创伤性膝关节积脂血症的CT及MRI诊断

目的 分析创伤性膝关节积脂血症的CT及MRI表现特点.方法 回顾性分析50例创伤性膝关节积脂血症患者的CT及MRI的影像学特征,所有患者于受伤后1h～7天内行MRI或CT检查.结果 CT和MR成像50例关节积脂血症患者均有关节内骨折,关节积脂血症CT和MRI表现为关节囊内单液-液平面或双液-液平面.其中36例表现为单液-液平面积液征象,14例表现为双液-液平面积液征象.单液-液平面及双液-液平面的不同成份在CT和MRI上密度和信号不同,但上层均为脂肪.结论 关节积脂血症在CT和MRI上具有特征性表现,可做出明确诊断,关节积脂血症均与关节内骨折并存,可作为关节内骨折的可靠间接征象.     

关节积脂血征的影像学表现

目的：分析外伤所致关节积脂血征的X线、CT和MRI表现,总结其影像学特征表现。方法：回顾性分析46例关节积脂血征的X线、CT和MRI特点,其中膝关节32例、髋关节4例、肩关节4例、踝关节5例及肘关节1例。结果：仅4例在X线上有特征性表现,CT或MRI上46例关节积脂血征患者均有关节内骨折,关节积脂血征CT和MRI表现为关节囊内单液-液平面或双液-液平面,单液-液平面及双液-液平面的不同成份在CT和MRI上密度和信号不同,但上层均为脂肪。结论：关节积脂血征在CT和MRI上具有特征性表现,可做出明确诊断,关节积脂血征均与关节内骨折并存,可作为关节内骨折的可靠间接征象。     

膝关节创伤性积脂血症的MRI诊断

目的：探讨膝关节创伤性积脂血症的MRI影像学特点及诊断价值。方法：回顾性分析32例膝关节创伤性积脂血症患者的MRI影像学特征。所有患者于受伤后1h～6天内行MRI检查。结果：32例膝关节积脂血症患者关节囊（髌上囊）出现脂肪-血液界面征,均为单侧,左侧14例,右侧18例。单液-液平面的23例,双液-液平面9例,液-液平面最上层均为脂肪信号。结论：膝关节创伤性积脂血症在MRI上有特征性的影像学表现,可作为诊断关节囊内骨折的间接征象,MRI是诊断膝关节创伤性积脂血症最佳影像学方法。     

创伤性关节脂血症的影像学特征及其诊断价值

目的：分析创伤性关节脂血症的影像学特征．探讨其对关节囊内骨折的诊断价值。方法：回顾性分析研究100例经手术或穿刺证实的创伤性关节脂血症患者行X线、CT及MRI检查并分析影像学资料。结果：100例患者经3种检查方法印证均存在关节内骨折。X线表现为关节囊肿胀,密度增高与肌肉近似,经特殊体位投照部分可显示脂液平征象。CT全部清晰显示关节囊内有脂液平征．其中单液-液平征72例,双液-液平征25例,气体脂肪血液单或双液-液平征3例。MRI有明确脂液平征89例,位于膝、髋等大关节。脂液平征不明确者11例,位于踝、腕等小而复杂的关节。构成关节囊内单液-液平征的上下2层液体和双液-液平征的上、中、下3层液体有明显不同的CT值和MRI信号强度,其中最上层CT为脂肪密度、MRI为脂肪信号。结论：CT示脂血症清晰而准确,对大部分囊内骨折能明确诊断。MRI对小关节脂血症的诊断不如CT,但对关节囊内骨折及其附属结构损伤的显示明显优于X线片及CT。创伤性关节脂血症可作为关节内骨折可靠的间接征象。     

CT与MRI对创伤性膝关节积脂血症的诊断价值

目的探讨CT与MRI对创伤性膝关节积脂血症(traumaticlipohemarthrosis,TLH)的诊断价值。方法回顾性分析34例TLH的普通X线平片、CT及MRI的影像学表现,并探讨其诊断价值。结果 34例患者中,左膝关节22例,右侧膝关节12例。34例均行普通X线平片检查,提示膝关节骨折32例;16例行CT检查,15例可见明确脂肪、关节液、血液不同成分的分层密度改变。18例行MRI检查,均可见"脂肪-血液接口征"。并拟诊隐性骨折2例。结论 X线平片对骨折的诊断意义大,对积脂血症的诊断帮助不大。CT及MRI均能很好显示创伤性TLH,均有"脂肪-血液接口征"这一特征性表现,尤其MRI除显示积脂血症的典型征象外,对隐性骨折的诊断更有意义。     

创伤性膝关节积脂血症的MRI诊断价值

目的:分析急性膝关节损伤积脂血症的MRI征象,评价MRI在急性膝关节损伤诊断中的应用价值。方法:回顾性分析42例膝关节积脂血症患者的MRI资料。结果:42例膝关节外伤患者均发现膝关节积脂血症,发生在左膝关节18例,右膝关节22例,双膝关节2例,均由急性外伤引起。可见单液-液平面25例,双液-液平面13例,混合异常信号4例。还发现合并创伤性半月板损伤、前后交叉韧带损伤、侧副韧带损伤、骨折及不同程度的骨损伤。结论:在急性膝关节损伤中,MRI能清楚地显示膝关节积脂血症,同时还能准确地显示创伤性半月板损伤、前后交叉韧带损伤、侧副韧带损伤及骨折、骨髓水肿等。     

