能谱CT单能量成像在减少腰椎内固定术后金属伪影的临床价值

目的 探讨宝石CT能谱成像在减少腰椎椎弓根螺钉内固定术后金属伪影方面的临床价值.方法 选取20例带有腰椎椎弓根钉棒系统的患者行宝石能谱CT扫描后用能谱分析软件每隔10 keV重建40～140 keV单能量图像,每组图像中选取螺纹钉伪影影响最大平面下腔静脉内感兴趣区A及同一椎体平面无或少受金属伪影影响层面下腔静脉内感兴趣区B,测量相应部位、相同面积CT值及CT标准差(SD)值,记录数据为ROIa、ROIb,采用配对t检验比较A与B感兴趣区的CT值,最小显著差(LSD)t检验比较CTa-CTb.进一步行混合能量图像、最佳单能谱图像客观、主观指标评价:①测量椎弓根螺钉前端最明显放射状伪影的长度,使用配对t检验.②由2位有经验的放射医师肉眼观察评估伪影等级.结果 在120 keV单能量图像A、B层面CT值差异最小(t=1.965,P＞0.05),且与混合能量及其他10组单能量两两比较CTa-CTb差异均有统计学意义(P均＜0.05),故以120 keV作为最佳单能量与混合能量图像比较,最佳单能量图像金属椎弓根螺钉前端的放射状伪影长度明显减少(t=8.914,P＜0.05),主观评级单能量图像质量亦优于混合能量的图像质量(t=7.768,P=0.000＜0.05).结论 宝石CT能谱成像能显著减少腰椎椎弓根螺钉内固定术后金属伪影,120 keV为图像质量最佳的单能量成像点.     

冠状动脉能谱CT单能量成像与混合能量成像质量的比较——静态模型的实验研究

目的通过模拟冠状动脉静态模型分析比较能谱CT宝石能谱成像(GSI)与混合能量成像的图像质量。材料与方法采用模拟冠状动脉静态体模,体模内共3支相同的模拟冠状动脉,管腔内斑块采用人造混合斑块(120 kVp下CT值约60.0～148.6 HU)伴有三种不同程度狭窄(25%、50%及75%)。在3支模拟冠状动脉内分别注入3种不同浓度的对比剂进行扫描,模型内对比剂碘浓度由低到高依次为6.25 mgI/ml、7.89 mgI/ml、14.06 mgI/ml,分别将其定为A、B、C组。采用GE Discovery CT 750 HD扫描仪,采集120 kVp下的混合能量模式(包括混合能量标准扫描和混合能量高清扫描标准重组)及GSI能谱扫描模式;每支模拟冠状动脉分别在每种狭窄处选取4个层面的感兴趣区进行测量,分别测量管腔内CT值、模拟斑块的CT值及背景噪声,计算各层面的对比噪声比(con-trast-to-noise ratio,CNR)。同时由两名专业影像医师根据图像显示情况对感兴趣区的轴位及冠状重组图像进行评分。通过CNR及主观评分的比较评价冠状动脉的图像质量。结果比较GSI序列40～140 keV图像的CNR,A～C组均在50～60 keV具有较好的CNR,比较60 keV单能量图像与混合能量图像不同狭窄率条件下A～C组CNR,除A组浓度25%及75%狭窄率的CNR间比较没有统计学差异,B、C组浓度单能量60 keV扫描模式CNR值均高于混合能量扫描模式,其差异有统计学意义。比较不同狭窄率条件下A～C组图像质量的主观评分,60 keV单能量图像与混合能量图像相比,在对比剂浓度较低时(A组及B组)其评分均高于混合能量图像,其差异有统计学意义,而对比剂浓度相对较高的C组内50%及75%狭窄率的GSI 60 keV单能量图像与混合能量模式图像比较图像质量评分无统计学差异性。结论冠状动脉狭窄模型运用宝石能谱CT扫描,在60 keV时能够获得最佳图像质量,优化图像的CNR,较冠状动脉常规混合能量扫描模式具有更好的图像质量。     

A Comparative Study on Simulated Coronary Artery with Artificial Plaques with Gemstone Spectral Imaging and Conventional Polychromatic X-ray Imaging

