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.     

MR与关节镜诊断半月板损伤的临床价值研究

目的探讨MR与关节镜诊断半月板损伤的临床价值。方法本组72例患者检查86个膝关节,共172例半月板,入院后进行MRI检查评价半月板损伤情况,2周内进行膝关节镜检查,MRI检查结果按Fischer分级标准分I级信号、II级信号、III级信号,关节镜检查结果分正常、退变、撕裂。结果 MRI与关节镜检查诊断半月板损伤结果比较,X~2=1.432,P=0.698,κ=0.694;MRI与关节镜检查诊断半月板撕裂结果比较,X~2=0.529,P=0.629,κ=0.767,MRI诊断半月板撕裂的敏感度86.27%、特异度91.73%、阳性预测值81.48%、阴性预测值94.07%、阳性似然比10.43、阴性似然比0.15、准确度90.12%、假阳性率8.27%、假阴性率13.73%。结论 MRI能够较好的诊断半月板损伤的程度,特别是对半月板撕裂的诊断,MRI的Ⅲ级信号可作为临床选择关节镜检查和手术治疗的一个重要指征。     

MRI和关节镜诊断膝半月板损伤的比较研究

目的 :探讨膝关节半月板损伤MRI和关节镜下的不同表现及其对半月板损伤的诊断意义。方法 :回顾性分析 10 2个半月板损伤的MRI表现和关节镜下图像。根据MRI信号改变将半月板损伤分为Ⅰ级、Ⅱ级、Ⅲ级 ,并与关节镜下所见对比 ,分别加以研究。结果 :根据MRI信号强度改变 ,10 2个膝关节中Ⅰ级损伤 3 4个 ,Ⅱ级损伤 2 7个 ,Ⅲ级损伤 41个。与关节镜检结果对比 ,MRI诊断半月板撕裂的敏感度 90 .0 % ,特异度 91.9% ,符合率 91.2 %。结论 :MRI在半月板损伤的诊断中具有极高价值 ,对指导患者的治疗具有重要的临床意义。     

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。     

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.     

半月板损伤及撕裂的MRI与关节镜或手术对照研究

目的评价不同观察者对膝关节半月板损伤MRI诊断一致性及撕裂形态学MRI诊断分级的准确性。方法由两位有经验的影像科医生回顾性对82例82个疑有半月板损伤的MRI图像,所得两次诊断结果进行Kappa统计量分析。本研究中用关节镜或手术结果作为诊断参考标准,确诊撕裂的内侧半月板有29例,外侧半月板有40例,分别分析内外侧半月板经参考标准确诊的撕裂的两次诊断的诊断价值。结果对内侧半月板Kappa值为0.71,对外侧半月板Kappa值为0.65,两次诊断均有好的诊断一致性。对内侧半月板可修复撕裂两次诊断的灵敏性、特异性、准确性分别为95%、38%、79%;100%、38%、83%。对外侧半月板可修复撕裂两次诊断的灵敏性、特异性、准确性分别为93%、65%、75%;93%、77%、93%。结论MRI两次诊断对内外侧半月板诊断一致性良好,对内外侧半月板可修复撕裂准确性、灵敏度较高,对外侧半月板可修复撕裂特异度较高。     

MRI与关节镜诊断半月板损伤临床表现的对比分析

目的 探讨MRI和关节镜检查半月板损伤的诊断价值。方法 收集40例我院接受诊断与治疗的膝关节损伤患者的MRI图像,以关节镜诊断为标准,计算MRI诊断的敏感性、特异性、准确性。结果 本组40例膝关节,左膝18例,右膝22例,共80个半月板。MRI表现为Ⅰ度损伤9个,Ⅱ度损伤15个,Ⅲ度损伤56个。MRI诊断半月板撕裂56个,其中外侧半月板35,内侧半月板21个,关节镜证实半月板撕裂50个,其中外侧半月板32,内侧半月板18个,其余6个半月板关节镜下肉眼未见明显撕裂。24个半月板MRI诊断无撕裂者中,关节镜下证实有3个半月板撕裂并进行部分切除。以关节镜检查为标准,MRI对半月板撕裂诊断的敏感性为94.3%,特异性为77.8%,准确性为88.8%,MRI诊断与关节镜结果差异无统计学意义（x^2=0.44,P〉0.05）。结论 MRI对半月板撕裂具有较高的诊断价值。而关节镜检查为最终确诊半月板损伤提供了清晰的镜像和依据,两者相互补充才能得到更好的临床效果。     

