MRI诊断颞下颌关节损伤的价值

目的:探讨MRI诊断颞下颌关节损伤的应用价值。材料和方法:对30例颞下颌关节损伤患者于外伤后3～20天内行颞下颌关节MRI检查,MRI扫描序列包括闭口斜矢状位T1WI、PDWI、斜冠状位T1WI、T2WI,张口斜矢状位T1WI、PDWI。由两位资深放射科医师分析MRI表现。结果:30例共60个颞下颌关节中发现18个髁状突骨折,9个骨损伤,29个关节盘移位,26个关节囊积液、积血。结论:MRI能很好的显示颞下颌关节的骨折、骨损伤以及关节盘与关节囊损伤情况,是颞下颌关节损伤的重要检查与评价手段,具有很高的临床应用价值。     

间接性TMJ损伤的实验研究——CT、MRI和病理结果对照

目的　建立间接性颞下颌关节损伤（TMJI）动物模型,探讨CT、MRI在TMJI中的应用。方法　选择4～6月健康大耳白兔18只,随机分组,一侧关节为实验组（侧）,对侧关节为对照组（侧）,损伤前为正常组（侧）。以自制钟摆式TMJI打击器,对实验兔TMJ造成同量级间接性TMJI,用GE9800CT机和Picker0.5TMR机在TMJI后6h、1周、1月分别进行CT、MR成像,并与病理相对照。结果　共建成18个兔间接性TMJI模型;CT上见不同程度下颌骨及髁突下骨折和TMJ软组织损伤;MRI上均见TMJI形态学及信号强度改变;病理上均有TMJI表现。部分对照组也有上述改变。结论　所建立的18个间接性TMJI模型具有高度可重复性,这为开展CT、MRI与病理学系列研究奠定了可靠基础。     

MRI在肩锁关节损伤中的临床应用价值

目的:探讨肩锁关节(ACJ)损伤的MRI影像表现和诊断价值。方法:收集自2008年6月～2009年12月间共38例经手术及临床治疗证实的肩锁关节外伤患者的MRI检查,对ACJ损伤的核磁共振表现进行观察分析并按Tossy分类进行分级。结果:38例ACJ损伤中Ⅰ级损伤7例,表现为肩锁韧带部分撕裂。Ⅱ级损伤9例,表现为肩锁韧带完全撕裂,伴有喙锁韧带的扭伤或部分撕裂。Ⅲ级损伤19例,表现为肩锁韧带和喙锁韧带完全撕裂。慢性损伤3例,表现为肩锁韧带或喙锁韧带增厚和信号减低。ACJ损伤的伴随征象主要有关节囊积液、关节盘撕裂和骨挫伤等。结论:MRI对ACJ损伤的显示率高,并能进行准确分级,具有较高的临床应用价值。     

颞下颌关节盘移位的MRI表现及其临床诊断价值

目的:探讨颞下颌关节盘移位的MRI表现及其临床诊断价值。方法:23例共46侧关节盘行斜矢状面和冠状面T1WI、T2WI及T2*WI扫描,分析关节盘在开口位和闭口位上的位置变化和关节盘的形态等。结果:46侧关节盘中有17侧(17/46)正常;可复性关节盘前移位11侧(11/46),主要MRI表现为闭口位时关节盘在髁状突前方,关节结节前下方,开口位时,关节盘回到关节窝正常位置,关节盘可变形伸长,后带膨大,信号基本正常;不可复性关节盘前移位15侧(15/46),主要MRI表现为在闭口位和开口位时关节盘位置均位于髁突前方,关节结节前下方,不回到关节窝内,关节盘形态严重变形,出现圆形、折叠型、伸长型等,关节盘信号基本正常;关节盘内侧移位2侧(2/46),外侧移位1侧(1/46),这两种类型主要MRI表现为关节盘变形,呈低信号改变。结论:MRI可以清楚显示关节盘的位置、结构及盘突关系,对颞下颌关节盘移位有重要的临床诊断价值。     