目的 通过模拟冠状动脉静态模型分析比较能谱CT宝石能谱成像(GSI)与混合能量成像的图像质量.材料与方法 采用模拟冠状动脉静态体模,体模内共3支相同的模拟冠状动脉,管腔内斑块采用人造混合斑块(120 kVp下CT值约60.0-148.6 HU)伴有三种不同程度狭窄(25％、50％及75％).在3支模拟冠状动脉内分别注入3种不同浓度的对比剂进行扫描,模型内对比剂碘浓度由低到高依次为6.25 mgI/ml、7.89 mgI/ml、14.06 mgI/ml,分别将其定为A、B、C组.采用GE Discovery CT 750 HD扫描仪,采集120kVp下的混合能量模式(包括混合能量标准扫描和混合能量高清扫描标准重组)及GSI能谱扫描模式;每支模拟冠状动脉分别在每种狭窄处选取4个层面的感兴趣区进行测量,分别测量管腔内CT值、模拟斑块的CT值及背景噪声,计算各层面的对比噪声比(contrast -to-noise ratio,CNR).同时由两名专业影像医师根据图像显示情况对感兴趣区的轴位及冠状重组图像进行评分.通过CNR及主观评分的比较评价冠状动脉的图像质量.结果 比较GSI序列40～140 keV图像的CNR,A～C组均在50～60 keV具有较好的CNR,比较60 keV单能量图像与混合能量图像不同狭窄率条件下A～C组CNR,除A组浓度25％及75％狭窄率的CNR间比较没有统计学差异,B、C组浓度单能量60 keV扫描模式CNR值均高于混合能量扫描模式,其差异有统计学意义.比较不同狭窄率条件下A～C组图像质量的主观评分,60 keV单能量图像与混合能量图像相比,在对比剂浓度较低时(A组及B组)其评分均高于混合能量图像,其差异有统计学意义,而对比剂浓度相对较高的C组内50％及75％狭窄率的GSI 60 keV单能量图像与混合能量模式图像比较图像质量评分无统计学差异性.结论 冠状动脉狭窄模型运用宝石能谱CT扫描,在60 keV时能够获得最佳图像质量,优化图像的CNR,较冠状动脉常规混合能量扫描模式具有更好的图像质量.     

能谱CT和MRI在手肌腱病变中的应用

目的：初步探讨能谱CT的宝石能谱成像（gemstone spectral imaging,GSI）模式和MRI在手肌腱正常解剖以及基本病变中的应用。方法：30例手肌腱病变患者,手肌腱正常,因其他疾病需手部CT扫描者5例作为解剖对照,分别行GSI和MRI检查,通过能谱分析软件,选择适宜单能量值（KeV）,将混合能量图像转换为单能量图像,运用多种图像重组方式,观察能谱CT图像,并和MRI对照分析。结果：GSI能显示肌腱的形态,连续走行,止点,特别在显示肌腱,骨骼,肌肉的三维空间关系上,较MRI有优势。对于肌腱断裂,增粗,缺失,受压的显示,GSI与MRI比较,,差异无统计学意义（P〉0.05）。对肌腱粘连、变性、腱鞘病变的显示不如MRI清晰,差异有统计学意义（P〈0.05）。结论：宝石能谱CT在手部肌腱解剖及病变显示方面有较大应用价值,能为临床提供有力的影像学支持;而MRI在肌腱变性、粘连及腱鞘病变中,优势明显。     

CT能谱成像用于减少锁骨下对比剂伪影的临床研究

目的:寻找CT能谱成像的最佳能量点以减少肺部增强CT扫描锁骨下腋静脉和锁骨下静脉对比剂伪影,并改善图像质量。方法:共66名病人接受能谱CT扫描。一次能谱成像获得12组图像:140kVp混合能量图像和11组单能量图像(40～140keV)。比较混合能量和单能量图像在肺部增强CT动脉期的伪影区噪声、信噪比(SNR)、对比噪声比(CNR)和平均线束硬化伪影指数(BHAs)。BHAs是感兴趣区和背景区噪声平方差的平方根。结果:与常规混合能量组相比,120keV可最大程度地减少硬化伪影(P=0.000),同时SNR、CNR明显减小,导致软组织对比度明显减低。70keV可以减小硬化伪影(P=0.042),且SNR、CNR最高,优于混合能量图像和其他单能量图像,而伪影区噪声减低,图像质量最好。结论:在肺部增强扫描中,120keV去除对比剂硬化伪影的能力优于混合能量图像及其他单能量图像,但是组织对比度较差,可以结合70keV图像共同进行诊断。     