膝关节积脂血病

膝关节内骨折后创伤性关节积脂血病以前曾有报导。作者复习了268例膝关节损伤病例标准正位片及水平投照侧位片,发现43例(16%)有关节内骨折,其中28例仅有关节积液,15例可见脂液平面,以胫骨平台骨折最常见,占27%的而髌骨骨折大部分无脂液平面。胫骨平台骨折较易发生关节积血(7/11例),13例髌骨骨折中10例仅有关节积液,     

创伤性关节积气脂血征的多层螺旋CT诊断

创伤性关节积气脂血征指创伤后关节囊内气体、脂肪和血液同时存在，CT表现具有特异性，国内文献目前尚未见对此征象的详细报道。本文对2003年9月以来我院收治6例创伤性关节积气脂血征患者的多层螺旋CT（MSCT）及临床资料进行回顾性分析，探讨创伤性关节积气脂血征的CT表现及其发生机制。     

创伤性膝关节脂血症和血症的影像诊断

目的 探讨膝关节脂血症和血症的X线平片、CT、MRI、超声的影像表现及其诊断价值.方法 对经手术(27例)或穿刺(3例)证实的关节血症(12例)及脂血症(18例)的仰卧位水平摄影X线平片(16例)、CT(30例)、MRI(30例)、超声(24例)4种影像检查方法和结果进行研究.结果 (1)X线平片:9例脂血症中8例见脂-液平面,1例脂血症和7例血症见髌上囊密度增高,与肌肉近似.正确诊断骨折13例.(2)CT:18例脂血症中双液-液平面11例,单液·液平面7例.12例血症中3例见单液-液平面.9例呈中等密度,4例见卵圆形稍高密度血凝块.30例均正确诊断骨折.(3)MRI:18例脂血症中12例呈双液-液平面,上层呈短T1、长T2高信号及压脂像低信号,中层呈长T1、长T2信号及压脂像高信号,下层呈中等T1、T2信号及压脂像较高信号;6例呈单液-液平面.12例关节血症仅见上述的中、下2层.4例见边缘光滑的血凝块,在T1WI呈中等信号或中等信号伴高信号环,压脂像呈高信号,T2WI及压脂像呈中等或稍高信号伴低信号环.30例均正确诊断骨折.(4)超声:14例脂血症中双液.液平面10例,上层呈中等回声,中层无回声,下层呈云雾状回声;单液-液平面4例.10例关节血症中3例见单液-液平面,即仅见上述的中、下2层;7例呈云雾状回声并见漂浮状物.3例血凝块呈低-等回声类实性团块.均未见骨折线.结论 CT能很好地显示骨折线及关节脂血症和血症,可以替代X线平片.MRI是该病的最佳影像检查方法.超声可诊断关节脂血症和血症,但不能显示骨折.     

动脉瘤样骨囊肿-CT和MR图像上的再认识

目的：评价CT和MRI图像上液-液平面征象对诊断动脉瘤样骨囊肿(ABC)的价值．材料和方法：回展性分析11例经病理证实的ABC的平片，CT和MR表现．并用双盲法测试单纯平片和综合影像分析(平片、CT、MRI)的诊断符合率。结果：1.单纯平片诊断符合率低于综合影像诊断；2．CT和MR有助于显示病变的范围，与周圈组织的关系和病灶内的特征；3．在CT和MRI上ABC可见到液-液平面征。结论：CT和MRI上的液-液平面征是ABC较特征性的征象．综合性影像检查能提高ABC的诊断准确率．     

A case of intra-articular fracture of the knee joint with three layers within lipohemarthrosis by ultrasonography and computed tomography

We report a case of intra-articular fracture of the knee joint showing three layers within lipohemarthrosis. Sagittal ultrasonography showed three layers (double fluid-fluid level): a superior hyperechoic layer of fat, an intermediate anechoic layer of serum, and an inferior hypoechoic layer of red blood cells. Horizontal computed tomography imaging demonstrated the same three layers. This is the first case of lipohemarthrosis in which three layers of joint effusion were confirmed by both ultrasonography and computed tomography.     

Acute knee trauma: role of ultrasound

The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.     

Floating fat in the wrist joint and in the tendon sheaths

A traumatic fat effusion in a tendon sheath is an unreported entity. We report on the clinical and imaging features, including radiography and computed tomography (CT), of a fat-density effusion in the wrist joint and tendon sheaths of the extensor pollicis longus, extensor carpi radialis longus, and extensor carpi radialis brevis in a 28-year-old patient after a roller-skating accident. Radiographs showed a fracture of the distal radius and a wrist joint effusion. Preoperative CT examination exhibited two distinct layers resulting in a fat-fluid level pathognomonic of lipohemarthrosis in the radiocarpal joint. In addition, a fat-density effusion was noted in the sheaths of the second and third compartment extensor tendons. The lipohemarthrosis depicted on imaging classically results from the extrusion of fat from bone marrow into the joint space after an intraarticular fracture. Similarly, a traumatic fat effusion in a tendon sheath presents characteristic imaging features that may help to diagnose a potentially overlooked fracture.     

Bildgebungsstrategie bei Kniegelenkverletzungen

Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery.