髋关节MR造影检测髋臼唇

髋部MRI为潜在的机械性髋疼痛提供了新的显示方法.对于髋部结构尤其是髋臼唇的显示,其它方法一直非常有限.通过MR关节造影术使髋关节膨胀起来,从而能够确认唇缘分离及撕裂,并与许多无症状的髋臼唇形态相鉴别.综述了髋的正常解剖、结构紊乱的临床表现以及MR关节造影,同时也总结了无症状髋臼唇的形态学改变及不正常髋臼唇的表现.     

髋关节MR造影检测髋臼唇

髋部MRI为潜在的机械性髋疼痛提供了新的显示方法。对于髋部结构尤其是髋臼唇的显示，其它方法一直非常有限。通过MR关节造影术使髋关节膨胀起来，从而能够确认唇缘分离及撕裂，并与许多无症状的髋臼唇形态相鉴别。综述了髋的正常解剖、结构紊乱的临床表现以及MR关节造影，同时也总结了无症状髋臼唇的形态学改变及不正常髋臼唇的表现。     

3.0T常规MRI与MR髋关节造影诊断髋臼唇撕裂的对比研究

目的 在3.0 T场强中,比较常规髋关节MRI及MR髋关节造影对髋臼唇撕裂的诊断价值.方法 回顾分析44例髋关节病变患者的患侧髋关节常规MRI及MR髋关节造影资料,将每例患者的臼唇划分为前、上、后3处区域(共计132处),确定有无撕裂,并进行分型.其中5例患者经髋关节镜检查.对于常规MRI及MR髋关节造影获得的臼唇撕裂及分型数据差异比较采用Wilcoxon秩和检验,一致性比较采用Kappa检验.结果 常规MRI与MR髋关节造影诊断完全相同者计116处臼唇,只有16处存在诊断差异.其中,前者诊断无撕裂而后者诊断撕裂者9处,前者诊断撕裂但后者诊断无撕裂者6处,其余1处两者均诊断为撕裂但分型不同.常规MRI与MR髋关节造影的评价差异没有统计学意义(Z=0.347,P＞0.05),且具有极好的一致性(K=0.781,P＜0.01).在接受关节镜的5例患者中,常规MRI、MR髋关节造影及关节镜结果均完全吻合.结论 对髋臼唇撕裂,3.0 T常规髋关节MRI可获得与MR髋关节造影基本相同的诊断效果.     

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。     

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     

唇板横断面积在诊断髋臼前唇撕裂中的作用

正摘要目的研究超声测量横断面积(CSA)诊断髋臼前唇(AL)撕裂的作用。方法将初诊为AL撕裂的52例病人的55个髋关节与28名健康志愿者的56个髋关节的超声定性/定量检查纳入研究。仅病人行MR关节成像检查,复习MR影像评价AL增厚和撕裂情况。结果MR关节成像检查AL撕裂病人髋臼前唇的     

肩关节MR造影对肩关节前方盂唇病变的诊断价值

目的明确肩关节造影MR对肩关节前方盂唇病变的诊断价值，并比较中立位肩关节造影MR和外展外旋（abduction and external rotation, ABER）造影MR的价值。方法回顾性分析经证实的44例肩关节造影MR资料，以肩关节镜检查结果为金标准，对比中立位肩关节造影MR和ABER造影MR对肩关节前方盂唇病变的诊断价值。结果中立位肩关节造影MR对前方盂唇的诊断敏感度为79．3％（23／29），特异度为100％（15／15），准确度为86．4％（38／44）；ABER造影MR的敏感度为93．1％（27／29），特异度为100％（15／15），准确度为95．5％（42／44）。ABER造影MR显著提高了前方盂唇病变的诊断敏感度（P=0．037）。结论ABER造影MR可以提高肩关节前方盂唇病变的诊断敏感度。     