双源CT单能量成像对肝癌检出影响的初步研究

目的 探索显示肝癌病灶对比噪声比(CNR)和图像质量的最佳keV条件,并与融合能量图像比较,探讨能谱CT单能量成像对肝癌检出的影响.方法 回顾性分析经双源CT双能量双期扫描的30例肝癌患者影像学表现.采用双源分析软件处理产生单能量(40～140 keV,间隔10 keV)图像,测定单能量图像、100 keV和140 keV图像中病灶的CNR和图像噪声.优化单能量图像中检测肝癌的最佳CNR值和图像噪声值.通过两相关样本的非参数秩和检验的方法对单能量图像和混合能量图像的结果进行比较.结果 动脉期图像中所有病灶的最佳CNR的单光子能量水平集中分布在70 keV,所占的比例为81.8％(27/33).图像噪声水平的最低点位于70 keV和80 keV.综合考虑图像质量和病变对比,笔者选择70 keV图像与融合图像进行比较.70 keV单能量图像的CNR与100 keV图像无显著性差异(1.68±1.04,1.88±1.59,P=0.149),>140 keV图像且有显著性差异(1.68±1.04,0.62±0.92,P=0.000).图像噪声<100 keV图像,差异有统计学意(6.52±1.53,8.55±1.11,P=0.000),与140 keV图像差异无统计学意义(6.52±1.53,7.60±2.73,P=0.050).结论 能谱CT 70 keV单能量图像可以在不降低图像质量的前提下有效提高肝癌病灶的CNR,这将有助于病灶的检出.     

宝石CT能谱成像去除脊柱金属植入物伪影的应用研究

目的:探讨宝石CT能谱成像(GSI)在减除脊柱金属植入物伪影的应用价值;同时研究应用能谱曲线寻找最佳keV值的可行性。方法:对6例脊柱金属植入术患者行宝石CT GSI扫描,并以10keV为间隔重建11组单能量(Mono)图像质量的客观指标。通过比较140kVp(QC)和各级别Mono图像的客观指标伪影指数(AI)和对比噪声比(CNR)、软组织和骨质以及金属植入物图像质量的主观评分(4分法,1分图像最优,4分图像最差),寻找GSI去金属伪影最佳成像条件。并以最佳图像为对照,比较利用能谱曲线寻得最佳Mono图像的质量和诊断效能。结果:AI在90~140keV时减低,在100~130keV达最低;CNR在100～120keV时减低且最低。能谱成像技术在90~140keV对软组织、骨质及金属植入物诊断效能提高,在110~130keV对软组织观察最优,在110~140keV对骨质及植入金属观察最优。利用能谱曲线寻得最佳单能量成像条件为100~120keV,范围落在普通方法确定的电压值区间内,其图像均能满足诊断。结论:宝石能谱CT GSI在高电压区可有效减除脊柱金属植入物伪影,最佳成像区间为100~120keV。利用能谱曲线可快速有效获得最佳单能量成像。     

肝癌介入栓塞术前的能谱CT血管成像评估

目的:探讨能谱CT最佳单能量血管成像在肝癌介入栓塞术前评估的进展。方法:分析60例能谱成像增强扫描的动脉早期图像,分别行冠状位CT混合能量图像重建、最佳单能量血管重建。采用能谱分析软件处理后可产生常规混合能量(140kVp)的图像(方案A)和最佳单能量(50～70kVp)图像(方案B)。分别对两种重建图像中肿瘤周围的肝动脉分级评分,通过配对t检验的方法两种方案中的结果进行比较。结果:最佳单能量血管重建图像同混合能量血管重建图像两种方法在评价肝肿瘤动脉供血分级显示中存在显著性差异(t=28.74,P<0.001),能谱CT最佳单能量血管成像对于肿瘤的动脉血管评估优于混合能量成像。结论:能谱CT最佳单能量成像作为一种术前评估的方法,可以在不降低图像质量的前提下显著提高肝肿瘤血管的噪声比,有利于感兴趣区小血管的检出。     

宝石能谱CT显示肌腱的最佳单能量

目的：寻求宝石能谱CT显示肌腱的最佳kev单能量。方法：对从2010年10月至今来我院行手足部能谱CT扫描的患者,同时进行健患侧对比扫描,随机抽取30例,选取健侧手足肌腱,应用能谱分析软件,寻求显示肌腱与周围组织（肌肉）最佳对比噪声比（contrast-to-noise ratio,CNR）的合适kev单能量。结果：肌肉与肌腱65kev的单能图像具有最高的CNR。结论：65kev单能量是显示肌腱的最佳单能量。     

