四肢关节专用低场强MRI对前交叉韧带损伤的诊断价值

目的分析前交叉韧带损伤的MRI表现,评价四肢关节专用低场强MRI诊断前交叉韧带损伤的价值。方法应用A-torscan0·2T永磁型四肢关节专用低场强磁共振机,对40例膝关节前交叉韧带损伤患者分别采用自旋回波(SE)T1W、快速自旋回波(TSE)T2W、梯度回波(GE)T2W的矢状位、冠状位进行扫描。结果四肢关节专用低场强MRI对前交叉韧带损伤的诊断灵敏度高达100%,矢状位T1W和T2W可精确地发现前交叉韧带损伤程度。结论四肢关节专用低场强MRI是临床诊断膝关节前交叉韧带损伤的一种重要、可靠的主要检查手段。对临床医生制订手术方案有重要意义。     

膝关节交叉韧带损伤的多层螺旋CT与磁共振检查诊断价值比较研究

目的研究分析MR与多层螺旋CT对膝关节前后交叉韧带损伤的诊断价值。方法选取2014年7月至2017年8月本院收治的膝关节交叉韧带损伤患者82例,82例患者均行多层螺旋CT和MR检查。所有患者均行多层螺旋CT及核磁共振检查后2~5天以内进行膝关节镜检查。检查结束后评估多层螺旋CT、核磁共振对膝关节前、后交叉韧带损伤的诊断结果,观察患者的患侧、健侧膝关节多层螺旋CT、多平面重组图像斜状位、矢状位的前、后交叉韧带CT值,胫骨平台与前交叉韧带间夹角,后交叉韧带角度。结果所有患者的健侧膝关节的前交叉韧带CT值、后交叉韧带CT值、胫骨平台与前交叉韧带夹角及后交叉韧带角度均明显大于患侧膝关节(P0.05);膝关节镜检查结果显示,82例患者膝关节共有89处前、后交叉韧带损伤,多层螺旋CT的诊断率为95.51%(85/89),核磁共振的诊断率为97.75%(87/89),差异无统计学意义(χ2=0.7024,P0.05)。结论核磁共振和多层螺旋CT在诊断膝关节前、后交叉韧带损伤方面,均具有较高的临床准确度,但多层螺旋CT的检查费用相对较低,适合临床选择应用。     

MR对膝关节交叉韧带损伤的临床诊断价值

目的探讨MR诊断膝关节交叉韧带损伤的临床价值。方法回顾性分析2017年2月至2019年2月医院收治的196例疑似膝关节交叉韧带损伤患者的临床资料,196例患者均给予MR、超声和关节镜检查,以关节镜检查诊断结果作为金标准,将MR、超声诊断结果与关节镜进行对比,计算MR、超声诊断的准确度、特异度、敏感度,分析其在膝关节交叉韧带损伤诊断中的临床价值。结果经关节镜手术诊断结果显示,196例疑似膝关节交叉韧带损伤患者有141例为完全损伤,41例为部分损伤,14例无损伤。196例患者均获得清晰的超声、MR图像。经超声检查发现,膝关节交叉韧带损伤169例,其中134例为完全损伤,35例为部分损伤,27例无损伤;经MR检查发现,膝关节交叉韧带损伤176例,其中138例为完全损伤,38例为部分损伤,20例无损伤。以关节镜检查诊断结果作为金标准,将MR、超声诊断结果与关节镜进行对比,结果显示超声诊断膝关节交叉韧带损伤的特异度、敏感度、准确性分别为57.14%、89.56%、87.24%,MR诊断的特异度、敏感度、准确性分别为71.43%、94.51%、92.86%,超声和MRI诊断的一致性均较高。结论 MR和超声诊断漆关节交叉韧带损伤的诊断一致性均较高,超声的诊断效能略低于MR,在临床诊断中应根据患者情况选择合适的诊断方式。     

MR扫描技术和CT用于急性膝关节外伤患者中的临床效果

目的观察和探讨MR扫描技术和CT用于急性膝关节外伤患者的临床检查结果。方法选取2015年3月到2016年12月本院收治的急性膝关节外伤临床患者120例,对其分别进行MR和CT检查,并对检查结果进行对比分析。结果通过采用统计得知,CT与MR对膝关节外伤的检出率分别为71.67%(86/120)与95.83%(115/120),组间比较MR的检出率显着高于CT,差异具有统计学意义(P0.05)。以手术结果作为参照,对不同类型膝关节外伤的诊断准确率进行比较显示,MR扫描技术对于骨质损伤、韧带损伤、半月板损伤及关节囊积液的显示情况均优于CT,差异有统计学意义(P0.05)。结论与CT技术相比,对急性膝关节外伤患者采用MR扫描技术检查的准确率相对较高,值得临床对其进行推广。     

