3.0 T MRI 3D-SPACE序列对膝关节半月板损伤的诊断价值

目的：探讨3.0 T MRI三维快速自旋回波序列（3D-SPACE）对膝关节半月板损伤的诊断价值。方法：收集经关节镜确诊的膝关节半月板损伤60例为研究对象，均行3.0 T MRI 3D-SPACE序列与2D-SPACE序列扫描。对2种检查方法诊断半月板损伤准确率及半月板和各种组织的对比噪声比进行比较。结果：3D-SPACE序列图像半月板与韧带的对比噪声比明显高于2D-SPACE序列（P<0.05）。3D-SPACE序列诊断半月板斜行撕裂的准确率明显高于2D-SPACE序列（P<0.05）。结论：3.0 T MRI3D-SPACE序列应用于膝关节半月板损伤的诊断中可有效提高半月板损伤的诊断准确性，具有一定的临床诊断价值。     

膝关节MRI平扫与直接法造影诊断半月板损伤准确性分析

目的:比较分析MRI平扫与造影MRI对半月板损伤诊断的准确性。方法:100例疑似半月板损伤患者,行MRI矢状位T1WI、T2WI GRE、STIR、PD+Fatsat,冠状位T2WI GRE,平扫后立即在直接关节腔内注射对比剂行矢状位、冠状位、轴位T1WI,层厚4mm、层距1mm。结果:94例经关节镜或手术确诊为半月板撕裂,其中,MRI GRE序列诊断撕裂84例,膝关节MRI造影诊断83例。6例经关节镜或手术确诊为正常或变性,MR GRE序列和膝关节MRI造影也为正常或变性。结论:MRI平扫与MRI造影对半月板损伤的诊断准确性差异无统计学意义(P>0.05)。     

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。     

关节镜下微创治疗儿童膝关节外侧盘状半月板损伤的疗效分析

目的 探讨关节镜下微创治疗儿童膝关节外侧盘状半月板损伤的疗效.方法 1996年3月-2008年3月共对229例盘状半月板损伤患儿进行关节镜检查以及关节镜下微创手术.男133例,女96例;年龄4～14岁[(9.2±3.5)岁].219例进行盘状半月板修整成形术(包括2例术后复发患儿),8例进行盘状半月板修整成形缝合术,2例进行盘状半月板次全切除术.手术前、后采用Lysholm评分对膝关节功能进行评定.结果 221例得到随访,8例失访,随访时间5～144个月[(65±48.9)个月].所有患儿术后6个月膝关节疼痛及肿胀症状消失或明显减轻,活动度恢复正常.术后无感染、血管神经损伤、关节活动受限等手术并发症.术前Lysholm评分为45～73分[(61.85±7.65)分],术后6个月提高至87～100分[(95.30±3.50)分](t=26.778,P<0.01).结论关节镜下微创手术治疗儿章膝关节外侧盘状半月板损伤创伤小、疗效佳,能很好地保留半月板形态,维持其生理功能,减少膝关节炎发生率.     

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.     

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。     

关节镜下盘状半月板损伤治疗效果影响因素分析

目的探讨关节镜下盘状半月板损伤疗效的影响因素。方法将我院2000年12月～2011年12月198例膝关节（212膝）盘状半月板损伤的关节镜手术,通过12个月以上的随访,观察患者年龄、症状持续时间、软骨损伤、损伤类型、手术方式对盘状半月板疗效的影响。术后采用Ikeuehi评价标准对膝关节功能进行评定。结果依据Ikeuehi评分标准：优74膝,良67膝,中71膝。患者年龄〈20岁,持续症状〈1年,无软骨损伤程度,半月板成型术均有利于盘状半月板损伤治疗,而损伤类型和疗效无关。结论患者年龄、症状持续时间、软骨损伤程度、手术方式对盘状半月板的治疗效果影响较大。     

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。     

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。     

磁共振T2-mapping成像对早期膝关节软骨损伤的诊断价值研究

目的：测量不同程度膝关节骨关节炎（osteoarthritis,OA）患者和正常对照组关节软骨的T2弛豫时间并比较其差异性,评价磁共振T2-mapping成像在早期膝关节软骨损伤中的应用价值。方法：采用GE signa 3.0T磁共振扫描系统T2-mapping成像测量OA组（n=78）和正常组（n=32）膝关节股骨内侧髁、外侧髁,胫骨内侧髁、外侧髁4处软骨的T2值,并进行统计学分析。结果：正常组、轻度OA组、重度OA组平均T2值分别为（38.36±2.45）ms（、49.28±4.24）ms、（53.12±5.36）ms,病例组与对照组关节软骨表面T2值有差异且具显著性统计学意义（P〈0.05）,轻度OA组和重度OA组之间差别无统计学意义（P〉0.05）。结论：T2-mapping成像可以发现没有形态学改变的关节软骨内组织成分的变化,对早期膝关节软骨损伤的诊断和监测具有很高的临床应用价值。     

