MRI在膝关节隐匿骨折中的诊断价值

目的：探讨MRI对膝关节隐匿骨折的诊断价值，特别是其MRI的信号特征。方法：使用日立MRP—7000AD(0，3T)水磁型共振仪，分析39例膝关节隐匿骨折的MRI信号特征。结果：常规扫描显示34例，表现为骨髓腔内TlWI低信号，STIR，T2WI高信号；5例微小损伤在反相位GET2WI清晰显示，表现为外周低信号带，中间等、高信号病灶。结论：MRI能清晰显示膝关节骨损伤的范围和程度，应作为膝关节不典型损伤的首选检查方法，在膝关节隐匿骨折的诊断中具有重要诊断价值。     

MRI在膝关节隐匿性骨折伴半月板及韧带损伤诊断价值

目的 分析磁共振成像（MIR）在膝关节隐匿性骨折（Concealed fracture of the knee joint,CF-KJ）伴半月板及韧带损伤（Ligament injury,LI）诊断中的应用价值。方法 选取2021年3月至2023年3月72例于本院接受治疗的疑似CF-KJ伴半月板及LI患者为研究对象,72例患者均进行多层螺旋CT (MSCT)、MRI检查,比较两种检查方法 CF-KJ伴半月板及LI的影像特征、诊断效能以及不同病变的检出率。结果 MSCT检查发现CF-KJ骨折处可见骨小梁变形,存在骨质连续性断裂或伴骨折线影等情况。MRI检查显示CF-KJ骨折处T1WI序列均表现为低信号,T2WI序列则可显示T1WI序列低信号区域的片状高信号区域,或者镶嵌的高信号区域,且相对应的关节面显示为高信号。以手术结果作为金标准,72例患者中65例患者确诊为CF-KJ伴半月板及LI,以此比较两种检查方法的诊断效能,结果显示,与MSCT检查比较,MRI检查的敏感度、准确率均明显升高（P<0.05）;但两种检查方法特异度比较差异不显著（P>0.05）。与MSCT检查比较,MR...     

MRI STIR序列在四肢关节隐匿性骨折中的诊断价值

目的探讨MRISTIR序列在四肢关节隐匿性骨折诊断中的应用价值。方法收集四肢关节隐匿性骨折患者19例行MRI常规SE序列T1WI及T2WI、FFE和STIR-T2WI多序列检查,比较各序列显示隐匿性骨折的差异。结果本组19例隐匿性骨折患者MRI主要表现及检出率分别为：SE序列T1WI检出线样低信号骨折线11例（57.8%）,小片状低信号骨挫伤12例（63.1%）;T2WI检出稍低信号骨折线4例（21.1%）,小片状等高信号骨挫伤1例（5%）;FFE序列检出模糊稍高线样骨折6例（31.5%）,模糊稍高信号小片状影2例（10.5%）,STIR序列检出线样高信号影16例（84.2%）,小片状高信号影19例（100%）。骨挫伤骨髓水肿检出率STIR序列高于SET1WI,SET1WI高于T2WI、FFE系列。结论磁共振STIR序列对四肢关节隐匿性骨折的诊断敏感性较高,特别易于显示以骨挫伤为主要表现的Ⅰ型隐匿性骨折,是明确诊断的最佳序列。     

膝关节隐匿性骨折的MRI诊断价值探讨

目的 探讨膝关节隐匿性骨折的MRI特征和临床应用价值．方法 选择35例膝关节外伤后X线检查阴性但有明显疼痛等症状的患者进行研究，所有患者全部进行MRI检查．重点观察股骨下端、胫腓骨上端及髌骨的骨质信号．前后交叉韧带、内外侧副韧带、内外侧半月板的完整性和信号异常情况。结果 隐匿性骨折的好发部位为：胫骨内外侧平台(14／35)、股骨内外侧髁(I3／35），35例患者中X线检查全部阴性，其中CT检查11例，3例阳性(27％)，MRI检查全部阳性(100％)。结论 MRI是检查隐匿性骨折的最佳影像学方法，对于X线或CT显示正常但又有明显症状的膝关节外伤患者，应做MRI检查，以防漏诊和误诊。     

外伤性腰椎隐匿性骨折诊疗分析

目的应用MRI检查分析治疗前后的腰椎外伤性隐匿性骨折,探讨其治疗方法及诊断标准。方法对外伤后腰椎隐匿性骨折行MRI检查并随机分两组。治疗组73例,以鹿瓜多肽注射液及钙尔奇D等治疗;对照组44例,以钙尔奇D等治疗。结果治疗组的临床症状评分治疗有效率、MRI观察有效率均明显优于对照组,两组比较有显著性差异(P<0.05)。结论MRI检查可减少隐匿性骨折漏诊率;鹿瓜多肽注射液可明显提高隐匿性骨折的疗效。     