专用四肢关节低场MR在胫骨结节骨软骨炎中的应用

目的 评价专用四肢关节低场MR在胫骨结节骨软骨炎中的应用价值.方法 回顾分析25例胫骨结节骨软骨炎患者的膝关节MR表现.结果 25例均可见髌韧带下段肿胀增厚,信号增高;其中14例胫骨干骺端前缘骨髓信号增高,11例无增高;且19例伴有胫骨结节旁软组织及髌下脂肪垫渗出改变.结论 专用四肢关节低场MR在诊断胫骨结节骨软骨炎中有良好的应用价值,能提供充足的诊断依据和反映疾病发展过程.提示早期和进展期病灶,为临床提供更多信息.     

肌骨超声在中老年退行性膝关节病变的临床应用价值

目的探讨肌骨超声对中老年退行性膝关节病变的临床诊断价值。方法选取我院临床诊断为退行性膝关节病变患者60例(87个膝关节),男32例,女28例;年龄55～78岁,平均(61.5±6.5)岁。所有患者患侧膝关节均行US、MRI检查及关节镜手术。通过膝关节US和MRI检查结果与关节镜手术后诊断进行比较,分析肌骨超声(ultrasound,US)诊断退行性膝关节病变的临床价值。结果肌骨US可以清晰地显示关节软骨病变、滑膜增厚及关节积液,并且可以观察增生滑膜内的血流信号丰富程度,其与MRI的诊断符合率比较,差异无统计学意义(P0.05)。但是对于诊断肌腱、半月板及韧带的损伤,MRI明显优于肌骨US,二者比较差异有统计学意义(P0.05)。结论肌骨US对退行性膝关节早期病变的诊断价值与MRI相同,可作为中老年膝关节病的常规检查,值得临床推广应用。     

膝关节MR检查对100例交叉韧带损伤患者的诊断作用研究分析

目的研究分析核磁共振对膝关节交叉韧带损伤患者的临床诊断价值及特点。方法选取2016年1月至2017年7月本院收治的怀疑为膝关节前交叉韧带损伤患者100例,所有患者均行CT、MRI检查,检查后2~4天以内行关节镜检查,最终CT、MRI诊断结果以关节镜检查结果作为判断准确度的金标准。观察并比较CT、MRI检查前交叉韧带损伤诊断结果及前交叉韧带的损伤在CT及MRI影像学检查的表现。结果本研究100例患者,经关节镜检查结果显示,22例无韧带损伤(22.0%),34例为部分韧带撕裂(34.0%),剩余44例为完全韧带撕裂(44.0%)。CT检查前交叉韧带的诊断为80.0%(80/100),MRI检查前交叉韧带的诊断率为97.0%(97/100),差异具有统计学意义(χ~2=5.0493,P0.05);MRI检查结果显示,完全韧带撕裂的后交叉韧带角度、后交叉韧带弯曲度指数、前交叉韧带与胫骨内侧平舌矢状面夹角均明显小于无韧带损伤及部分韧带撕裂,比较差异具有统计学意义P0.05。结论 MRI在诊断前交叉韧带损伤方面具有明显优势,其对软组织的分辨率及对比度均较高,可以清晰显示关节整体结构及韧带、半月板损伤情况等,可作为交叉韧带损伤诊断的重要检查方法。     

急性膝关节损伤的低场MRI诊断

在日常诊疗中．由于外伤或运动不当等原因造成的膝关节损伤很常见．常规X线检查．常仅能显示明显关节骨折，而对关节内半月板、韧带及软骨的损伤显示有很大的局限性。MRI能多平面成像，对软组织具有很高的分辨率．能使关节内和关节周围的软骨、韧带、肌肉等满意显示，对平片或CT不能发现的骨挫伤也可清晰显示．是诊断膝关节损伤最理想的检查方法。笔者回顾分析了应用低场MRI明确诊断的85例86个急性膝关节损伤的MRI检查结果．以探讨低场MRI在无明显关节骨折的急性膝关节损伤中的应用价值。     

