盂肱关节前方不稳MR表现与关节镜手术所见比较

 目的 探讨盂肱关节前方不稳的关节镜检查和3.0T MRI表现。方法 收集45例盂肱关节前方不稳患者的MRI检查及关节镜检查资料,回顾性对照分析MRI与多角度镜头关节镜手术结果,总结损伤类型、程度,采用Kappa检验分析MRI与关节镜诊断结果的一致性,观察MRI对各种损伤诊断结果及敏感度。结果 盂唇损伤在盂肱关节前方不稳病变中占84.4%(38/45),其中前下盂唇损伤占 51.1%(23/45),盂唇损伤合并Hill-sachs损伤、关节囊损伤占44.2%(20/45),盂唇损伤合并骨性Bankart损伤占17.7%(8/45)。MRI诊断前下盂唇损伤、HAGL病变、Hill-sachs病变的敏感度分别为78.2%、71.0%、90.0%。MRI与关节镜诊断结果具有一致性,其中诊断肩胛下肌及肌腱损伤及骨性Bankart损伤的结果完全一致,诊断前下盂唇损伤、HAGL病变及Hill-sachs病变的一致性较好,诊断SLAP损伤一致性一般。结论 3.0T MRI能够较准确地显示盂肱关节前方不稳常见病变及MRI征象,为临床早期诊断和治疗提供依据。     

应用三维CT重建图像研究肩关节前向不稳的盂肱关节骨性因素

目的 应用三维CT重建图像测量肩关节前向不稳患者的盂肱关节骨性数据.方法 回顾性分析有肩关节前脱位史的患者48例(病例组)和正常肩关节50例(对照组)的CT图像,测量其肩胛盂高宽比、盂窝深度、肱骨头包含角度及喙肱距离.结果 对照组和病例组的肩胛盂高宽比为1.52±0.03和1.64±0.05,肱骨头包含角度为(68.5...     

CT关节造影和1.5 T MR关节造影对盂肱关节软骨评估的诊断性能:与关节镜的对比研究

<正>目的比较多层螺旋CT关节造影(CTA)和1.5 TMR关节造影(MRA)在检测肩关节透明软骨损伤的诊断性能,并与关节镜进行对比研究。材料与方法对连续56例病     

糖尿病大鼠盂肱关节活动度变化的测量研究

目的:应用一种新的测量大鼠盂肱关节活动范围(ROM)的方法测量糖尿病大鼠盂肱关节活动度,建立与探讨糖尿病性冻结肩的动物实验研究方法。方法:9只雄性SD大鼠随机分为糖尿病组(n=5)和对照组(n=4),糖尿病组予高果糖饮食,对照组予正常饮食。12周时进行口服糖耐量试验,13周时测空腹血糖、血胰岛素、甘油三酯浓度和计算稳态模型指数(HOMA-R),同时取材测量每只鼠双侧盂肱关节的外展、内收、外展0度位和90度位内外旋的角度,计算并比较两组大鼠盂肱关节冠状面、水平面和矢状面的活动范围。结果:(1)糖尿病组大鼠糖耐量受损,空腹血糖、血胰岛素、甘油三酯浓度和HOMA-R较对照组显著升高。(2)糖尿病组大鼠盂肱关节活动度平均值在冠状面下降14.6%,在矢状面下降22.8%,有统计学意义(P值分别为0.007和0.031),水平面下降20.4%,但差别不显著(P=0.077)。(3)糖尿病组大鼠10个盂肱关节中有2个(20%)在3个平面活动度同时下降。(4)糖尿病组双侧盂肱关节在3个关节活动平面的ROM均无统计学差别。结论:长期高果糖饮食喂养大鼠会出现类似2型糖尿病的表现,同时双侧盂肱关节活动范围均会下降,其中对外展90度位旋转活动影响较大。     

关节盂唇和肩袖撕裂检测的准确性：CT与MR关节造影的前瞻性评估

目的：评估CT关节造影和MR关节造影在诊断肩部关节盂唇和肩袖损伤的准确性。方法：对2004年5月～2005年12月112例患者分别进行16层螺旋CT关节造影和MR关节造影扫描，40例患者同时进行了关节镜检查。所有MR关节造影和CT关节造影检查结果都由3例骨肌系统影像学专家进行分析鉴定，     

超声定量评估髋关节前上盂唇面积及关节囊厚度的可行性研究

目的:探讨超声测量无症状人群髋关节前上盂唇截面积(CSA)、前关节囊厚度测量重复性.方法:测量40位(80髋)无髋关节症状患者髋关节前上盂唇CSA及前关节囊厚度.男20人,女20人,年龄21～49岁,平均32.4±8.2岁.2位超声医师分别测量髋关节前上盂唇CSA、前关节囊厚度.采用组内相关系数(ICC)评价测量重复性...     

肩关节盂肱韧带损伤的3．OTMRI表现

目的探讨盂肱韧带损伤的超高场MRI表现。方法回顾分析25例行MRI检查并经关节镜手术证实盂肱韧带损伤的临床资料及其MRI表现。结果盂肱上韧带损伤11例（44％）,盂肱中韧带损伤23例（92％）,盂肱下韧带损伤17例（68％）,冈上肌腱损伤19例（76％）,冈下肌腱损伤20例（80％）,肩胛下肌损伤12例（48％）,小圆肌损伤1例（4％）,肱二头肌长头肌腱损伤15例（60％）,盂唇损伤10例（40％）;25例均有不同程度的关节积液。结论超高场MRI检查在盂肱韧带损伤的临床应用中的优越性是显而易见,为临床的治疗提供准确可靠的影像学依据。     

上盂唇病变的诊断与治疗

越来越多的证据表明上盂唇（SLAP）病变是引起肩关节疼痛和不稳定的一个重要原因。随着关节镜下对肱二头肌腱附着部位的深入研究和关节镜器械、操作技术等的发展,人们对SLAP病变的发病机制、临床表现、分类和治疗等方面的认识也不断深化。选用恰当的技术,SLAP病变在关节镜下能得到安全和有效的治疗,大多数患者能恢复正常活动,甚至能恢复投掷运动.     

关节盂唇损伤的影像学评估

人体内关节盂唇主要存在于肩关节和髋关节,这两个部位的盂唇在各方面均有极大的相似性,它们均由纤维软骨构成,呈吸盘样包绕骨性关节盂边缘,起到增大球窝关节包绕面积、缓解关节面应力以及稳定关节的作用.盂唇损伤主要包括磨损、撕裂以及移位,是引起关节疼痛、不稳及退变的重要因素.盂唇损伤的正确诊断对指导其临床治疗有着重要的意义.本文着重阐述目前诊断盂唇损伤的各种影像学方法及相关进展,为临床实践提供可靠的参考.     

间接磁共振关节造影成像对肩袖关节上关节唇病变的诊断价值

目的:前瞻性评估间接磁共振关节造影对肩袖关节上关节唇病变的诊断价值。方法:对3 5例有急性或慢性肩袖关节疾病史的患者(男9例,女2 6例)行磁共振平扫和间接磁共振关节造影成像。独立分析磁共振平扫和间接磁共振关节造影的图像并与关节镜的检查结果行相关性比较分析。关节镜、磁共振平扫和间接磁共振关节造影对肩袖关节上关节唇病变的诊断分型都参照Synder分类系统。结果:3 5例患者中有2 2例经关节镜诊断患有肩袖关节上关节唇病变( 63 % ) ,其中9例为Ⅰ型( 4 1% ) ,9例Ⅱ型( 4 1% ) ,3例( 13 .5 % )Ⅲ型和1例( 4 .5 % )Ⅳ型。磁共振平扫发…     

CT引导下肩关节造影诊断肩关节前不稳症的价值

目的 :探讨CT引导下穿刺、空气 -碘水双对比造影CT诊断肩关节前不稳症的意义。材料和方法 :经临床和手术证实 5 6例为肩关节前不稳症患者 ,在CT引导下 ,行肩关节囊穿刺 ,并注入 30 %～ 35 %泛影葡胺 6～ 10ml和过滤空气10～ 2 0ml后 ,分别行仰卧位和俯卧位CT扫描 ,必要时 ,行螺旋CT扫描和 3维重建。结果 :5 6例肩关节前不稳症患者中除1例因耐药性差未检查成功外 ,其余 5 5例造影均获成功 ,16例手术患者气 碘双对比造影CT表现均与手术中所见一致。结论 :CT引导下肩关节造影可以准确诊断肩关节前不稳症并为外科手术治疗肩关节不稳症提供可靠的影像学信息。     

Glenohumeral joint instability

Due to the configuration of its bony elements, the glenohumeral joint is the most mobile joint of the body, but also an inherently unstable articulation. Stabilization of the joint is linked to a complex balance between static and dynamic soft tissue stabilizers. Because of complex biomechanics, and the existence of numerous classifications and acronyms to describe shoulder instability lesions, this remains a daunting topic for most radiologists. In this article we provide a brief review of the anatomy of the glenohumeral joint, as well as the classifications and the pathogenesis of shoulder instability. Technical aspects related to the available imaging techniques (including computed tomography [CT] arthrography, magnetic resonance imaging [MRI], and MR arthrography) are reviewed. We then describe the imaging findings related to shoulder instability, focusing on those elements that are important to the clinician.     