磁共振肩关节造影在肩袖损伤的临床应用

目的探讨MRA检查对肩袖损伤的诊断价值。方法回顾性分析127例肩袖损伤MRA及MRI表现,与肩关节镜手术结果对照。结果 127例肩袖损伤病例,MRI诊断肩袖完全撕裂的敏感度、特异度及准确度分别是79.25%、82.43%和81.10%;诊断部分撕裂的敏感度、特异度及准确度分别是73.33%、67.31%和70.87%;其一致性较好(Kappa=0.708),差异均有统计学意义(P0.05)。MRA诊断Ⅰ型8例(6.30%)、Ⅱ型21例(16.54%)、Ⅳ型32例(25.20%),其敏感度分别为100%、95.24%、96.88%;特异度分别为100%、99.06%、98.95%;准确度分别为100%、98.43%、98.43%;明显高于常规MRI诊断;与关节镜结果对比,其一致性极佳(Kappa=0.944),差异均有统计学意义(P0.05);而对于Ⅲ型、Ⅴ型和Ⅵ型肩袖损伤,MRA均不能显示其损伤部位及程度,无法对其进行诊断。结论 MRA能准确判断Ⅰ型、Ⅱ型和Ⅳ型肩袖撕裂范围及程度,是MRI诊断肩袖损伤的有效补充,为临床诊断和治疗能提供更准确的依据。     

MRI检查对半月板桶柄状撕裂的诊断价值研究

目的:探讨MR影像在膝关节半月板桶柄状撕裂(Bucket Handle Tear,BHT)中的诊断价值及MRI诊断BHT的观察方法。方法:采用敏感度、特异度等指标,盲法回顾分析130例同时行MRI及关节镜(Arthroscope,AS)检查治疗的膝关节损伤患者诊断结果,其中以经关节镜诊断BHT76例作为金标准,评价项目包括:①原始报告诊断;②中央移位的半月板碎片;③双后交叉韧带征;④蝶结消失征。结果:原始报告诊断BHT敏感度为43%,特异度为87%。中央移位的半月板碎片敏感度为72%,特异度为87%。双后交叉韧带征敏感度为31%,特异度为97%。蝶结消失征敏感度为71%,特异度为69%。结论:采用MRI诊断BHT时,中央移位的半月板碎片的特异度和敏感度均较高,而蝶结消失征的敏感度高,特异度低,双后交叉韧带征的特异度最高,敏感度最低。     

MRI水脂分离序列成像对膝关节半月板损伤的诊断价值

目的 :探讨MRI水脂分离技术——扰相梯度回波水脂分离T2WI(简称FatSepG-WFT2*)序列对膝关节半月板损伤的诊断价值。方法:回顾性分析MRI诊断的62例372个半月板区域的相关资料,以关节镜诊断为金标准,对结果行统计学分析。用χ2检验比较不同MRI序列对膝关节半月板损伤的差异。采用Kappa检验分析MRI诊断半月板撕裂与关节镜诊断的一致性。采用χ2检验分析MRI对内外侧半月板撕裂部位诊断准确性的差异。结果:以关节镜结果作为标准,MRI FatSepG-WFT2*序列诊断半月板撕裂的准确度为94%(350/372)、敏感度为93%(140/149),特异度为94%(210/223),对诊断半月板撕裂有较好的有效性(K=0.877)。结论 :MRI FatSepG-WFT2*序列较常规MRI序列具有更高的敏感性和特异性,两者结合可提高低场强MRI对膝关节病变的检出率。MRI是诊断膝关节半月板损伤的有效手段,与关节镜有较好的一致性,两者结合具有更好的诊断和治疗效果。     

膝关节半月板撕裂磁共振成像与关节镜对照研究

目的分析磁共振成像（MRI）在膝关节半月板撕裂诊断中的价值。方法分析168例（共计336个半月板）临床疑诊半月板损伤患者,依次在1周内行磁共振（MR）和关节镜检查,对比MR和关节镜检查结果,探讨MRI对膝关节半月板撕裂诊断符合率。结果以关节镜为参考标准,168例（共计336个半月板）中MRI诊断半月板撕裂敏感性96．9％,特异性为87．5％,准确性为92．5％,假阳性率为12．5％,假阴性率3．1％,MRI具有术前诊断价值。结论MRI诊断半月板撕裂具有很高准确性,但仍有一定的假阳性与假阴性。     

膝关节半月板损伤的MRI与关节镜对照研究

目的评价MRI在膝关节半月板撕裂诊断和评级中的价值。方法参照Mesgarzadeh标准对76位患者78个撕裂半月板的MR影像作回顾性分析,3位MRI主治医师在不知道关节镜检查结果的情况下独自阅片,按Mesgarzadeh的分级标准确定半月板撕裂的类型并记录评定结果,包括联合的前交叉韧带撕裂。结果MRI诊断半月板撕裂的敏感性和特异性分别为92%和87%,Ⅵ型是半月板撕裂中最常见的类型,尤其在发生移位的半月板撕裂中最常见。结论MRI是半月板撕裂伤和交叉韧带损伤的可靠诊断工具。     