能谱CT单能量技术联合ASIR及ASIR-V改善胸部增强CT图像质量的研究

目的探讨应用能谱CT最佳单能量成像联合ASIR及ASIR-V重建技术对胸部CT增强扫描动脉期图像质量的优化。方法搜集行胸部增强能谱CT检查的62例患者资料,使用能谱GSI模式进行扫描并重建,在传统重建模式(FBP)重建下,以间隔10 keV为一组重建出40~140 keV的11组单能量(MONO)图像,与140 kVp混合能量(QC)图像共组成12组图像。对12组图像的CNR、BHA采用单因素方差分析进行统计,并采用秩和检验分析其主观评分。得出能谱CT成像中伪影较小且图像质量较高的单能量图像。将其单能量图像分别与30%、50%、70%水平的ASIR及ASIR-V进行重建,得到6组新重建模式下的单能量图像,将其与FBP重建下QC及此单能量图像共组成8组图像并使用较前相同的统计学方法对其主观及客观评价进行分析比较。结果在FBP重建下,80 keV图像的CNR值为7.7±2.0,与QC图像无统计学差异(P>0.05);血管处的BHA值为44.4±22.0,低于QC图像(P<0.05);图像质量主观评分为4.50±0.62,与QC图像无差异(P>0.05);伪影主观评分为2.45±0.62,低于QC图像(P<0.05);具有较低的伪影水平并保持了较好的图像质量。因此选取80 keV做为最佳单能量值进行下一步研究。80 keV联合50%ASIR-V的CNR值为13.9±4.3,高于QC图像(P<0.05);BHA值与其他组差异无统计学意义;图像质量主观评分为4.90±0.298,高于其他组(P<0.05)。结论与常规胸部增强扫描动脉期图像相比,能谱CT 80 keV单能量联合50%ASIR-V图像能够减低对比剂硬化伪影,同时提高图像质量,可常规应用于胸部CT增强扫描。     

Preliminary Application of High-Definition CT Gemstone Spectral Imaging in Hand and Foot Tendons

Objective

To assess the feasibility of visualizing hand and foot tendon anatomy and disorders by Gemstone Spectral Imaging (GSI) high-definition CT (HDCT).

Materials and Methods

Thirty-five patients who suffered from hand or foot pain were scanned with GSI mode HDCT and MRI. Spectrum analysis was used to select the monochromatic images that provide the optimal contrast-to-noise ratio (CNR) for tendons. The image quality at the best selected monochromatic level and the conventional polychromatic images were compared. Tendon anatomy and disease were also analyzed at GSI and MRI.

Results

The monochromatic images at about 65 keV (mean 65.09 ± 2.98) provided the optimal CNR for hand and foot tendons. The image quality at the optimal selected monochromatic level was superior to conventional polychromatic images (p = 0.005, p < 0.05). GSI was useful in visualizing hand and foot tendon anatomy and disorders. There were no statistical differences between GSI and MRI with regard to tendon thickening (χ² = 0, p > 0.05), compression (χ² = 0.5, p > 0.05), absence (χ² = 0, p > 0.05) and rupture (χ² = 0, p > 0.05). GSI was significantly less sensitive than MRI in displaying tendon adhesion (χ² = 4.17, p < 0.05), degeneration (χ² = 4.17, p < 0.05), and tendinous sheath disease (χ² = 10.08, p < 0.05).

Conclusion

GSI with monochromatic images at 65 keV displays clearly the most hand and foot tendon anatomy and disorders with image quality improved, as compared with conventional polychromatic images. It may be used solely or combined with MRI in clinical work, depending on individual patient disease condition.     