低场MRI对膝关节隐匿性骨折的诊断价值

目的:探讨膝关节隐匿性骨折的低场MRI表现特点,评价MRI检查的诊断价值.方法:常规DR及MSCT检查骨质未见明显异常患者126例,膝关节外伤一至三周内行MRI检查,检查序列包括T1WI、T2WI和STIR.结果:126例中共152处膝部隐匿性骨折.T1WI呈不规则、边缘模糊的片状低信号,T2WI呈略高信号,STIR呈明显高信号,可伴有线样异常信号.常伴有韧带等软组织损伤.结论:低场MRI是检查膝关节隐匿性骨折的较佳影像学方法,可减少或避免误诊和漏诊,STIR序列最为敏感.     

膝关节隐匿性骨折的临床分析

目的 探讨膝关节隐匿性骨折的诊断方法与治疗措施.方法 分析我院2005年11月至2007年1月收治的28 例急性膝关节损伤病例,均行X线片、磁共振（MRI）检查.按照最终诊断给予相应治疗.结果 X线片无一例显示骨折;MRI显示膝关节不同部位骨损伤28 例,半月板损伤25 例,交叉韧带损伤8 例,侧副韧带损伤9 例,膝关节积液28 例.结论 膝关节周围外伤后仅行常规X线片检查容易漏诊,MRI因其具有多方位成像、软组织分辨率高及无创伤性等特点,已成为膝关节损伤理想的检查方法.隐匿性骨折与软组织损伤的治疗不同.     

常规X线阴性的隐匿性骨折

大多数外伤性骨折病人，可通过常规X线作出诊断，但也存在着假阴性结果，从而延误诊断，影响疗效。本院１９９８年１月至２０００年６月收治骨折病例２１２０例，其中６４例常规X线假阴性，后经复查X线、CT扫描诊断为骨折。现报告如下。临床资料本组６４例，其中男４８例，女１６例；年龄８～７０岁，平均４０岁。临床上有不同程度外伤史，患部疼痛伴功能障碍等体征，急诊行常规X线示假阴性，后复查X线确诊１８例，CT确诊４６例。确诊时间１～２８天，平均２周。X线复查包括改变投照体位、角度、动态观察。CT扫描多采用轴位横断扫描，…     

髋部隐匿性骨折

隐匿性股骨转子间骨折属于特殊类型的低能量骨损伤,多发生于老年骨质疏松患者,是一种假阴性骨折。因常规X线片检查不易发现,如不进行其他影像学检查(如超声、CT、MRI、核素扫描等),常延误诊治或发展演变为明显移位的骨折,给患者带来本可避免的痛苦。本文介绍股骨转子间隐匿性骨折的特点、诊断方法、分型和处理的研究进展。     

外伤致膝关节损伤的MRI诊断

目的：探讨MRI对诊断外伤所致膝关节损伤的能力。方法：使用Picker公司1．5T超导MRI装置对50例膝关节进行检查。结果：将MRI所显示的半月板损伤分为三级，明确指出了各级信号特点；提出了韧带损伤的直接和间接征象；并将膝部骨质隐匿性病灶分为五型，其中I－Ⅲ型多见于急性损伤，Ⅳ-Ⅴ型多见于慢性损伤。结论：由于MRI的信号特点及其可进行多平面成像，MRI在显示半月板、韧带、关节软骨及滑膜方面明显优于X线平片，在显示骨质情况尤其是显示隐匿性病灶时，可作为X线性的必要补充。     

膝关节外伤性隐匿性骨折的MRI应用及价值分析

目的 分析膝关节外伤性隐匿性骨折的MRI应用价值.方法 对50例膝关节外伤伴隐匿性骨折的患者X线平片、CT和MRI图像进行回顾性分析,了解及比较MRI在诊断隐匿性骨折的特征及其比较X线平片、CT的价值优势.结果 50例患者X线平片均未能清楚显示骨折,但MRI均能显示骨折病灶,并显示继发骨髓水肿、出血,其中33例伴有软骨损伤,6例伴有韧带损伤,46例伴有关节腔积液.结论 MRI成像具有多平面多角度展示隐匿性骨折的存在,并清楚灶周并发的软组织损伤情况,为临床提供准确和详尽的诊断信息,避免漏诊或误诊的发生,具有相当重要的临床实用价值.     

