半月板桶柄样撕裂的MRI表现

目的 探讨半月板桶柄样撕裂的MRI征象. 资料与方法 对经关节镜证实的半月板桶柄样撕裂56例(58侧)患者的MRI表现进行研究. 结果 领结残破征21膝,空领结征28膝,双前交叉韧带征6膝,双后交叉韧带征19膝,双半月板前角征11膝,前角异常肥大征5膝,双半月板后角征16膝,后角异常肥大7膝,后角残破征19膝,厚饼征6膝,半月板分离移位征53膝.合并膝关节囊积液58膝、股骨(或胫骨)挫伤36膝、内侧副韧带损伤6膝、前交叉韧带损伤5膝、后交叉韧带损伤9膝、关节软骨损伤13膝、骨梗死2膝. 结论 空(残)领结征、后角残破征、双后交叉韧带征及半月板分离移位征提示半月板桶柄样撕裂.     

MRI诊断膝关节半月板桶柄状撕裂

目的:总结分析半月板桶柄状撕裂的MRI征象和诊断价值.方法:回顾性分析146个经关节镜证实的膝关节MR图像,其中28个膝关节存在半月板桶柄状撕裂,记录如下5种MRI征象:碎块内移征、外周残半月板征、双PCL征、空领结征及双前角征,并分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、准确度、阳性预测值和阴性预测值.结...     

MRI评价膝关节半月板的桶柄状撕裂

目的 明确5种MRI征象对膝关节半月板桶柄状撕裂的诊断价值。方法 回顾135例患者139个经关节镜证实的膝关节MR图像，其中19个存在半月板桶柄状撕裂。在均不告知关节镜结果的条件下，由2名有经验的放射医生对所有图像进行独立读片，差异协商解决。每个膝关节均记录如下5种MRI征象：双后交叉韧带征(双PCL征)、半月板翻转征、空领结征、碎块内移征和外周残半月板征。分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果 5种征象的诊断敏感度分布于52．6％和89．5％之间，特异度分布于83．3％和98．3％之间，阳性预测值分布于42．9％和88．2％之间，阴性预测值分布：于92．7％和98．3％之间，准确度分布于82．7％和96．4％之间。“碎块内移征”和“外周残半月板征”的诊断敏感度最高，“双PCL征”的诊断特异度和阳性预测值最高，而“碎块内移征”具有最高的阴性预测值和诊断准确度。结论 半月板桶柄状撕裂在MRI上可以有多种表现，各种征象对诊断的能力有所不同。     

膝关节半月板桶柄样撕裂的MRI表现

目的 探讨膝关节半月板桶柄样撕裂的MRI特征.方法 搜集经手术或关节镜证实的膝关节半月板桶柄样撕裂56例,回顾性分析其MRI表现,总结MRI特征.结果 56例半月板桶柄样撕裂中,内侧半月板34例,外侧半月板22例,半月板碎块移位征42例,阳性率75%(42/56);双前(后)交叉韧带征36例,阳性率64.3%(36/56);半月板翻转征30例,阳性率53.6%(30/56);半月板双前角征24例,阳性率42.9%(24/56);领结缺如征39例,阳性率69.6%(39/56);外周残半月板征41例,阳性率73.2%(41/56).结论 膝关节半月板桶柄样撕裂具有典型的MRI特征,MRI对其诊断具有重要价值.     