颞下颌关节紊乱综合征的MRI诊断价值

目的 探讨ＭＲＩ诊断颞下颌关节紊乱综合征（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｉｎｔ ｄｅｒｅｎｇｍｅｎｔ ｓｙｎｄｒｏｍｅ,ＴＭＪＤｓ）的价值。材料与方法 回顾性分析３７例（７４侧）ＴＭＪＤｓ患者ＭＲＩ表现。７４侧均采用超导磁共振成像系统扫描。５０侧附加模拟动态扫描;关节腔造影３３侧,关节腔镜检查１９侧,手术１４侧,病理切片４侧,结果 （１）４４侧有症状关节中,３８侧关节盘病变,其中最多见为     

MR FIESTA技术在TMJ动态成像中的应用

目的:探讨磁共振FIESTA技术在颞下颌关节(TMJ)动态成像中的应用.方法:连续对40例受检者的80侧TMJ行斜矢状位FIESTA动态磁共振成像.根据各TMJ在成像过程中完成的运动周期数分其为2组:运动周期≤3者(1组)和>3者(2组).分别对每侧TMJ的关节盘和髁突的运动状况进行评估.结果:80侧TMJ中,关节盘位置、形态和运动范围清晰显示者分别为76侧(95%)、75侧(93.75%)和77侧(96.25%);关节盘运动过程中出现伪影和"跳跃"征象者分别为27侧(33.75%)和28侧(35%),两者具有相关性(P(0.01).髁突位置、形态和运动范围清晰显示者分别为78侧(97.5%)、76侧(95%)和79侧(98.75%);髁突出现运动伪影和"跳跃"征象者分别为30侧(37.5%)和28侧(35%),两者亦具有相关性(P<0.01). 1组关节盘和髁突位置、形态的清晰显示率高于2组(P<0.05),而运动伪影和"跳跃"征象显现率低于2组(P<0.05).结论:FIESTA技术能对自然状态下缓慢运动的TMJ进行动态成像,并为TMJ运动状况的显示提供有益信息.     

膝关节韧带损伤的MRI诊断价值

目的:探讨膝关节韧带损伤的MRI表现特点。方法:回顾性分析50例损伤的膝关节韧带的MRI表现。结果:本组50例87根韧带损伤,其中前交叉韧带15根(17.2%),后交叉韧带18根(26.7%),外侧副韧带15根(17.2%),内侧副韧带39根(44.8%)。50例中复合韧带损伤16例37根,其中前交叉+后交叉+外侧副韧带3例9根,前交叉+后交叉+内侧副韧带2例6根,前交叉+内侧副韧带3例6根,后交叉+内侧副韧带3例6根,后交叉+外侧副韧带3例6根,前交叉+外侧副韧带2例4根。单一韧带损伤34例50根,其中前交叉韧带5根,后交叉韧带7根,外侧副韧带7根,内侧副韧带31根。韧带完全横断撕裂7根,其中前交叉韧带1根,后交叉韧带2根,内侧副韧带3根,外侧副韧带1根。87根中部分纵行撕裂80根;7根完全断裂中3根交叉韧带MRI表现为韧带的连续性中断,断端回缩,局部或弥漫性肿胀,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号;4根侧副韧带MRI表现为韧带连续性中断或韧带肿胀增粗,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号。80根部分纵行撕裂MRI表现为韧带连续性完整,韧带增粗,PD-WI上呈中等信号,T2WI和脂肪抑制序列呈高信号。经手术关节镜检查21例33根,与MRI诊断相符31根,不符合2根,符合率为93.9%。54根经保守治疗后30~40天MRI复查见韧带原异常高信号而恢复至正常低信号,韧带形态类似正常,33根经关节镜下行韧带重建修复术,30~40天MR复查见原异常高信号而恢复至正常低信号,但局部成角或形态仍不规则。结论:MRI对软组织有极高的分辨率,不仅能较清楚显示膝关节韧带损伤,并能显示半月板损伤和骨挫伤,具有较高的实用价值。     

