏感性、特异性和准确性分别为100％、94％和97％。同时,肩关节MR造影还正确诊断了所有的多肌腱撕裂、合并的盂唇异常及肱二头肌长头腱异常。结论 肩关节MR造影可以准确、全面地评价肩袖撕裂。     

X线、CT和MR关节造影在外伤性肩袖撕裂中的诊断价值

目的　分析X线、CT和MR单对比关节造影在外伤性肩袖撕裂中的诊断价值。方法经关节镜证实的外伤性肩袖撕裂 2 0例。在透视下穿刺肩关节腔 ,注入 15～ 2 0ml的混合性对比剂 (由10ml欧乃派克和 2 0ml3mmol/L的马根维显稀释液组成 ) ,在 45min内完成X线摄片、CT和MR扫描。结果　关节镜证实肩袖的完全撕裂、部分撕裂分别为 9例和 11例。完全撕裂的X线、CT和MR关节造影均正确诊断 9例 (9/ 9)。肩袖部分撕裂的X线关节造影正确诊断 3例 (3/ 11) ;CT关节造影正确诊断 2例 (2 / 11) ;MR关节造影正确诊断 7例 (7/ 11)。结论　单对比的MR关节造影在外伤性肩袖撕裂中的诊断价值高于X线及CT造影     

3D-SPACE序列在肩关节MR造影中评估上盂唇前后撕裂

目的：评价肩关节 MR造影三维各向同性脂肪抑制快速自旋回波（SPACE）序列对上盂唇前后撕裂（SLAP损伤）的诊断价值。方法：影像诊断医师回顾性分析经关节镜证实的肩关节 MR 造影图像,判定有无SLAP 损伤及分型,对比常规二维序列和SPACE序列对SLAP损伤的敏感度、特异度及准确率,比较常规二维序列与SPACE 序列的诊断价值。结果：肩关节镜证实SLAP损伤12例,肩关节 MR造影SPACE序列与常规二维序列对SLAP 损伤的敏感度分别为83．33％（10/12）及91．67％（11/12）,特异度分别为81．25％（13/16）及87．50％（14/16）,准确度分别为82．14％（23/28）及89．29％（25/28）。SPACE序列与常规二维序列对 SLAP 损伤的诊断效能无明显统计学差异（P＞0．05）。结论：肩关节MR造影中SPACE序列是评价SLAP损伤准确、可靠的影像学方法。     

肩关节MR造影三维VIBE序列对肩袖撕裂的评价

目的 对比评价肩关节MR造影三维 VIBE和常规二维TSE T1W序列对肩袖撕裂的诊断价值.方法 由2名影像诊断医师独立回顾对比分析99例肩关节造影三维 VIBE重建图像和常规二维TSE T1W序列图像,判定有无肩袖撕裂,分别计算其敏感性和特异性.采用McNemar检验评价2种方法诊断价值是否存在统计学差异.结果 99例患者中,肩关节镜证实肩袖撕裂为35例,其中全层撕裂为13例,部分撕裂为22例(关节侧撕裂8例,滑囊侧撕裂9例,腱内撕裂5例).三维 VIBE与常规二维TSE T1W序列对肩袖全层撕裂和关节侧撕裂均准确诊断.三维 VIBE对肩袖撕裂的敏感性和特异性分别为62.86%和96.88%(医师甲),60.00%和98.44%(医师乙);常规二维TSE T1W序列对肩袖撕裂的敏感性和特异性分别为60.00%和96.88%(医师甲),65.71%和96.88%(医师乙).三维 VIBE与常规二维TSE T1W序列的诊断性能无统计学差异.结论 肩关节MR造影三维 VIBE序列可以替代常规二维TSE T1W序列评价肩袖撕裂.     

肩袖全层撕裂:肩关节MRI评价

目的 评价肩关节MRI对肩袖全层撕裂的诊断价值,并对比分析肩关节MRI造影和常规肩关节MRI的诊断性能.资料与方法 由两名影像诊断医师独立回顾分析264例肩关节MRI图像,包括127例常规肩关节MRI检查和137例肩关节MRI造影,分析结果与肩关节镜手术相比较.计算肩关节MRI评价肩袖全层撕裂的敏感性和特异性.采用Kappa统计计算两名影像诊断医师评价的一致性.结果 264例患者中,肩袖全层撕裂60例(冈上肌腱全层撕裂60例,冈下肌腱全层撕裂5例,肩胛下肌腱全层撕裂5例,小圆肌腱全层撕裂4例).肩关节MRI评估肩袖全层撕裂的敏感性和特异性两名医师分别为88.33%(53/60)和97.55%(199/204),95.00%(57/60)和95.10%(194/204),K=0.906.肩关节MRI与肩关节MRI造影对于肩袖全层撕裂的敏感性和特异性差异无统计学意义.结论 肩关节MRI是评价肩袖全层撕裂可靠的方法.对于冈上肌腱全层撕裂,肩关节MRI造影和常规肩关节MRI的诊断价值相似.     

MRI肩关节造影在肩袖间撕裂诊断中的临床应用价值

肩袖间隙(rotator interval)是指位于喙突外侧、肩胛下肌的上缘和冈上肌前缘之间的解剖间隙,联结冈上肌和肩胛下肌,间隙前方有喙肱韧带、盂肱上韧带使之得到加强,肱二头肌长头肌腱在其深面走行。肩袖间撕裂在常规MRI平扫时较难显示,MRI肩关节造影是目前诊断肩袖间撕裂的有效     

Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears

Objective

To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears.