MRI对膝关节交叉韧带损伤的诊断价值研究

目的 探讨磁共振成像技术（magnetic resonance imaging,MRI）对膝关节交叉韧带损伤的诊断价值。方法 采用回顾性研究方法，研究对象为2017年6月至2022年6月间本院具有完整资料的疑似膝关节交叉韧带损伤患者临床资料，按照制定的纳入、排除标准进行筛选入组共计92例，以手术或关节镜检查结果为标准，分析MRI对于膝关节交叉韧带损伤诊断效价。结果 以手术或关节镜检查结果为金标准，MRI诊断膝关节交叉韧带损伤敏感度为92.86%(78/84)，特异性为62.50%(5/8)，准确性为90.21%(83/92);MRI诊断交叉韧带损伤0级12例、1级14例、2级12例、3级32例，不同分级准确率分别为0级75%(12/16)、1级63.63%(14/22)、2级80%(12/15)、3级82.05%(32/39)，总体一致率78.26%(72/92)。经Kappa检验，MRI与手术或关节镜检查诊断结果基本一致性（加权Kappa值=0.779,SE of kappa=0.060,95%置信区间：0.549～0.786）。结论 MRI应用于膝关节交叉韧带损伤诊断及分级诊断具有...     

前交叉韧带损伤:3.0TMR影像与关节镜对照分析

目的分析膝关节前交叉韧带损伤的3．0TMRI特征,并与关节镜手术结果对照。方法回顾性分析来我院行3．0T MR膝关节检查的36例前交叉韧带损伤患者的40个膝关节,全部病例经关节镜检查确诊。应用3．0T MR机（Philips Achieva型）,膝关节专用线圈,进行斜矢状位TSE T1WI、TSE T2WI、PD-SPIR和冠状位、轴位TSE T2WI扫描。前交叉韧带损伤分为完全断裂、撕裂（部分断裂）及胫骨端撕脱。将膝关节前交叉韧带损伤的3．0T MR影像特征与关节镜手术结果进行对照分析。结果前交叉韧带完全断裂MRI直接征象表现为韧带连续性中断,断端肿胀（21／25）,间接征象为交叉韧带过度弯曲、T2WI和PD-SPIR股骨髁间窝外侧骨挫伤;MRI与关节镜诊断完全符合率为84．00％。前交叉韧带撕裂（部分断裂）MRI直接征象为ACL矢状T2WI和PD-SPIR显示形态不规则、部分撕裂,ACL局部肿胀增粗,信号增高,仍可见连续存在的纤维低信号;MRI与关节镜诊断完全符合率为66．67％。前交叉韧带胫骨端撕脱MR检查直接征像为胫骨近端可见T1WI、T2WI低信号撕脱骨片（3／3）,ACL水肿、形态不规则,周围可见出血、积液,MRI与关节镜诊断符合率为100％。结论高场强3．0TMR膝关节诊断的多平面、多序列影像相结合可形成ACL立体影像观,结合临床能够有效诊断ACL损伤。     

MR imaging of the knee: clarification of its role

In an attempt to further delineate the role of magnetic resonance (MR) imaging in evaluating knee pathology, a retrospective study of 60 patients who underwent MR scanning before arthroscopy was undertaken. For medial meniscus tears, the sensitivity of MR imaging was 97% whereas its specificity was 77%. For lateral meniscus tears, MR imaging was 90% sensitive and 87% specific. The positive predictive value of MR imaging was 85% for medial meniscus tears and only 79% for lateral meniscus tears. The negative predictive value was 95% for the medial meniscus and 94% for the lateral meniscus. MR imaging had an accuracy of 93% in assessing anterior cruciate ligament pathology also. These results begin to clarify the role of MR imaging in evaluating intraarticular knee pathology. Grade III signals represented tears at arthroscopy more than 90% of the time. False-positive results occurred more frequently than false negative results did. The high negative predictive value of MR imaging indicates that with a negative MR image, the orthopaedist can reliably conclude that no meniscal pathology is present. MR imaging is a useful diagnostic tool; however, it should be used selectively and in conjunction with the clinical examination in evaluating internal derangements of the knee.     

MR scanning of the acutely injured knee: Sensitive, but is it cost effective?

