肩关节损伤的MR影像诊断

目的 探讨常规MRI和MR间接关节造影对肩关节损伤的诊断价值.方法 回顾分析经关节镜证实的90例肩关节损伤患者肩关节常规MRI和MR问接关节造影表现,其中肩袖病变组57例、盂肱关节不稳组33例.对常规MRI和MR间接关节造影诊断结果进行Fisher确切概率法比较.结果 (1)肩袖病变组中MR间接关节造影37例,显示部分撕裂10例,1例漏诊;显示完全撕裂17例,2例误诊,7例肩袖无撕裂.MR间接关节造影显示部分撕裂的敏感度、特异度、准确度分别为90.9%(10/11)、92.3%(24/26)、91.9%(34/37);显示完全撕裂的敏感度、特异度、准确度分别为89.5%(17/19)、94.4%(17/18)、91.9%(34/37).MR间接关节造影诊断肩袖部分及完全撕裂的敏感度及准确度均高于常规MRI(P<0.05).(2)盂肱关节不稳组中,盂唇损伤26例,Hill-sachs病变27例、反Hill-sachs病变2例、骨陛Bankart损伤7例、关节囊损伤18例.间接关节造影20例,显示盂唇损伤14例,1例漏诊,5例正常.MR间接关节造影显示盂唇损伤的敏感度、特异度、准确度分别为93.3%(14/15)、100.0%(5/5)、95.0%(19/20).前者诊断盂唇损伤的敏感度及准确度明显高于常规MRI(P<0.05).结论 MR检查特别是MR间接关节造影能够准确显示肩关节常见病变及相关组织的病理发展过程,为临床诊断及治疗提供影像学依据.

MR imaging diagnosis of shoulder joint injury

Objective To analyze the imaging characteristics and the diagnostic value of conventional MRI and indirect MR arthrography in shoulder joint injury.Methods MR imaging in90 patients with shoulder joint disease were retrospectively analyzed by two musculoskeletal radiologist based on the results of arthroseopic examination,including 57 cases of rotator cuff disease and 33 cases of recurrent shoulder instability.The result of the indirect MR arthrography and conventional MR was statistically compared by Fisher exact probability test.Results (1)In the group of rotator cuff disease,37 patients underwent indirect MRA,demonstrating 10 cases of partial-thickness rotator cuff tear and 1 case of missed diagnosis;demonstrating 17 cases of full-thickness rotator cuff tear and 2 cases of misdiagnosis.For partialthickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 90.9%(10/11),92.3%(24/26),and 91.9%(34/37),respectively;for full-thickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 89.5%(17/19),94.4%(17/18),and 91.9%(34/37),respectively.Indirect MR arthrography in the diagnosis of partial and full thickness rotator cuff was significantly better than conventional MR(P＜0.05).(2)In the group of recurrent shoulder instability,labium tear was found in 26 cases,Hill-sachs lesion in 27,reverse Hill-sachs in 2,bony Bankart lesion in 7,and capsular tear in 18 cases,respectively.Twenty patients underwent indirect MRA,demonstrating 14 cases of labrum tear,1 case of missed diagnosis,and 5 cases of normal labrum.For labrum tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 93.3%(14/15),100.0%(5/5),and 95.0%(19/20),respectively.Indirect MR arthrography in the diagnosis of labrum tear was significantly better than conventional MR(P＜0.05).Conclusion MRI,especially indirect MR arthrography,is the most helpful method for the diagnoses of shoulder joint injury.