多层螺旋CT与MRI在膝关节隐匿性骨折伴半月板及韧带损伤中的诊断比较

目的:探讨多层螺旋CT(multislice spiral CT,MSCT)和MRI对膝关节隐匿性骨折伴半月板及韧带损伤的诊断价值。方法:自2020年1月至2021年3月,经关节镜或手术定性确诊膝关节隐匿性骨折伴半月板及韧带损伤患者63例,男41例,女22例,年龄21~67(44.35±8.77)岁,病程1~6(4.64±1.75) d;体质量指数(body mass index,BMI)(19.85±2.78) kg/m²。收集63例患者的MSCT和MRI检查资料,统计分析相关数据并评价二者的诊断价值。结果:MRI对膝关节隐匿性骨折伴半月板及韧带损伤、关节腔积液、骨髓水肿和关节面损伤的检出率分别为100.00%(63/63),95.24%(60/63),42.86%(27/63)和36.51%(23/63),MSCT的检出率分别为49.21%(31/63),41.27%(26/63),0.00%(0/63)和1.59%(1/63),差异有统计学意义(P<0.05);MRI的诊断灵敏度、特异度和准确度高于MSCT(P<0.05)。结论:MRI对膝关节隐匿性骨折伴半月板及韧带损伤的诊断灵敏度、特异度和准确度明显优于多层螺旋CT,对关节腔、关节面及骨髓等周围组织病变诊断准确性较高,可降低临床误诊风险。     

多层螺旋CT足踝部隐匿性骨折的诊断价值

目的：通过对隐匿性骨折的诊断,提示足踝部外伤后X线检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查的必要性,以期减少漏诊、误诊。方法：收集2007年1月至2010年6月31例足踝部外伤病例,男18例,女13例;年龄21～67岁,平均35岁。均有明确外伤史,主要表现为足踝部疼痛,局部肿胀,压痛点固定,压痛明显,活动受限。31例X线检查均阴性,因临床高度怀疑骨折而行多层螺旋CT检查。结果：螺旋CT检查发现11例骨折,共累及17处。单发骨折6例,多发骨折5例。单发骨折中,外踝骨折1例,距骨骨折1例,足舟骨骨折1例,第5跖骨基底部骨折1例,跟骨骨折2例;多发骨折中,内、外踝骨折1例,内踝、跟骨、距骨骨折1例,距骨、足舟骨骨折1例,足第1、2楔骨骨折1例,第2、3跖骨基底部骨折1例。结论：足踝部外伤后X线片检查阴性、临床高度怀疑有骨折的患者进行多层螺旋CT检查,可明显提高隐匿性骨折的检出率,为临床治疗及司法鉴定提供可靠的影像学依据,具有重要的应用价值。     

MRI diagnosis of occult hip fractures

Background Most fractures of the proximal femur are easily diagnosed by conventional radiography. When the images are judged to be negative or equivocal and a clinical suspicion of fracture persists, another approach is to use magnetic resonance imaging (MRI) to help reach a diagnosis.

Methods In a prospective study running from November 1998 to December 2001, we registered all patients being examined by MRI who had had a negative or equivocal radiograph and where there was continued clinical suspicion of hip fracture.

Results 100 consecutive patients (67 women) were included, with an average age of 80 (37–100) years. The MRI examinations corresponded to 4% of the 2,350 patients admitted with hip trauma during the study period. 46 patients had a femoral neck or intertrochanteric fracture on MRI. 27 patients had other fractures. 18 had other findings on MRI, and 10 were interpreted as being negative, although one of these was a false negative. In a separate interobserver analysis, two experienced radiologists agreed on the diagnoses in 19/23 cases (kappa value 0.78). They agreed with a less experienced radiologist in 17/23 and 19/23 cases, respectively (kappa values 0.66 and 0.76).

Interpretation MRI is a useful tool for demonstration of occult hip fractures. In the absence of a hip fracture, another explanation for the patient’s pain and disability will often be given.     

MRI diagnosis of occult hip fractures

Background Most fractures of the proximal femur are easily diagnosed by conventional radiography. When the images are judged to be negative or equivocal and a clinical suspicion of fracture persists, another approach is to use magnetic resonance imaging (MRI) to help reach a diagnosis.

Methods In a prospective study running from November 1998 to December 2001, we registered all patients being examined by MRI who had had a negative or equivocal radiograph and where there was continued clinical suspicion of hip fracture.