MRI检查膝关节半月板桶柄样撕裂的临床价值分析

目的探讨MRI在膝关节半月板桶柄样撕裂诊断中的临床应用价值。方法对我院经关节镜证实为膝关节半月板损伤患者62例进行MRI检查。结果双前角征、髁间碎片征、双后交叉韧带征、领结消失征等四个征象对内侧半月板桶柄样撕裂的诊断敏感性分别为61.54%、92.31%、38.46%、76.92%,特异性均为100.00%。双前角征、髁间碎片征、双后交叉韧带征、领结消失征等四个征象对外侧半月板桶柄样撕裂的诊断敏感性分别为23.53%、47.06%、0.00%、70.59%。在28例膝关节半月板桶柄样撕裂中,有22例在MRI上出现了两种以上的征象,总体诊断敏感性为78.57%。对比分析发现内侧半月板桶柄样撕裂在双前角征、髁间碎片征、双后交叉韧带征等征象下诊断敏感性明显高于外侧半月板,且差异具有统计学意义。髁间碎片征是诊断内侧半月板桶柄样撕裂敏感性最高的征象(92.31%),特异性达100.00%。结论 MRI是诊断膝关节半月板桶柄样撕裂的有效方法,其对内侧半月板桶柄样撕裂的敏感性及特异性较外侧高,髁间碎片征对诊断内侧半月板桶柄样撕裂的来说最具价值,而外侧半月板桶柄样撕裂则很难利用该征象进行确诊。双前角征在诊断外侧半月板桶柄样撕裂时敏感性低,特异性高,而领结消失征则是敏感性高,特异性低,仅能作为诊断参考。     

MRI对膝关节半月板桶柄样撕裂的诊断价值

目的　评价MRI诊断膝关节半月板桶柄样撕裂的应用价值。方法　经关节镜证实的 2 1例的桶柄样撕裂患者及 11例非桶柄样撕裂患者。采用百胜公司的关节专用磁共振成像系统进行扫描。观察以下 4种MRI征象 ,双前角征 ,双后交叉韧带征 ,髁间碎片征及领结消失征。结果　 3 2例患者中 ,出现双前角征的有 10例 ,双后交叉韧带征 5例 ,髁间碎片征 2 0例 ,领结消失征 2 5例。结论　MRI是诊断半月板桶柄样撕裂的有效手段 ,内侧半月板桶柄样撕裂的敏感性及特异性较外侧高 ,髁间碎片征是诊断内侧半月板桶柄样撕裂最有价值的征象     

前后交叉韧带及半月板损伤的MDCT与关节镜的对比研究

目的探讨多层螺旋CT在膝关节外伤中前后交叉韧带与半月板损伤的诊断价值。方法回顾性分析45例经膝关节镜证实的前后交叉韧带和半月板损伤的多层螺旋CT直接征象和间接征象。结果前后交叉韧带损伤的直接征象表现为韧带断裂、密度欠均匀,韧带附着点撕脱性骨折,间接征象表现为韧带肿胀,周围脂肪间隙模糊欠清;半月板损伤的MDCT直接征象是形态失常、密度不均匀及裂隙征,间接征象是膝关节滑膜增厚、关节囊关节腔内积液、损伤的半月板周围软组织肿胀等。45例患者中,MDCT显示前交叉韧带损伤14例(14/20),后交叉韧带损伤11例(11/15),内侧半月板损伤8个(8/12),外侧半月板损伤12个(12/20),交叉韧带与半月板同时损伤10例,韧带附着点及胫骨平台骨折18例。结论多层螺旋CT在膝关节外伤中的前后交叉韧带及半月板的损伤有一定的诊断价值,可为缺少磁共振设备的基层医院提供一有用的检查方法。     

膝关节外侧半月板后根部撕裂的MRI评价

目的:评价MRI对膝关节外侧半月板后根部撕裂的诊断价值,以提高对该病的认识,为临床诊疗提供帮助。方法:回顾性分析16例经关节镜或手术证实的外侧半月板后根部撕裂患者的MRI资料;在MRI冠状位、矢状位及横断位上评价外侧半月板后根部撕裂的直接征象及伴随征象;对冠状位"裂隙征"、矢状位"幽灵征"及横断位"裂隙征"的发生率行Fisher确切概率法检验,以P0.05为差异有统计学意义。结果:外侧半月板后根部撕裂冠状位"裂隙征"15例,矢状位"幽灵征"14例,横断位"裂隙征"4例;冠状位"裂隙征"与矢状位"幽灵征"发生率比较差异无统计学意义(P 0.05),冠状位"裂隙征"与横断位"裂隙征"显示率比较差异有统计学意义(P0.05),矢状位"幽灵征"与横断位"裂隙征"发生率比较差异有统计学意义(P0.05)。伴随征象中外侧半月板突出5例(5/16);外侧半月板后根部附着处软骨下骨水肿3例(3/16);胫骨外侧关节软骨损伤4例(4/16);合并外侧半月板其他节段撕裂4例(4/16);合并前交叉韧带撕裂6例(6/16),后交叉韧带撕裂1例(1/16),板股韧带缺失7例(7/16),其中外侧半月板突出5例中,4例板股韧带缺失或显示不清;合并胫骨平台骨折6例。结论:外侧半月板后根部撕裂MRI表现具有特征性;MRI对评价外侧半月板后根部撕裂具有重要价值。     