Although magnetic resonance (MR) imaging has been established as an accurate diagnostic modality for knee pathology, the cost-effectiveness of this test is not known. In this investigation, we formulated a mathematical equation to assess cost-effectiveness and then used this formula to evaluate the use of knee MR as a diagnostic modality in acute knee injuries. We analyzed 105 consecutive MR scans performed at an imaging center with a diverse referral base, and identified 63 patients who had had symptoms for less than 6 months. Based on average regional medical costs, we calculated that diagnostic arthroscopy is more cost-effective than MR if 78% of the scanned patients eventually undergo arthroscopy. In our study population, 87% had arthroscopy after the MR scan. Therefore, in this patient cohort representing a diverse orthopedic community, arthroscopy alone would have been more cost-effective. Careful analysis in this type of cost-benefit framework would be beneficial and may lead to the establishment of objective criteria by which MR can be used in the most cost-effective manner.     

Clinical value of magnetic resonance imaging of the knee

Background : Magnetic resonance (MR) imaging is an accurate imaging modality of the knee. The role of MR in clinical practice has not been precisely defined, largely due to the relative expense of the technique. Methods : For each new patient with a knee problem who was referred for MR, a provisional diagnosis was made together with a level of certainty regarding the diagnosis. The waiting time for the scan was recorded. To assess clinical usefulness the MR diagnosis was compared with the provisional diagnosis and classified according to the following descending order of value: unexpected negative (no intra‐articular pathology), confirmatory negative, unexpected positive or confirmatory positive. To assess accuracy of the MR diagnosis, the operative diagnosis was compared to the MR diagnosis in those patients who underwent arthroscopy. Results : Fifty‐two per cent of scans were assessed as being very useful and a further 20% were assessed as being moderately useful. Magnetic resonance had a 95% accuracy for medial meniscal tears, 91% accuracy for lateral meniscal tears, and 98% accuracy for anterior cruciate ligament tears, similar to previously reported studies. The diagnostic arthroscopy rate in the patients who underwent MR scanning was similar to that in patients for whom the surgeon was more confident about the diagnosis and who therefore did not undergo MR scanning. The diagnostic arthroscopy rate could have been reduced if surgery had not been performed in 14 patients who had a negative MR scan. Conclusions : There is a role for selective use of MR in the assessment of knee conditions. In particular, MR can be used to reduce the diagnostic arthroscopy rate.     

Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology

In this study, we compared magnetic resonance arthrography results with hip arthroscopy findings to assess the diagnostic value of this imaging technique in evaluating acetabular labral tears and concurrent articular hip pathology. One hundred one consecutive patients (102 hips) with a clinical diagnosis of acetabular labral tear were assessed using magnetic resonance arthrography and had hip arthroscopy after failing to improve with nonoperative treatment. Magnetic resonance arthrography detected 71 of 93 (76%) acetabular labral tears (92 patients) with five false positive studies in five patients (4.9%). Articular cartilage findings diagnosed by magnetic resonance arthrography were confirmed by arthroscopy in 64 hips in 64 patients (62.7%). With respect to labral pathology, magnetic resonance arthrography showed a sensitivity of 71%, specificity of 44% positive predictive value of 93%, negative predictive value of 13%, and accuracy of 69%. With respect to articular cartilage pathology, magnetic resonance arthrography had a sensitivity of 47%, specificity of 89%, positive predictive value of 84%, negative predictive value of 59%, and accuracy of 67%. Although magnetic resonance arthrography is an excellent positive predictor in diagnosing acetabular labral tears and articular cartilage abnormalities, it has limited sensitivity. A negative imaging study does not exclude important intra-articular pathology that can be identified and treated arthroscopically.     

Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI

OBJECTIVE: The objectives of this study were to determine the sensitivity to change of magnetic resonance imaging (MRI) quantification of chondropathy after 1 year in osteoarthritis of the medial tibiofemoral compartment and to assess the predictive value of subchondral bone marrow edema and bone abnormalities on progression of chondropathy. DESIGN: Twenty patients with symptomatic knee osteoarthritis of the medial compartment underwent a prospective, longitudinal study. All patients were evaluated the same day at entry and after 1 year by plain weight-bearing radiographs, MRI with a three-dimensional gradient-echo sequence, using a 0.2-T dedicated MR unit, and arthroscopy. The medial tibiofemoral chondropathy was quantified blindly with MRI and arthroscopy using the French Society of Arthroscopy (SFA) score. Presence of subchondral bone marrow edema and bone abnormalities on initial MRI was recorded in order to evaluate their influence on both unchanged and worsened chondropathy after 1 year. RESULTS: After 1 year, no statistically significant changes were observed with plain radiographs and arthroscopy. At variance, a statistically significant worsening of chondropathy was found with MRI using the SFA-MR score (P=0.01). SFA-MR score was the most responsive outcome. Absence of subchondral bone abnormalities and bone marrow edema on initial MR assessment predicted absence of worsening of chondropathy after 1 year. CONCLUSION: MRI appears promising for evaluating progression of knee osteoarthritis.     

Efficacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear

Although magnetic resonance imaging (MRI) has improved the diagnostic accuracy of meniscal pathology, the authors believe that physical examination remains essential to the evaluation of knee pathology. In this study, the diagnostic accuracy of five clinical tests for meniscal pathology was prospectively evaluated in 160 patients, who thereafter underwent arthroscopy. 69% (109 knees) of the knees tested had associated ACL deficiency. There were 144 meniscal lesions in 130 of the 160 knees which were examined. The sensitivity of the tests was lower than the specificity. Conventional tests such as McMurray and Apley tests showed a low accuracy rate of 45% and 28% respectively. The diagnostic value of the axially loaded pivot shift test was significantly higher, indicating that this remains a useful diagnostic aid.     

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy

The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4.     

Correlation of clinical examination,ultrasound sonography,and magnetic resonance imaging findings with arthroscopic findings in relation to acute and chronic lateral meniscus injuries

Purpose

The aim of this study was to evaluate whether ultrasound sonography (USS) performed by orthopedic surgeons is a reliable method of investigating lateral meniscus (LM) knee lesions as compared to magnetic resonance imaging (MRI), and arthroscopy, which is the gold standard in clinical practice.

Methods

In total, 107 patients were involved in this study. They were hospitalized for arthroscopy due to LM injury of the knee. Clinical examination (McMurray’s, Apley’s, and joint line tenderness tests), USS, and MRI were performed prior to arthroscopy. We compared the results of clinical examination, USS, and MRI with the arthroscopic findings for the knee, which were considered the reference values.

Results

McMurray’s clinical test, which is the most sensitive method of detecting lateral meniscus lesions, gave the same sensitivity rate for both acute and chronic LM injuries: 65 %. USS was observed to be more sensitive and specific for chronic LM injuries (85 and 90 %, respectively) than for acute LM injuries (71 and 87 %). MRI also yielded higher values of sensitivity and specificity for chronic lateral meniscus injuries (75 and 95 %, respectively) than for acute LM injuries (68 and 87 %).

Conclusions

The accuracy of ultrasound examination is demonstrated by the high reliability of this method in the diagnosis of lateral meniscus lesions of the knee, and the evaluation performed in this study showed that ultrasound is a useful clinical tool for diagnosing knee pathology.     

A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears

A prospective and retrospective study was undertaken to compare the accuracy of magnetic resonance imaging (MRI) with clinical examination in diagnosing meniscal and anterior cruciate ligament (ACL) tears. Pathological findings were then confirmed during arthroscopy. One hundred fifty-four patients clinically diagnosed with a meniscal or ACL tear who ultimately had arthroscopic knee surgery were evaluated; 100 patients underwent clinical examination followed by MRI, and 54 underwent clinical examination alone. The presence or absence of meniscal and ACL tears was confirmed during arthroscopy. The accuracies of clinical examination and MRI were compared for the 100 patients who underwent both clinical examination and MRI. The accuracy of MRI was 75% for medial meniscal tears, 69% for lateral meniscal tears and 98% for ACL tears. The accuracy of clinical examination was 82% for medial meniscal tears, 76% for lateral meniscal tears and 99% for complete tears of the ACL. Furthermore, the accuracy of clinical examination for the 54 patients who underwent clinical examination alone was not significantly different from the accuracy of clinical examination in the 100 patients who also underwent MRI. There was no significant difference between the accuracy of clinical examination and MRI in the diagnosis of meniscal and ACL tears and, overall, MRI contributed to treatment in only 16 of 100 cases. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology.     

Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears

BACKGROUND: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. METHODS: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. RESULTS: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. CONCLUSIONS: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.