The pilot study of dual-energy CT gemstone spectral imaging on the image quality of hand tendons

PurposeThe aim of this study was to evaluate the image quality of hand tendons using dual-energy computed tomographic gemstone spectral imaging (DECT GSI) compared with conventional CT images.Materials and methodsForty patients scanned with GSI mode on DECT were enrolled. The 65-keV optimal contrast-to-noise ratio for viewing hand tendons was selected. The image quality of monochromatic GSI images (65 keV) and conventional CT images was compared with two different methods including a subjective method and an objective method by two radiologists, respectively.ResultsIn the subjective method, the image quality in GSI images was superior to conventional CT images (P< .05). And in the objective method, the beam-hardening artifacts in the phalanges of finger space were reduced markedly, with hand tendons displaying more clearly in GSI images (P< .05). There was no significant difference between the two radiologists in both methods, with good correlation (kappa=0.75, kappa=0.85).ConclusionDECT GSI with the optimal 65-keV monochromatic images could reduce the artifacts and increase image quality significantly in hand tendons imaging. It might be very useful in detecting tendon diseases in routine work.     

Magnetic resonance imaging of hindfoot involvement in patients with spondyloarthritides: comparison of low-field and high-field strength units

OBJECTIVE: To compare MRI evaluation of a painful hindfoot of patients with spondyloarthritides (SpA) on low-field (0.2 T) versus high-field (1.5 T) MRI. MATERIALS AND METHODS: Patients with SpA and hindfoot pain were randomly referred to either high-field or low-field MRI. Twenty-seven patients were evaluated (male/female: 17:10; mean age: 39+/-1.4 years). Fifteen patients were examined by low-field and 12 by high-field MRI. Two patients (evaluated by high-field MRI) were excluded. Images were separately read by two radiologists who later reached a consensus. In each patient the prevalence of erosions, fluid, synovitis or bone marrow edema of the hindfoot joints, tendinosis or tenosynovitis of tendons, enthesitis of the plantar fascia and Achilles tendon and retrocalcaneal bursitis were recorded. Clinical and demographic parameters were comparable between both groups. RESULTS: MRI evaluation of joints and tendons of the hindfoot revealed no significant differences in patients with SpA groups for all parameters. Analyzing all joints or tendons together, there was no statistically significant difference between the two groups. CONCLUSION: Low-field and high-field MRI provide comparable information for evaluation of inflammatory hindfoot involvement. Thus, low-field MRI can be considered as a reliable diagnostic tool for the detection of hindfoot abnormalities in SpA patients.     

高山滑雪运动踝关节急性期损伤MRI表现

目的:探讨高山滑雪运动(AS)踝关节急性期损伤MRI特点。方法:搜集27例AS运动踝关节急性损伤患者(共29个踝关节损伤)作为实验组;随机选取30例普通外伤踝关节患者(共30个踝关节损伤)作为对照组。采用3.0T MRI和相控阵线圈进行踝关节扫描。由2名放射科主治医师评估膝关节骨、软骨、韧带、肌腱等损伤。结果:实验组多结构联合损伤29(100%)个;对照组多结构联合损伤24(80.00%)个。MRI显示实验组内踝、外踝、胫骨滑车、距骨、跟骨、舟骨、骰骨挫伤/骨折分别为14、12、12、17、15、13、14个,对照组分别为7、5、5、9、8、6、6个;实验组内侧胫距关节软骨、外侧胫骨关节软骨、距下关节软骨、距跟舟关节软骨、距骰关节软骨损伤分别为16、15、14、12、13个,对照组分别为8、6、7、5、5个;实验组三角韧带、距腓前韧带、距腓后韧带、跟腓韧带、下胫腓前韧带、下胫腓后韧带损伤分别为16、17、13、16、15、12个,对照组分别为8、9、6、9、7、5个;实验组拇长屈肌肌腱、趾长屈肌肌腱、胫骨后肌肌腱、腓骨长短肌肌腱、拇长伸肌肌腱,趾长伸肌肌腱、胫骨前肌肌腱损、跟腱损伤分别为14、15、14、14、14、13、14、15个,对照组分别为7、7、6、7、6、6、7、8个。两组损伤发生率差异具有统计学意义(P均<0.05)。实验组关节软骨损伤0、Ⅰ、Ⅱ、Ⅲ、Ⅳ级分别为75、33、16、11、10个,对照组分别为119、12、7、6、6个;实验组韧带损伤0、Ⅰ、Ⅱ、Ⅲ级分别为68、58、31、17个,对照组分别为124、31、13、12个;实验组肌腱损伤0、Ⅰ、Ⅱ、Ⅲ级分别为105、82、31、14个,对照组分别为171、45、15、9个。两组损伤程度差异具有统计学意义(P均<0.001)。实验组常见多个解剖部位、多发性骨挫伤/骨折,而对照组常见直接撞击部位的骨挫伤/骨折。实验组关节软骨常表现≥Ⅱ级损伤,而对照组软骨损伤常表现Ⅰ级损伤。实验组多表现为多条韧带联合损伤,以Ⅱ级损伤居多;对照组以单条韧带损伤为主,以Ⅰ级损表现居多。实验组常表现多条肌腱Ⅰ级损伤,对照组常表现单条Ⅰ级损伤。结论:滑雪运动踝关节损伤为骨髓、软骨、韧带及肌腱的联合损伤,正确认识滑雪运动踝关节急性期损伤的MRI表现,对早期诊断、踝关节功能恢复有重要意义。     

Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis

Objective The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis.Design and patients We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0–3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis.Results Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7, respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.Conclusion Enhanced MR imaging of the hand and wrist is a superior technique for detection of tenosynovitis. We observed carpal tunnel flexor tendons to be the most frequently affected tendons of the wrist. The flexor tendons of the second and third digits were the most frequently affected tendons of the hands. Higher contrast-enhancement scores and inflammation were noted in the hand flexor than in the extensor tendons.     

Magnetic resonance imaging of tendon and ligament abnormalities: Part II. Pelvis and lower extremities

Magnetic resonance imaging (MRI) has provided an ideal means, unmatched by other preexisting modalities, of examining musculoskeletal abnormalities, particularly those involving tendons and ligaments in the lower extremities. Lack of motion artifact, convenience of application of surface coil, and absence of overlying structures have made the lower extremities ideally suited to MRI. In addition, the abundance of adjacent adipose tissue provides a superb contrast background. Although evaluation of trauma remains the most common reason for MRI examination, many other conditions may also affect tendons and ligaments. As in other soft-tissue, chondral, and osteochondral lesions, MRI provides exquisite details of abnormalities in these structures. Part II of this review systematically reviews the abnormalities of tendons and ligaments in the pelvis and lower extremities.     

肱骨上髁炎的磁共振诊断价值

目的：评价磁共振成像（MRI）在肱骨内、外上髁炎的诊断价值。方法：回顾分析12例肱骨内、外上髁炎病变患者的MRI图像。部分患者与关节手术对照。结果：12例患者中,1例同时患有内、外上髁炎;余11例中,内上髁炎1例,外上髁炎10例;10例外上髁炎显示伸肌总腱增粗,其内不规则高信号,伴或不伴周围程度水肿,其中2例可见肱骨外上髁局部信号异常,1例伴外侧副韧带部分撕裂;2例内上髁炎显示屈肌总腱增粗,伴有信号增高,肱骨内上髁未见明显异常。结论：MRI能显示肌腱的急慢性损伤,显示骨髓水肿,同时,MRI有助于正确诊断和了解较为复杂的肘关节损伤。     

Validity and reliability of measurements of aponeurosis dimensions from magnetic resonance images

Muscle performance is closely related to the structure and function of tendons and aponeuroses, the sheet‐like, intramuscular parts of tendons. The architecture of aponeuroses has been difficult to study with magnetic resonance imaging (MRI) because these thin, collagen‐rich connective tissues have very short transverse relaxation (T2) times and therefore provide a weak signal with conventional MRI sequences. Here, we validated measurements of aponeurosis dimensions from two MRI sequences commonly used in muscle‐tendon research (mDixon and T1‐weighted images), and an ultrashort echo time (UTE) sequence designed for imaging tissues with short T2 times. MRI‐based measurements of aponeurosis width, length, and area of 20 sheep leg muscles were compared to direct measurements made with three‐dimensional (3D) quantitative microdissection. The errors in measurement of aponeurosis width relative to the mean width were 1.8% for UTE, 3.7% for T1, and 18.8% for mDixon. For aponeurosis length, the errors were 7.6% for UTE, 1.9% for T1, and 21.0% for mDixon. Measurements from T1 and UTE scans were unbiased, but mDixon scans systematically underestimated widths, lengths, and areas of the aponeuroses. Using the same methods, we then found high inter‐rater reliability (intraclass correlation coefficients >0.92 for all measures) of measurements of the dimensions of the central aponeurosis of the human tibialis anterior muscle from T1‐weighted scans. We conclude that valid and reliable measurements of aponeurosis dimensions can be obtained from UTE and from T1‐weighted scans. When the goal is to study the macroscopic architecture of aponeuroses, UTE does not hold an advantage over T1‐weighted imaging.