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。     

急性前交叉韧带撕裂患者股骨外侧髁切迹征与半月板撕裂的关系

目的:探讨MRI显示急性前交叉韧带撕裂患者异常加深的股骨外侧髁压迹与半月板撕裂间的关系。方法 :选取180例急性膝关节外伤行MRI检查诊断为前交叉韧带撕裂的患者,测量股骨外侧髁压迹的深度,观察内、外侧半月板撕裂情况。统计分析股骨外侧髁切迹征(深度 2 mm)与半月板撕裂的关系。结果:180例中,48例股骨外侧髁切迹征阳性,其中外侧半月板撕裂19例(39.58%),内侧半月板撕裂9例(18.75%),内、外侧半月板同时撕裂2例(4.17%);132例股骨外侧髁切迹征阴性,其中外侧半月板撕裂4例(3.03%),内侧半月板撕裂7例(5.30%)。股骨外侧髁切迹征合并外侧半月板撕裂比例高于合并内侧半月板撕裂(P=0.025)。股骨外侧髁切迹征合并内、外侧半月板撕裂比例均明显高于阴性患者(P=0.005,P=0.000)。结论:股骨外侧髁切迹征是前交叉韧带断裂的间接征象,与外侧半月板撕裂密切相关。     

Meniscal bucket handle tears: a retrospective study of arthroscopy and the relation to MRI

In this study, we aim to evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Thirty-six patients who had a diagnosis of bucket handle tear in arthroscopy, in either medial or lateral meniscus, were included in our study (32 males and 4 females). Meniscal tears were evaluated in arthroscopy according to Dandys classification. The MRIs were retrospectively analyzed regarding the following findings: absence of bow tie sign, presence of double posterior cruciate ligament (PCL) sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign, and fragment within the intercondylar region. Locked types I and II fragment of medial meniscus and half-length, whole-width and whole length–half-width fragment of lateral meniscus in arthroscopy were basically correlated with fragment within the intercondylar notch and absent bow tie signs in MRI. We did not find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear. The most common signs in MR images of meniscal bucket handle tears were the fragment in the notch sign and the absent bow tie sign. They were observed with equal frequency of 88.8%. The presence of double PCL sign, double anterior horn sign, flipped meniscus sign, disproportional posterior horn sign were less common (41.66, 33, 25, and 27.7%, respectively). We conclude that the presence of at least two of the six MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.     

Pitfalls and limitations of Magnetic Resonance Imaging in bucket-handle tears of knee menisci