低场强MRI对膝关节半月板损伤的诊断价值探讨

目的评价低场强MRI对半月板损伤的诊断价值。方法对我院90例临床高度怀疑半月板损伤的患者行低场强MRI扫描和关节镜检查,并对其结果进行比较。结果本组90例患者的98个膝关节共累及103个半月板,经MRI诊断为真性撕裂者55个半月板．经父节镜证实为53个半月板;经MRI检查阴性而关节镜下见撕裂者2个半月板,MRI和父节镜检查均为阴性者30个半月板,其中有3个为盘状半月板。低场强MRI对半月板损伤的敏感性为9375％,特异性94．37％,准确性94．17％。结论低场强MRI是诊断半月板损伤无创性的极有价值的诊断疗法．是膝关节镜术前的重要榆查。     

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。     

Diagnostic accuracy of MRI knee in reference to arthroscopy in meniscal and anterior cruciate ligament injuries

Objective

Data regarding the diagnostic accuracy of Magnetic Resonance Imaging (MRI) are contradictory. The aim of this study was to find the accuracy of MRI knee against arthroscopy, in cases of meniscus and Anterior Cruciate Ligament (ACL) injuries. To the best of our knowledge, this is the largest Indian study comparing MRI knee with arthroscopy comprehensively.

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy

Objective To evaluate the diagnostic efficacy of thin-slice (1 mm) axial proton density-weighted (PDW) MRI of the knee for meniscal tear detection and classification. Methods We prospectively assessed pre-operative MR images of 58 patients (41 males, 17 females; age range 18-62 years) with arthroscopically confirmed meniscal tear. First, we evaluated the performance of the sagittal and thin-slice axial MR images for the diagnosis of meniscal tears. Second, we compared the correlation of tear types presumed from sagittal and axial MRI with arthroscopy and tear classification from axial MRI. Tears were classified on the sagittal plane and the axial plane separately. The diagnostic performance and tear classification were compared statistically with arthroscopy results, which is accepted as the standard of reference. Results 8 of 58 patients were removed from the study group because they had complex or degenerative tears. A total of 62 tears were detected with arthroscopy in 50 patients. On the sagittal images, sensitivity and specificity values were 90.62% and 70.37%, respectively, for medial meniscus tears and 72.73% and 77.14%, respectively, for lateral meniscus tears. The corresponding values for axial images were 97.30% and 84.00%, respectively, for medial meniscus tears and 95.65% and 80.50%, respectively, for lateral meniscus tears. There was no significant difference in tear classification between the arthroscopy results and the thin-slice axial PDW MRI results (p>0.05). Conclusion thin-slice axial PDW MRI increases the sensitivity and specificity of meniscal tear detection and especially classification, which is important for surgical procedure decisions.     

膝关节韧带损伤的MRI诊断

目的:探讨膝关节韧带损伤的MRI表现及诊断价值。方法:36例临床怀疑膝关节损伤的患者于关节镜及手术前行MRI检查,以关节镜结果作为金标准,前瞻性分析膝关节韧带损伤的MRI表现及诊断价值。结果:关节镜证实前交叉韧带损伤21例,其中完全撕裂15例,部分撕裂6例,后交叉韧带损伤12例,正常患者15例。MRI诊断前交叉韧带损伤的敏感度为95.2%,特异度为80%,准确度为88.9%;诊断后交叉韧带损伤的敏感度为100%,特异度为95.8%,准确度为97.2%。结论:MR1是诊断膝关节韧带损伤的理想检查方法,具有较高的临床应用价值。     

The value of magnetic resonance imaging in our current management of ACL and meniscal injuries

Magnetic resonance imaging (MRI) is frequently used in the diagnosis of anterior cruciate ligament (ACL) and meniscal injuries. The aim of this retrospective study was to determine the reliability and value of MRI in our management of ACL and meniscal tears. 138 patients who had undergone a MRI to confirm or refute the clinical diagnosis of an ACL or meniscal tear were identified. Those who had subsequently undergone arthroscopy were selected. MRI findings and clinical diagnosis were compared with those at arthroscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of clinical diagnosis and MRI were then calculated. The overall accuracy for MRI was 91, 68 and 86% for detecting ACL, medial meniscal and lateral meniscal tears, respectively. Accuracy for clinical diagnosis was 90 and 64% for ACL and meniscal tears, respectively. In contrast to other series, our results indicate a lower accuracy of MRI in detecting pathology, especially of the ACL and medial meniscus. We noted a low sensitivity, specificity and positive predictive value but a high negative predictive value rendering MRI most useful as a negative diagnostic tool. We suggest that where symptoms and clinical findings support one of these diagnoses and arthroscopic therapeutic intervention is contemplated, that MRI scanning is not always beneficial. Our current practice of requesting scans to routinely confirm the diagnosis should be altered. Unnecessary MRI scanning increases the financial burden and delays patient treatment. No funding has been received from any sources and no conflicts of interests are stated in the submission of this article.