Results 100 consecutive patients (67 women) were included, with an average age of 80 (37-100) years. The MRI examinations corresponded to 4% of the 2,350 patients admitted with hip trauma during the study period. 46 patients had a femoral neck or intertrochanteric fracture on MRI. 27 patients had other fractures. 18 had other findings on MRI, and 10 were interpreted as being negative, although one of these was a false negative. In a separate interobserver analysis, two experienced radiologists agreed on the diagnoses in 19/23 cases (kappa value 0.78). They agreed with a less experienced radiologist in 17/23 and 19/23 cases, respectively (kappa values 0.66 and 0.76).

Interpretation MRI is a useful tool for demonstration of occult hip fractures. In the absence of a hip fracture, another explanation for the patient's pain and disability will often be given.     

The value of T1-weighted coronal MRI scans in diagnosing occult fracture of the hip

A delay in establishing the diagnosis of an occult fracture of the hip that remains unrecognised after plain radiography can result in more complex treatment such as an arthroplasty being required. This might be avoided by earlier diagnosis using MRI. The aim of this study was to investigate the best MR imaging sequence for diagnosing such fractures. From a consecutive cohort of 771 patients admitted between 2003 and 2011 with a clinically suspected fracture of the hip, we retrospectively reviewed the MRI scans of the 35?patients who had no evidence of a fracture on their plain radiographs. In eight of these patients MR scanning excluded a fracture but the remaining 27 patients had an abnormal scan: one with a fracture of the pubic ramus, and in the other 26 a T(1)-weighted coronal MRI showed a hip fracture with 100% sensitivity. T(2)-weighted imaging was undertaken in 25?patients, in whom the diagnosis could not be established with this scanning sequence alone, giving a sensitivity of 84.0% for T(2)-weighted imaging. If there is a clinical suspicion of a hip fracture with normal radiographs, T(1)-weighted coronal MRI is the best sequence of images for identifying a fracture.     

MRI在胫骨平台骨折诊治中的意义

目的:探讨MRI在胫骨平台骨折诊治中的价值.方法:胫骨平台骨折患者63例,所有患者都行MRI及X线检查,评价胫骨平台劈裂和塌陷的程度,骨折断端是否有软组织嵌入,以及合并的韧带和半月板损伤,以选择合适的治疗方案.结果:所有患者都合并不同程度的韧带或半月板损伤,单纯劈裂骨折11例,单纯胫骨髁间骨折3例,49例患者有明显的胫骨平台塌陷,骨折端有软组织嵌入17例,X线未发现的隐性骨折7例.13例患者MRI检查后改变了治疗方案和手术方式.结论:MRI能清晰的显示X线不能显示的隐性骨折,并能同时显示骨折的形态和塌陷的程度,以及是否有软组织的嵌入和合并的半月板、韧带损伤,为治疗方案、手术方式和入路的选择提供详细的资料.     

Justifying CT prior to MRI in cases of suspected occult hip fracture. A proposed diagnostic protocol

IntroductionPatients with clinical suspicion of hip fracture, but negative radiographs are suspected of having an occult hip fracture (OHF). Different diagnostic modalities are available for investigating OHF and various protocols have been suggested. MRI has the highest sensitivity and specificity, however availability is limited in many institutes. CT is readily accessible in the large majority of hospitals throughout the world but has lower sensitivity and may miss some fractures. In this article we investigate a protocol that balances these issues providing a practical and cost-effective solution.MethodsDuring a four-year period between 2012 and 2016 a strict diagnostic protocol was followed at our Medical Center for patients suspected of OHF. This MRI selective protocol consisted of CT initially being performed and only when negative for fracture, followed by an MRI. Retrospective analysis of all patients who followed the protocol was performed. The patients were divided into two groups: those diagnosed by CT alone and those diagnosed by MRI after having a negative CT scan. Diagnostic performance, time to diagnosis and the cost of this protocol were evaluated.Results103 patients were treated under the protocol. In 50 patients (49%) hip fracture was diagnosed by CT alone. In the remaining 53 patients (51%) no definitive diagnosis was reached by CT and MRI was subsequently performed. 12 of these 53 patients (23%) were diagnosed with hip fracture necessitating surgery. In the CT only group mean time from admission to diagnosis was 3 hours, in the CT + MRI group this rose to 40 hours. Cost analysis showed that this protocol was more cost-effective than performing MRI in all patients, saving an estimated 66,805 Euro during the study period.ConclusionThe clinical challenge of diagnosing OHF can be minimised by implementing a diagnostic protocol. The protocol should take into consideration the diagnostic sensitivity, availability and cost of different imaging modalities. An MRI selective strategy with initial CT scanning is recommended, as it reduces time to diagnosis and lowers overall costs.