PURPOSE: The aim of the present study was to assess the accuracy of magnetic resonance imaging (MRI) in the diagnosis of bucket-handle tears of the knee menisci, determining the sensitivity and specificity of the imaging for each of the signs typical of these tears. MATERIALS AND METHODS: MR examinations of 495 patients suffering from knee traumas were assessed retrospectively. Forty-eight patients had arthroscopically-proven bucket-handle tears of the meniscus. MR examinations were performed using a 0.5-T superconducting magnet, with T1-weighted spin-echo (SE) and gradient-echo (GE) T2*-weighted sequences. Imaging findings used for the diagnosis were: a) double posterior cruciate ligament sign; b) flipped meniscus sign; c) presence of a displaced fragment of the meniscus in the intercondylar notch, visible in coronal and axial images; d) truncated triangular shape of the peripheral non-displaced portion of the meniscus, visible in coronal images. RESULTS: A total of 43 out of 48 bucket-handle tears of the meniscus were correctly diagnosed at MR, thus overall MR accuracy was 98%. In 12 (28%) cases three signs were present simultaneously the double posterior cruciate ligament (sensitivity 28%, specificity 99%, accuracy 93%) + the displaced fragment in the intercondylar notch (sensitivity 69.8%, specificity 98.7%, accuracy 96.2%) + the truncated triangular shape of the peripheral portion of the meniscus (sensitivity 74.4%, specificity 98%, accuracy 96%). In 18 (42%) cases two signs were present together the displaced fragment of the meniscus + the truncated triangular shape of the peripheral portion of the meniscus. In 13 (30%) cases only one sign was presenting two cases the truncated triangular shape of the peripheral portion of the meniscus and in 11 cases the flipped meniscus sign (sensitivity 25.6%, specificity 93.4%, accuracy 87.5%). No statistically significant differences were found comparing the results for tears of the medial meniscus with those for the lateral meniscus. CONCLUSIONS: MR imaging is highly accurate in diagnosing bucket-handle tears of the menisci due to its ability to identify a displaced fragment of the meniscus in the intercondylar notch or flipped over the anterior horn of the meniscus of origin. We speculate that bucket-handle tears not found by MR imaging are cases where the meniscus was displaced after MR examination.     

Posterior double PCL sign: a case report of unusual MRI finding of bucket-handle tear of medial meniscus

Among the MRI signs of bucket-handle tears of medial meniscus, double posterior cruciate ligament (PCL) sign denotes a low signal band anterior and parallel to the PCL, which looks like another PCL in MR images. If the bucket-handle fragment subsequently tears at the anterior horn, the torn meniscal substance can be displaced to the posterosuperior region of the PCL, and looks like another PCL behind the original PCL. We propose the lesion be called the “posterior double PCL sign” in contrast to the ordinary double PCL sign. We present a case showing the posterior double PCL sign.     

Partial and complete tear of the anterior cruciate ligament

PURPOSE: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. MATERIAL AND METHODS: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). RESULTS: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 degrees +/-20 degrees ) had a tendency to be less than in chronic partial ACL tear cases (119+/-18 degrees ). CONCLUSION: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.     

外伤性膝关节前外侧韧带损伤的MR影像特征及相关性分析

目的探讨外伤所致膝关节前外侧韧带损伤病人的MR影像特征,并分析其与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性,为深入研究前外侧韧带对膝关节稳定性的作用提供可靠依据。方法回顾性分析2016年1月—2017年2月间因外伤进行膝关节MRI检查的320例病人(共321膝)的影像资料。采用美国GE公司生产的Signa HDe 1.5 T MR扫描设备,分别行膝关节斜矢状面T1WI、质子密度加权成像(PDWI)和冠状面、横断面PDWI扫描。根据前外侧韧带的完整性和损伤部位对所有病人进行分类统计。采用独立性卡方检验对前外侧韧带撕裂与前交叉韧带撕裂、外侧半月板撕裂及骨挫伤的相关性进行分析。结果全部病人膝关节MR影像均可显示前外侧韧带,显示率为100%。151/321膝(47.0%;95%CI为41.6%~52.5%)存在前外侧韧带损伤,其中累及胫骨部、股骨部及半月板部的分别为97膝、96膝及65膝。前交叉韧带撕裂158膝,外侧半月板撕裂98膝,股骨外侧髁挫伤58膝,外侧胫骨平台挫伤71膝,分别与前外侧韧带撕裂具有相关性(均P0.001)。结论 MRI检查可以很好地显示前外侧韧带解剖及其损伤情况。膝关节前外侧韧带损伤与前交叉韧带撕裂、外侧半月板撕裂及膝外侧骨挫伤具有相关性。