Anatomy,Variants, and Pathologies of the Superior Glenohumeral Ligament: Magnetic Resonance Imaging with Three-Dimensional Volumetric Interpolated Breath-Hold Examination Sequence and Conventional Magnetic Resonance Arthrography

The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.     

MRI间接膝关节造影诊断半月板损伤的价值

目的:探讨MR I间接膝关节造影诊断半月板撕裂的价值。材料和方法:选取MR I平扫疑似半月板损伤32例,静脉注射常规剂量(0.1mmol/kg)与双倍剂量(0.2mmol/kg)造影剂(Gd-DTPA),运动后延时扫描。参照MR I平扫片对比两组不同浓度MR I关节造影表现。结果:两种不同浓度造影均可使半月板撕裂的高信号增加,以采用0.2mmol/kg造影效果较好。32个半月板,造影后确诊半月板撕裂18例(占56.3%),排除诊断8例(占25%),确诊和排除诊断合计占81.3%,6例可疑,可疑的6例经关节镜检查排除诊断3例。结论:对半月板损伤MR I平扫不能肯定诊断时,行间接膝关节造影对确定或排除诊断是十分必要的。0.1mmol/kg Gd-DTPA能达到诊断目的。     

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

Objective

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.

Materials and Methods

The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.

Results

The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.

Conclusion

MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.     

Optimization of the Contrast Mixture Ratio for Simultaneous Direct MR and CT Arthrography: an in Vitro Study

Objective

This study was designed to determine the optimal mixture ratio of gadolinium and iodinated contrast agent for simultaneous direct MR arthrography and CT arthrography.

Materials and Methods

An in vitro study was performed utilizing mixtures of gadolinium at six different concentrations (0.625, 1.25, 2.5, 5.0, 10 and 20 mmol/L) and iodinated contrast agent at seven different concentrations (0, 12.5, 25, 37.5, 50, 75 and 92-99.9%). These mixtures were placed in tissue culture plates, and were then imaged with CT and MR (with T1-weighted sequences, proton-density sequences and T2-weighted sequences). CT numbers and signal intensities were measured. Pearson''s correlation coefficients were used to assess the correlations between the gadolinium/iodinated contrast agent mixtures and the CT numbers/MR signal intensities. Scatter diagrams were plotted for all gadolinium/iodinated contrast agent combinations and two radiologists in consensus identified the mixtures that yielded the optimal CT numbers and MR signal intensities.

Results

The CT numbers showed significant correlation with iodinated contrast concentrations (r = 0.976, p < 0.001), whereas the signal intensities as measured on MR images showed a significant correlation with both gadolinium and iodinated contrast agent concentrations (r = -484 to -0.719, p < 0.001). A review of the CT and MR images, graphs, and scatter diagram of 42 combinations of the contrast agent showed that a concentration of 1.25 mmol/L gadolinium and 25% iodinated contrast agent was the best combination for simultaneous CT and MR imaging.

Conclusion

A mixture of 1.25 mmol/L gadolinium and 25% iodinated contrast agent was found to be optimal for simultaneous direct MR arthrography and CT arthrography.     

Comparison of Image Quality of Shoulder CT Arthrography Conducted Using 120 kVp and 140 kVp Protocols

Objective

To compare the image quality of shoulder CT arthrography performed using 120 kVp and 140 kVp protocols.

Materials and Methods

Fifty-four CT examinations were prospectively included. CT scans were performed on each patient at 120 kVp and 140 kVp; other scanning parameters were kept constant. Image qualities were qualitatively and quantitatively compared with respect to noise, contrast, and diagnostic acceptability. Diagnostic acceptabilities were graded using a one to five scale as follows: 1, suboptimal; 2, below average; 3, acceptable; 4, above average; and 5, superior. Radiation doses were also compared.

Results

Contrast was better at 120 kVp, but noise was greater. No significant differences were observed between the 120 kVp and 140 kVp protocols in terms of diagnostic acceptability, signal-to-noise ratio, or contrast-to-noise ratio. Lowering tube voltage from 140 kVp to 120 kVp reduced the radiation dose by 33%.

Conclusion

The use of 120 kVp during shoulder CT arthrography reduces radiation dose versus 140 kVp without significant loss of image quality.