MRI对军事训练致盘状半月板损伤的临床应用价值

目的:探讨MRI对军事训练致膝关节盘状半月板损伤的临床应用价值。方法:回顾性分析36例武警部队军人盘状半月板资料,其中33例经关节镜证实盘状半月板撕裂,33例撕裂病例均有明确的军事训练致伤史,观察盘状半月板形态、大小及信号改变,判断盘状半月板及其损伤分型。结果:36例盘状半月板,均发生在外侧。36例中,板型21例,楔型9例,肥角型6例。33例盘状半月板发生撕裂,以关节镜为诊断标准,MRI诊断膝关节盘状半月板准确率为100%,MRI诊断盘状半月板水平撕裂、斜行撕裂、纵行撕裂、放射状撕裂、桶柄状撕裂及复杂撕裂的准确性分别为91.7%、94.4%、100%、97.2%、91.7%、94.4%。结论:MRI对军事训练致盘状半月板撕裂能清晰显示、准确分型,对临床治疗方案的制定有重要的指导作用,具有较高的临床应用价值。     

膝关节盘状半月板分型与撕裂类型相关性的MRI分析

目的:进行盘状半月板的流行病学研究,探讨膝关节盘状半月板的诊断标准、分型及其与年龄、撕裂类型的关系,以提高对盘状半月板及撕裂MRI表现的认识。方法:对842例诊断为盘状半月板的患者按年龄分为≤19岁、20³9岁、4039岁、40⁵9岁、≥60岁组。对全部患者冠状面髁间棘层面半月板宽度与胫骨平台宽度之比(板面比)、矢状面"领结样"改变层面中半月板后角最厚层面的厚度及矢状面"领结样"改变层数进行测量、分析。根据盘状半月板MRI表现,分为板型、楔型、肥角型。分析盘状半月板分型、年龄与撕裂类型的关系。结果:盘状半月板以外侧多见,女性发病率是男性的1.64倍。842例中,板型535例、楔型274例、肥角型33例。半月板撕裂354例,撕裂率为42.0%。842例板/面比均≥0.20,矢状面"领结样"改变层面中半月板后角最厚层面的厚度≥4.40mm。盘状半月板分型与撕裂类型及年龄分布有关系,而年龄分布与撕裂类型无明显相关。结论:盘状半月板多见于外侧,常伴半月板撕裂。板面比≥0.20、矢状面"领结样"改变层面中半月板后角最厚层面的厚度≥4.40mm、矢状面连续≥3层"领结样"改变,为盘状半月板的MRI诊断标准;盘状半月板分型与撕裂类型有关系;年龄可影响盘状半月板分型。     

膝关节盘状半月板及撕裂的MRI诊断

目的 探讨盘状半月板的MRl分型及其撕裂的MRI诊断.方法 对55例(57膝)经手术或关节镜证实且有完整MRI资料的盘状半月板进行回顾性分析,观察盘状半月板的形态、大小及信号改变,包括半月板宽度和厚度的测量.结果 57膝盘状半月板,56膝发生在外侧,只1膝在内侧.57膝中,板型34膝,楔型15膝,肥角型8膝,其中46膝盘状半月板发生撕裂、7膝伴有变性.结论 盘状半月板多见于外侧,且常并发半月板撕裂或变性.     

MRI对膝关节盘状半月板及其损伤的诊断价值

目的:探讨MRI对膝关节盘状半月板及其损伤的诊断价值。方法:回顾性分析89例(151个膝关节)盘状半月板及其损伤的MRI、关节镜及手术资料。结果:89例盘状半月板中,88例(150个膝关节)为外侧盘状半月板,1例(1个膝关节)为内侧盘状半月板,表现为半月板增大、增宽、增厚,矢状面上可见≥3个层面前后角相连,冠状面髁间棘层面半月板宽度>15mm。本组中81例(138个膝关节)伴半月板损伤,发生率为91.40%,MRI表现为半月板不同程度变性或撕裂。与膝关节镜及手术对照,MRI图像对半月板损伤诊断的特异度为92.31%、敏感度为99.28%;对Ⅰ～Ⅱ级半月板损伤诊断的符合率为95.00%;对Ⅲ级半月板损伤诊断的符合率为98.98%。结论:MRI能准确判断盘状半月板类型及其损伤的范围和程度,是诊断盘状半月板及其损伤的最佳检查方法。     