Materials and Methods

The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC).

Results

Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear.

Conclusion

3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.     

间接磁共振膝关节腔内造影诊断膝关节半月板撕裂的价值

目的:通过比较临床检查、常规磁共振检查(MRI)、间接磁共振膝关节腔内造影检查(间接MRA)和膝关节镜术中所见,探讨间接MRA用于膝关节半月板撕裂诊断中的价值.材料和方法:本次研究中我们共收集125例曾行膝关节镜手术患者,全部患者都经过详细的病史采集和体格检查,其中57例患者术前行MRI检查,其中21例患者做MRI检查后立即做间接MRA,以膝关节镜为金标准,对各种检查发现进行互相比较.结果:①临床检查:敏感性75.47%、特异性69.44%、准确性72.00%.②MRI检查:敏感性82.86%、特异性54.55%、准确性71.93%.③间接MRA检查:敏感性100%、特异性90.00%、准确性95.23%.结论:间接MRA在诊断膝关节半月板撕裂方面具有很高的敏感性、特异性和准确性.     

肩关节造影和MRI诊断肩袖损伤

目的评定肩关节造影、MRI诊断肩袖损伤的价值.材料和方法将33例临床诊断肩袖损伤患者的术前关节造影和MRI检查结果与术中观察结果的比较.另有13例复发性肩关节不稳、无肩袖损伤症状和体征的年轻患者术前的关节造影和MRI结果以及术中观察结果作为正常肩袖对照.结果在诊断肩袖完全断裂中,肩关节造影的敏感性为91%,特异性为100%;MRI的敏感性为95%,特异性为88%.结论关节造影诊断肩袖完全撕裂方法简单、迅速且费用低,易于广泛开展.但不能直接显示病变部位.MRI不但能够准确显示断裂的部位,反映肩袖病变的病理过程,而且能同时显示相邻组织的病理改变,更利于诊断和鉴别诊断.     

弥散法MR膝关节造影可行性研究

目的评价MR对比剂静脉内注射、膝关节腔内弥散关节造影的可行性研究并寻找最佳检查参数. 资料与方法选取膝关节正常者24名,按常规方法进行扫描后再将其分为运动组和未运动组.每组再分为3小组.3个小组分别从静脉注入不同剂量的Gd-DTPA.注射完后未运动组受检者静卧于检查床,进行延迟扫描;运动组步行10 min后再进行扫描,并进行延迟.扫描结束后,对平扫和增强图像中的关节腔周围组织及关节腔内信号进行测量.采集后的数据按组归类,并进行统计处理,观察对比剂注射后关节腔内信号增加程度并选取最佳检查方法. 结果弥散法膝关节造影可使关节腔信号强度明显增加,与周围组织产生明显信号差,以采用注射剂量为0.2 mmol/kg体重,注射后受检者正常步行10 min后造影效果最佳. 结论弥散法MR膝关节造影可起到关节造影的效果,造影效果良好,是一种操作简单、危险性小、并发症少的检查方法.     

Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders

Objective To prospectively compare the accuracy of noncontrast magnetic resonance imaging (MRI) with indirect MR arthrography (I-MRa) of unexercised shoulders for diagnosis of superior glenoid labral lesions. Materials and methods Institutional Review Board approval and patient informed consent were obtained for this prospective study. Superior labral findings on shoulder MRI and unexercised I-MRa studies of 104 patients were correlated with findings at arthroscopic shoulder surgery. Two musculoskeletal radiologists independently reviewed the two sets of MR images while blinded to arthroscopic results. For each radiologist, the McNemar test was used to detect statistically significant differences between techniques. Results The superior labrum was intact in 24 and abnormal in 80 subjects. For detection of superior labral lesions by each radiologist, I-MRa was more sensitive (84–91%) than MRI (66–85%), with statistically significant improvement in sensitivity for one reader (p = 0.003). However, I-MRa was less specific (58–71%) than MRI (75–83%). Overall, accuracy was slightly improved on I-MRa (78–86%) compared with MRI (70–83%), but this difference was not statistically significant for either reader. Conclusion Compared with noncontrast MRI, I-MRa was more sensitive for diagnosis of superior glenoid labral lesions. However, the diagnostic value of I-MRa in shoulders remaining at rest is potentially limited by decreased specificity of the technique. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

Objective

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.

Materials and Methods

The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.

Results

The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.

Conclusion

MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.     

肩袖破裂的影像诊断

肩袖，又称旋转肌袖，对肩关节起主要的稳定作用。肩袖破裂为肩部疼痛的主要原因之一，但在临床上许多病例往往被误诊为肩周炎，而Ｘ线平片又不能很好地显示肩袖发生的病变。笔者通过对５１例肩痛患者肩关节造影和造影后ＣＴ扫描检查，发现肩袖完全破裂１０例，部分破裂７例。认为，肩关节造影为诊断肩袖破裂的重要方法，ＣＴ肩关节造影不仅能提高诊断正确率，而且能提供更多的病变情况，有利于决定手术和手术方法的选择。