MRI在颞下颌关节盘移位诊断中的应用

目的 :探讨MRI在颞下颌关节盘移位诊断中的应用价值。方法 :收集经临床确诊的52例颞下颌关节紊乱病(temporomandibular disorders,TMD)患者,观察颞下颌关节MRI斜矢状位及斜冠状位图像,分析张闭口位关节盘的位置及形态的改变。结果:52例中,关节盘前移位47例(可复性前移位20例,不可复性前移位27例),前内移位5例。结论:MRI可清晰显示颞下颌关节盘形态及盘-突位置关系改变,为临床治疗提供可靠的诊断依据。     

膝关节损伤的MRI诊断

目的：探讨膝关节损伤的MRI特点、病理基础及临床意义。方法：分析52例膝关节损伤的MRI资料。结果：半月板损伤45例,MRI表现为黑色的半月板内出现结节状、线状、放射状裂隙样异常高信号,延伸达或未及关节软骨面两种,前交叉及后交叉韧带损伤24例,MRI表现为在条索状黑色韧带影中出现短T1长T2异常高信号,韧带变形,呈波浪状或不连续,胫骨移位,内、外侧副韧带损伤28例,表现为信号增高,形态增粗,边缘模糊,隐匿性骨折8例,表现为干骺端边界模糊的片状T1低信号影,T2信号多样,讨论：MRI对膝关节半月板、韧带损伤及隐匿性骨折的诊断有重要的临床意义,可对治疗方案的选择提供详尽的依据。     

膝关节半月板损伤的MRI诊断

目的：回顾性研究膝关节半月板不同程度损伤的ＭＲＩ表现。材料与方法：对１１０例临床可疑半月板损伤患者的ＭＲＩ和关节镜检查进行了对照研究。根据半月板内部ＭＲ信号特征将半月板损伤分为０～Ⅲ度。结果：在１１０例２２０个半月板中，有１７８个（８０．９％）半月板呈典型的０～Ⅲ度ＭＲ表现，４２个（１９．１％）损伤的半月板ＭＲ表现不典型。以关节镜检查结果为标准，ＭＲＩ诊断半月板撕裂和破碎的敏感性为９７．２％，特异性为９５．６％，准确性为９６．４％，阳性预测值为９５．４％，阴性预测值为９７．３％。结论：ＭＲＩ是一种无创伤性的能准确诊断半月板损伤的成像方法，将逐渐取代诊断性的关节镜检查。     

颈段脊柱损伤的MRI诊断

目的 探讨ＭＲＩ在颈段脊柱损伤中的应用价值。材料与方法 ３０例颈椎外伤患者行ＭＲＩ检查。所有患者均行Ｘ线检查,其中６例行ＣＴ检查。结果 ３０例中伤及颈５～７占８０％,根据ＭＲＩ表现将颈段脊柱外伤分为５类：单纯压缩性骨折;泪滴性骨折;爆裂性骨折;骨折脱位,无骨折脱位。全部病例ＭＲＩ均清楚显示伴有脊髓信号的异常,２例可见脊髓断裂。结论 ＭＲＩ可以对颈椎损伤形态及脊髓、韧带、间盘等软组织损伤作出准确的评     

肾损伤的MRI诊断及其临床价值

目的：评价肾损伤的MRI诊断和分类的临床价值。材料和方法：回顾性分析23例肾损伤MRI表现。结果：23例中肾挫伤7例,单纯肾包膜下血肿5例,肾挫裂伤5例,肾断裂2例,肾撕裂伤并血肿尿液外渗2例,陈旧性肾挫裂伤2例。依据MRI等影像诊断和临床情况行肾切除术3例,肾修补术3例,肾动脉栓塞治疗1例,保守治疗16例。结论：MRI是诊断肾损伤一种准确有效方法,对于观察损伤的治疗效果也具有重要意义。     

Incidental findings on MRI of the temporomandibular joint

Objectives:

The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ).

Methods:

MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized.

Results:

There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention.

Conclusions:

Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.     

儿童创伤性强直颞下颌关节的血流变化

目的：探讨创伤性颞下颌关节强直后儿童颞颌关节血流的变化。材料与方法：应用放射性同位素三相骨扫描方法检查７名创伤性颞下颌关节强直患儿,观察其颞颌关节区血流变化。结果：强直侧颞颌关节区三相骨扫描血流相曲线明显低于非强直侧,强直侧颞下颌关节区延迟相和血池相的放射计数比值比健侧大。结论：创伤性颞颌关节强直可使颞颌关节区血流灌注受到明显影响。     

Temporomandibular joint (TMJ) disc position in patients with TMJ pain assessed by coronal MRI

Objectives:

To assess the position of the temporomandibular joint (TMJ) disc in patients with TMJ pain and compare it with equivalent published data of asymptomatic volunteers.

Methods:

The oblique coronal closed- and open-jaw MR images from 66 patients with TMJ pain were evaluated. Clinical examination followed the research diagnostic criteria for temporomandibular disorders. In all coronal images, the transverse condylar axis and the medial and lateral edges of the disc were determined using special software. Inter-rater agreement was calculated [two raters; inter-rater correlation coefficient (ICC)]. The presence of osteoarthrosis (OA) was determined by two independent raters. The influence of OA was estimated in patients (generalized estimation equation model). The results were compared with those of healthy volunteers (t-test). Differences between closed and open jaw in patients were analysed with the Wilcoxon matched-pair test.

Results:

The ICC was good for the transverse condylar axis (0.987) and the medial edge of the disc (0.799) and fair for the lateral edge (0.355). On average, the disc projected 5.5% to the medial side; laterally, the condyle was partially uncovered by the disc (−16.6%). In the open-jaw position, both the medial and the lateral edges shifted medially (to 17.6% vs −23.6%, Wilcoxon matched-pair test, p < 0.001). OA had no significant influence (generalized estimation equation model, p = 0.952). The disc position differed significantly from asymptomatic individuals (t-test, p < 0.001) who showed a medial disc position and full coverage of the condyle.

Conclusions:

In patients with TMJ pain, the disc seems to be smaller and located less medially than in healthy volunteers. The extent of the medial shift on opening was similar.     

Dynamic MRI of the TMJ under physical load

Objectives:

The objective of this study was to examine the kinematics of structures of the temporomandibular joint (TMJ) under physiological load while masticating.

Methods:

Radial MRI was chosen as a fast imaging method to dynamically capture the motions of the joint’s anatomy. The technique included a golden ratio-based increment angle and a sliding window reconstruction. The measurements were performed on 22 subjects with and without deformation/displacement of the intra-articular disc while they were biting on a cooled caramel toffee.

Results:

The reconstructed dynamic images provided sufficient information about the size and localization of the disc as well as the change of the intra-articular distance with and without loading.

Conclusions:

The feasibility of the golden ratio-based radial MRI technique to dynamically capture the anatomy of the TMJ under physical load was demonstrated in this initial study.     

正常人和偏侧咀嚼者颞下颌关节核素骨显像的比较

目的:比较放射性同位素骨三相显像技术对正常人及偏侧咀嚼者颞下颌关节影像检查的差异.材料和方法:正常男性志愿者15名和偏侧咀嚼者20名,接受放射性核素骨三相显像检查,以分析、比较不同咀嚼方式对颞下颌关节及骨的血流和骨代谢的影响.结果:正常人及偏侧咀嚼者两侧颞下颌关节形态对称,偏侧咀嚼者两侧髁状突运动不一致.正常人下颌骨不同部位的骨血流和骨代谢有特定差异.偏侧咀嚼者骨扫描示上述部位差异改变,非咀嚼侧关节区放射性强度稍高于咀嚼侧.结论:放射性同位素骨三相显像可以准确显示颞下颌关节的功能变化.