The value of MRI in the diagnosis of injury of discoid meniscus

目的:探讨MRI对膝关节盘状半月板及其损伤的诊断价值.方法:回顾性分析89例(151个膝关节)盘状半月板及其损伤的MRI、关节镜及手术资料.结果:89例盘状半月板中,88例(150个膝关节)为外侧盘状半月板,1例(1个膝关节)为内侧盘状半月板,表现为半月板增大、增宽、增厚,矢状面上可见≥3个层面前后角相连,冠状面髁闻棘层面半月板宽度>15 mm.本组中81例(138个膝关节)伴半月板损伤,发生率为91.40%,MRI表现为半月板不同程度变性或撕裂.与膝关节镜及手术对照,MRI图像对半月板损伤诊断的特异度为92.31%、敏感度为99.28%,对I～Ⅱ级半月板损伤诊断的符合率为95.00%;对Ⅲ级半月板损伤诊断的符合率为98.98%.结论:MRI能准确判断盘状半月板类型及其损伤的范围和程度,是诊断盘状半月板及其损伤的最佳检查方法.     

盘状半月板42例的磁共振成像诊断分析

盘状半月板又称为盘状软骨．其发育异常、形态呈宽的盘状．容易发生半月板撕裂及囊肿,外侧半月板多见,易引起软骨磨损及剥脱性骨软骨炎。磁共振成像（MRI）检查是一种无创性的检查方法,能很好地显示骨质、半月板和韧带的形态和病变。回顾分析在我院进行膝关节检查并经手术或关节镜证实的42例盘状半月板的MRI图像,观察其形态及信号特征,以提高MRI诊断盘状半月板的确诊率。     

膝关节盘状半月板的MRI诊断

目的　探讨膝关节盘状半月板的MRI表现以及MRI诊断盘状半月板的标准。材料与方法　对 2 6例经手术或关节镜证实的盘状半月板和 3 0例健康志愿者的膝关节进行MRI检查 ,对正常及盘状半月板的形态、大小及信号改变进行对照观察 ,包括半月板宽度和厚度的测量。结果　 2 6例盘状半月板中 ,2 5例为外侧盘状半月板 ,只有 1例为内侧盘状半月板 ,18例为厚板型 ,8例为楔型。冠状面上 ,盘状半月板体部平均宽度及厚度明显大于正常半月板 ,分别为 2 3 .4mm、11.5mm (P <0 .0 5 )和 3 .2mm、0mm(P <0 .0 1)。但盘状半月板边缘厚度与对侧半月板厚度差超过 2mm者只有 6例。矢状面上 ,连续 3层或 3层以上显示盘状半月板的前后角相连形成“领结”样改变 ,而正常半月板只有 2层有此表现。 2 6例盘状半月板中 ,2 4例并发半月板变性或撕裂。结论　盘状半月板多见于外侧半月板。盘状半月板特征性的MR表现是盘状半月板明显较正常半月板厚、大 ,MRI检查易于诊断。盘状半月板常并发半月板变性或撕裂。     

膝关节半月板撕裂的MRI诊断

目的 探讨膝关节半月板撕裂的MRI诊断价值.方法 收集并分析经关节镜证实的60例膝关节半月板撕裂的MRI表现,并参考Stoller分级方法,提出半月板损伤的4级分法.结果 60例65个半月板撕裂中,内侧撕裂15个,外侧撕裂40个,两侧同时撕裂5例10个.合并外侧盘状半月板15个.MRI诊断准确率为90.8%.39例出现合并症,伴随病变有韧带撕裂,骨挫伤,关节积液,骨折,半月板囊肿等.结论 MRI能够准确诊断半月板撕裂,还能发现多种合并症.     

盘状半月板的MRI诊断

目的探讨盘状半月板及损伤的MRI表现及诊断标准。方法回顾性分析40例盘状半月板测量方法;盘状半月板分型及损伤诊断标准。结果本组40例均为外侧盘状半月板。24例为厚板型,16例为楔型。38个合并不同程度半月板损伤,损伤率95%。结论MRI检查是诊断盘状半月板的首选方法;半月板与相应层面胫骨平台横径之比(板/面比)超过40%是诊断盘状半月板必要的标准。     

MRI与关节镜诊断半月板损伤临床表现的对比分析

目的 探讨MRI和关节镜检查半月板损伤的诊断价值。方法 收集40例我院接受诊断与治疗的膝关节损伤患者的MRI图像,以关节镜诊断为标准,计算MRI诊断的敏感性、特异性、准确性。结果 本组40例膝关节,左膝18例,右膝22例,共80个半月板。MRI表现为Ⅰ度损伤9个,Ⅱ度损伤15个,Ⅲ度损伤56个。MRI诊断半月板撕裂56个,其中外侧半月板35,内侧半月板21个,关节镜证实半月板撕裂50个,其中外侧半月板32,内侧半月板18个,其余6个半月板关节镜下肉眼未见明显撕裂。24个半月板MRI诊断无撕裂者中,关节镜下证实有3个半月板撕裂并进行部分切除。以关节镜检查为标准,MRI对半月板撕裂诊断的敏感性为94.3%,特异性为77.8%,准确性为88.8%,MRI诊断与关节镜结果差异无统计学意义（x^2=0.44,P〉0.05）。结论 MRI对半月板撕裂具有较高的诊断价值。而关节镜检查为最终确诊半月板损伤提供了清晰的镜像和依据,两者相互补充才能得到更好的临床效果。     