常规MRI与MR关节造影诊断肩袖撕裂的初步对比研究

目的 比较3.0T常规MRI和MR关节造影检查对肩袖撕裂的诊断价值.方法 分析48例肩关节病变患者的常规MRI和MR关节造影检查资料,确定肩袖有无撕裂并进行分型.其中4例行肩关节镜检查.采用配对x2检验比较两种检查方法诊断肩袖撕裂的差异性.结果 常规MRI显示冈上肌腱全层撕裂6例,冈上肌腱部分撕裂9例;MR关节造影显示冈上肌腱全层撕裂7例,冈上肌腱部分撕裂8例.常规MRI和MR关节造影检查方法对肩袖全层撕裂诊断有6例相同,1例常规MRI诊断无撕裂MR关节造影诊断为撕裂;对肩袖部分撕裂的诊断有7例相同,3例不同,其中2例常规MRI诊断为撕裂而MR关节造影诊断为无撕裂,1例常规MRI诊断为无撕裂而MR关节造影诊断为撕裂;两种检查方法对肩袖全层撕裂(x2=0.000,P＞0.05)及部分撕裂(x2=o.000,P＞0.05)的诊断差异无统计学意义.结论 初步显示3.0T常规MRI对肩袖全层撕裂和肩袖部分撕裂的诊断能达到MR关节造影的诊断效果,同时可以显示肩袖撕裂伴发的各种异常.     

Meta分析MRI及MR关节成像诊断髋臼盂唇撕裂准确性的研究

目的 MRI及MR关节成像(MRA)被推荐用于诊断髋臼盂唇撕裂。本研究的目的是用Meta分析法确定MRI及MRA诊断髋臼盂唇撕裂的敏感性及特异性。材料与方法     

MR直接关节造影在腕三角纤维软骨复合体损伤中的应用

目的 通过与腕关节镜结果对照,探讨MR直接关节造影在腕三角纤维软骨复合体(TFCC)损伤中的作用.方法 14例临床怀疑腕TFCC损伤的患者接受了常规MRI和MR直接关节造影,其中10例行腕关节镜检查.MR直接关节造影在腕拇长伸肌腱与伸指总肌腱间隙(相当于桡舟关节间隙)处进针,注入5～7 ml的钆喷替酸葡甲胺(0.1 mmol/L)混合液(0.3 ml钆喷替酸葡甲胺+100 ml生理盐水),与腕关节镜结果相对照,分析常规MRI和MR直接关节造影表现.结果 (1)14例中TFCC尺侧撕裂5例,桡侧撕裂4例,整体损伤5例(包括2例长期类风湿关节炎).(2)在脂肪抑制序列(STIR)及T2和T1WI序列上,损伤的TFCC表现为高信号或等信号,正常的低信号部分或完全消失,MR直接关节造影显示4例桡侧撕裂在腕TFCC的下尺桡关节和5例尺侧撕裂在尺骨茎突附着处可见不同程度的高信号对比剂聚集,5例整体损伤在下尺桡关节和尺骨茎突附着处均可见对比剂.MR直接关节造影表现与腕关节镜结果在损伤部位相符合,包括4例桡侧撕裂,3例尺侧撕裂和3例整体损伤.(3)14例腕TFCC损伤患者,8例伴有下尺桡关节半脱位,6例伴有尺桡骨骨挫伤,常规MRI和MR直接关节造影均可清晰地显示其滑膜反应和骨髓水肿等表现.结论 MR直接关节造影可以清晰地显示腕TFCC损伤,同时与常规MRI相结合能显示伴随的滑膜反应和骨髓水肿.     

Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography

Objective In recent years, radial imaging has been advocated for improved visualization of the acetabular labrum in magnetic resonance arthrography of the hip. The purpose of this study was to investigate whether radial imaging demonstrates labral tears not visible on standard imaging planes. Methods Fifty-four consecutive magnetic resonance (MR) arthrograms of the hip that included radial imaging over 2 years were retrospectively analyzed by two radiologists. Standard imaging planes and radial imaging were reviewed for identification of labral tears in four specific areas of the labrum: anterosuperior, posterosuperior, anteroinferior, and posteroinferior. The standard imaging sequences include fat-saturated spin-echo T1-weighted images in the coronal and oblique axial planes, non-fat-saturated T1-weighted images in the coronal and sagittal planes, and T2-weighted sequence in the axial plane. Radial imaging was performed as previously described using fat-saturated T1-weighted sequences. Results Using standard imaging planes, 50 anterosuperior, 31 posterosuperior, 10 anteroinferior, and 9 posteroinferior labral tears were detected in 54 MR arthrograms of the hip. Using radial sequences alone, 44 anterosuperior, 25 posterosuperior, 9 anteroinferior, and 5 posteroinferior labral tears were detected. In all four areas of the labrum, the radial imaging did not show any labral tear not seen on standard imaging planes. Discussion In MR arthrography of the hip, radial imaging did not reveal any additional labral tears. Standard imaging planes sufficiently demonstrate all acetabular labral tears.     

3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

Objective

To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears.

Methods

90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy.

Results

59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05).

Conclusion

Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.     

Direct magnetic resonance arthrography

Magnetic resonance (MR) arthrography has gained increasing popularity as a diagnostic tool in the assessment of intra-articular derangements. Its role has been studied extensively in the shoulder, but it also has been explored in the hip, elbow, knee, wrist and ankle. This article reviews the current role of direct MR arthrography in several major joints, with consideration of pertinent anatomy, techniques and applications.     

The diagnostic performance of non-contrast 3-Tesla magnetic resonance imaging (3-T MRI) versus 1.5-Tesla magnetic resonance arthrography (1.5-T MRA) in femoro-acetabular impingement

ObjectiveThe aim of this study was to evaluate the diagnostic accuracy of 3-T non-contrast MRI versus 1.5-T MRA for assessing labrum and articular cartilage lesions in patients with clinical suspicion of femoro-acetabular impingement (FAI).Subjects and methodsFifty patients (thirty men and twenty women, mean age 42.5 years) underwent 1.5-T MRA, 3-T MRI and arthroscopy on the same hip. An optimized high-resolution proton density spin echo pulse sequence was included in the 3-T non-contrast MRI protocol.ResultsThe 3-T non-contrast MRI identified forty-two of the forty-three arthroscopically proven tears at the labral-chondral transitional zone (sensitivity, 97.7%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 87.5%; accuracy 98%). With 1.5-T MRA, forty-four tears were diagnosed. However, there was one false positive (sensitivity, 100%; specificity, 85.7%; PPV, 97.7%; NPV, 100%; accuracy 98%).Agreement between arthroscopy and MRI, whether 3-T non-contrast MRI or 1.5-T MRA, as to the degree of chondral lesion in the acetabulum was reached in half of the patients and in the femur in 76% of patients.ConclusionNon-invasive assessment of the hip is possible with 3-T MR magnet. 3-T non-contrast MRI could replace MRA as the workhorse technique for assessing hip internal damage. MRA would then be reserved for young adults with a strong clinical suspicion of FAI but normal findings on 3-T non-contrast MRI.When compared with 1.5-T MRA, optimized sequences with 3-T non-contrast MRI help in detecting normal variants and in diagnosing articular cartilage lesions.     

MR arthrography for evaluation of the acetabular labrum

MR arthrography of the hip has provided new insights into the lesions underlying mechanical hip pain. Until now evaluation of these structures, especially the acetabular labrum, has been limited. With the joint distention provided by MR arthrography, labral detachments and intrasubstance tears can be identified and differentiated from the many varied appearances of the asymptomatic labrum. This article reviews the normal anatomy of the hip, the clinical presentation of internal derangement and the technique for performing MR arthrography. The variations in morphology and signal of the asymptomatic labrum are reviewed as well as the appearance of the abnormal labrum. Received: 16 January 2001 Revision requested: 21 January 2001 Revision received: 19 April 2001 Accepted: 19 April 2001     

The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis

Objectives  

Magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) have been advocated for the diagnosis of acetabular labral tears. The purpose of this study was to determine the sensitivity and specificity of MRI and MRA in diagnosing acetabular labral tears using meta-analysis.