盘状半月板MRI表现（附56例分析）

目的分析56例盘状半月板MRI表现,以提高盘状半月板诊断正确率.材料和方法经手术、关节镜确诊的56例盘状半月板,对其MR图像不同层面进行测量,参照Crues等有关半月板损伤行MRI分级.结果56例盘状半月板形态学分型凹透镜型29例,厚板型10例,簸箕型5例,后角肥大型8例,不完全型4例,其中央薄弱部分以粉碎性撕裂为主,周缘厚实部分以退变为主,MRI诊断与手术对比总符合率为89.3%;结论对各种盘状半月板的认识有助于提高MRI诊断盘状半月板的正确率,并对外科手术有指导意义.     

Discoid menisci in children: ultrasonographic features

OBJECTIVE: Discoid meniscus is a rare congenital pathology affecting mainly the lateral meniscus. Radiological diagnosis, initially based on arthrographic findings, is now established on well defined MRI criteria. In this study, ultrasonography (US) was the modality proposed for diagnosing discoid meniscus and compared to the normal sonographic meniscal pattern. Subjects and methods. 8 children aged from 6 to 11 years, with a symptomatology highly suggestive of meniscal pathology, were investigated by US of both knees, followed by MRI in 3 and arthroscopy in all cases. RESULTS: In all 8 cases, a meniscus was diagnosed as discoid when it no longer had its normal triangular shape, was abnormally elongated and thick and demonstrated a heterogeneous central pattern. Associated lesions (fracture, cystic degeneration) were well demonstrated on US. The lateral meniscus was involved in all 8 cases, the pathology was bilateral in 5 cases and MRI/US correlation was good in 3 cases. Arthroscopy confirmed US findings in all cases. CONCLUSION: US, a more widely available imaging modality, is a reliable technique for the diagnosis of discoid meniscus in children.     

MRI of discoid lateral meniscus]

We retrospectively reviewed the MR examinations of 10 patients (17 knees) with surgically documented discoid lateral meniscus of the knee joint. As MRI of the knee is being used more often, the criteria for diagnosis of this entity with MRI need to be established. We tried to define MRI criteria for the detection of discoid menisci by performing numerical measurements of MR images on a display screen. The transverse diameter of the midbody of a discoid lateral meniscus averaged 21.9 mm (normal control: 8.6 mm), and its proportion to the transverse width of the tibia averaged 29.4% (normal control: 12.0%). The measurable difference in height between the discoid and the medial meniscus was negligible. The number of sagittal sections on which the anterior and posterior horns connected varied from two to five in cases of discoid lateral meniscus, and from zero to two in normal controls. Among these parameters, the transverse diameter and its proportion of the transverse width of the tibia proved to be the most reliable. We concluded that a discoid meniscus is indicated if a transverse diameter of a lateral meniscus exceeds 15 mm (proportion to the tibia: 20%).     

盘状半月板MRI分型及其表现分析

目的:探讨盘状半月板MRI表现及其分型特点,提高盘状半月板MRI诊断率.材料和方法:将70例行MRI检查并经关节镜证实的盘状半月板分为未成年组、成年组.对全部病例冠状面髁间棘层面半月板宽度与胫骨平台宽度之比(板面比)、矢状面层厚4mm扫描"领结样"改变层数及"领结样"改变最宽层面前后径宽度进行测量、分析.根据盘状半月板MRI表现分为板型、楔型、肥角型.结果:70例盘状半月板中未成年组30例、成年组40例,板型33例、楔型19例、肥角型18例,69例发生不同程度撕裂.整组病例板面比≥20%(P<0.01),各型年龄分布无显著性差异(P>0.05),各型矢状面"领结样"改变最宽层面不全相同(P<0.05).结论:板面比≥20%诊断盘状半月板最可靠,矢状面层厚4mm扫描"领结样"改变层数≥3诊断盘状半月板易发生漏诊,矢状面"领结样"改变最宽层面楔型较肥角型大,年龄可影响盘状半月板分型.     

A three-dimensional gradient refocussed 3D volume imaging of discoid lateral meniscus

An axial 3D volume scan with MRI was applied to the evaluation of discoid lateral meniscus of the knee. By 0.7 mm-thick thin-sliced and gapless images with volume scan, characteristically elongated appearance of discoid lateral meniscus was clearly depicted. These MR findings completely accorded with those on arthroscopy. Our conclusion is that an axial 3D volume scan was essential to the diagnosis of discoid lateral meniscus.     

Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation

An MRI diagnosis of the Wrisberg variant discoid lateral meniscus should be considered in patients presenting with an anteriorly flipped posterior horn fragment without a definable peripheral rim. We present four cases discovered on arthroscopy that were thought to resemble bucket-handle tears on preoperative MRI. Posterior hypermobility poses a surgical challenge as excessive debridement without careful attention to underlying meniscal morphology may lead to further instability. Although this diagnosis can be difficult to make on MRI, alerting the orthopedic surgeon preoperatively may influence repair technique and meniscus conservation.     

Epidemiologic, clinical and arthroscopic study of the discoid meniscus variant in Greek population

This retrospective study was aimed to investigate the epidemiologic, clinical and arthroscopic features of discoid meniscus variant in Greek population. We reviewed the cases of 2,132 patients who underwent knee arthroscopy between 1986 and 2004 and diagnosis of discoid lateral meniscus was established in 39 patients with mean age of 31.7 ± 9.4 years old. Incidence of the discoid lateral meniscus variant was recorded at rate of 1.8% presenting no significant differences according to patient gender or lesion body side. Regarding the type of discoid dysmorphy, 23 cases attributed to complete type, 15 were incomplete and in one case, Wrisberg type was observed. Predictive values of the most commonly recorded physical signs in the clinical diagnosis of the discoid meniscus were analysed. Comparative evaluation of the long-term results of arthroscopic partial meniscectomy performed in patients with intact or torn discoid lateral meniscus and torn normally shaped lateral meniscus was carried out using Lysholm and IKDC scoring systems. Also, we investigated any correlation between dysmorphy type and tear pattern analysing the arthroscopic findings. Results demonstrated that the discoid meniscus lesion represents an atypical clinical entity in adults and no significant predictive value of the signs encountered in the clinical examination of the patients with discoid meniscus was observed. Clinical outcome after arthroscopic partial meniscectomy regarding the intact discoid meniscus group was superior in comparison with that of torn discoid meniscus cases. On other hand, no difference in the result of partial meniscectomy between discoid and normal lateral meniscus tear groups was found. No statistically significant relationship between the type of discoid menisci and tear pattern or incidence rate of concomitant intraarticular lesions was confirmed.     

Discoid lateral meniscus can be overlooked by magnetic resonance imaging in patients with meniscal tears

Purpose

MRI evaluation of torn lateral meniscus was compared with arthroscopy. This study calculates the sensitivity, specificity, and accuracy of MRI in determining the presence or absence of discoid lateral meniscus (DLM) for different tear types.

Methods

MR imaging of 156 knees with arthroscopically confirmed lateral meniscus tears was analysed. There were 78 knees (70 patients) in non-DLM group and 78 knees (74 patients) in DLM group on arthroscopy as the reference standard. The presence of DLM on MRI was determined by an orthopaedic surgeon and a radiologist, who were blinded to the arthroscopic findings. The presence of discoid meniscus on MRI was determined by coronal and sagittal measurements, considering the tear pattern of lateral meniscus. The tear pattern was categorized into six types based on arthroscopic findings: horizontal, longitudinal, radial, combined radial, degenerative, and complex tear. The sensitivity, specificity, and accuracy of MRI were calculated for each type of lateral meniscus tear. In addition, we analysed the reason for non-detection of discoid meniscus on preoperative MRI.

Result

The sensitivity for determining the presence of discoid meniscus was 58% for radial tear, 57% for combined radial tear, and 65% for longitudinal tear, whereas the specificity was 100% for all tear groups. In the presence of radial or longitudinal tear, the accuracy of MRI was significantly lower than having no radial and longitudinal tear (p < 0.001). The presence of discoid meniscus was not recognized on MRI because of large radial tear (12 knees), deformed bucket-handle tear (6 knees), and inverted flap tear (3 knees).

Conclusions

MRI was not successful in determining the presence or absence of DLM in radial tear, combined radial tear, and longitudinal tear. When there are large radial tear, deformed bucket-handle tear, and inverted flap tear in lateral meniscus, it is recommended to consider the possibility of DLM. This information can help to make accurate diagnosis of DLM, which allows appropriate surgical planning and facilitates patient’s information on poor prognosis of DLM.

Level of evidence

Level I.