低场MR在膝外伤中的应用价值

目的探讨低场(0.35 T)MR在膝外伤中的应用及诊断价值。方法对67例X线、4例同时行CT检查均未见明显异常的膝外伤患者行低场MR常规检查,常规自旋回波(SE)T1WI矢状位、快速自旋回波(TSE)T2WI矢状位及T2脂肪抑制序列矢状位及冠状位成像。结果骨挫伤28例,韧带损伤17例,半月板损伤13例,54例患者关节腔内有不同程度的关节腔积液及周围软组织损伤。结论低场MR可诊断膝关节骨质、关节软骨、半月板、韧带、周围软组织的单一及复合损伤,膝外伤后经X线或CT检查无明显异常,临床体检阳性、症状明显者应首选MRI。     

膝关节交叉韧带损伤的MRI诊断

目的 :探讨MRI对膝关节交叉韧带损伤的诊断价值。方法 :回顾性分析 2 5例经手术或关节镜证实的前、后交叉韧带损伤患者 ,MR检查采用SE、TSE矢状位、冠状位及横断位T1WI、T2 WI及STIR。结果 :2 5例交叉韧带损伤中 ,部分性撕裂 16例 ,完全性撕裂 9例。MRI诊断交叉韧带部分性撕裂和完全性撕裂的符合率分别为 87.5 %和 88.9%。结论 :MR能较准确地诊断膝关节交叉韧带损伤及其并发症 ,为临床制订治疗方案提供可靠依据。     

Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee.     

Soft tissue twisting injuries of the knee

Objective: Twisting injuries occur as a result of differential motion of different tissue types in injuries with some rotational force. These injuries are well described in brain injuries but, to our knowledge, have not been described in the musculoskeletal literature. We correlated the clinical examination and MR findings of 20 patients with twisting injuries of the soft tissues around the knee. Design and patients: We prospectively followed the clinical courses of 20 patients with knee injuries who had clinical histories and MR findings to suggest twisting injuries of the subcutaneous tissues. Patients with associated internal derangement of the knee (i.e., meniscal tears, ligamentous or bone injuries) were excluded from this study. MR findings to suggest twisting injuries included linear areas of abnormal dark signal on T1-weighted sequences and abnormal bright signal on T2-weighted or short tau inversion recovery (STIR) sequences and/or signal to suggest hemorrhage within the subcutaneous tissues. These MR criteria were adapted from those established for indirect musculotendinous junction injuries. Results: All 20 patients presented with considerable pain that suggested internal derangement on physical examination by the referring orthopedic surgeons. All presented with injuries associated with rotational force. The patients were placed on a course of protected weight-bearing of the affected extremity for 4 weeks. All patients had pain relief by clinical examination after this period of protected weight-bearing. Conclusions: Twisting injuries of the soft tissues can result in considerable pain that can be confused with internal derangement of the knee on physical examination. Soft tissue twisting injuries need to be recognized on MR examinations as they may be the cause of the patient’s pain despite no MR evidence of internal derangement of the knee. The demonstration of soft tissue twisting injuries in a patient with severe knee pain but no documented internal derangement on MR examination may allow the orthopedic surgeon to elect for a trial of conservative nonsurgical management. Received: 28 December 2000 Revision requested: 8 February 2001 Revision received: 27 February 2001 Accepted: 27 February 2001     

Hemichorea-hemiballism in primary diabetic patients: MR correlation

PURPOSE: The purpose of this work was to describe the characteristic imaging findings and clinical presentations in patients with hemichorea-hemiballism (HC-HB) associated with nonketotic hyperglycemia (NKH) in primary diabetes mellitus (DM). METHOD: The MR findings from six patients with HC-HB associated with NKH in primary DM were evaluated. Their ages ranged from 43 to 81 years. CT was performed on three patients, one of whom underwent a SPECT exam and another who had follow-up MRI. RESULTS: A high-signal putaminal lesion was evident on the T1-weighted images in all cases without edema or mass effect. Three of the six cases also showed high-signal intensities in the caudate. Two cases revealed high-signal intensities in the globus pallidus, and the lesions extended to the midbrain in one patient. The T2-weighted and FLAIR images were more variable. One diffusion-weighted image showed increased signal intensity. All three patients who had postcontrast MRI showed no enhancement. Two of the three patients who had CT studies showed high attenuation and the other isodensity. The SPECT study showed decreased perfusion. In all our patients, the chorea resolved within days to weeks after correction of the underlying hyperglycemia. CONCLUSION: In patients with HC-HB with NKH in primary DM, T1-weighted MR images showed hyperintense lesions of the putamen or caudate. Early recognition of these imaging characteristics may facilitate the diagnosis of primary DM with hyperglycemia and lead to prompt and appropriate therapy.     

3.0T磁共振在乳腺检查中的初步应用

目的:探讨3.0T磁共振利用体部相控阵线圈进行乳腺检查的临床应用价值.方法:36例乳腺疾病患者中隆乳术后26例,乳腺癌6例,乳腺良性病变4例,均行常规MR T1WI、T2WI和压脂序列T2WI,17例行动态增强扫描,13例行扩散加权成像,并与术后病理结果进行对照分析.结果:36例乳腺疾病患者均能显示显示乳腺结构及邻近组织情况,图像清晰无变形.22例聚丙烯酰胺水凝胶注射隆乳术后患者,注入物于T1WI呈稍低信号、T2WI呈高信号,在脂肪抑制T2WI上显示最清晰,呈均匀高信号;4例角鲨烯注射液隆胸术后,注入物在T1WI和T2WI上呈小颗粒状脂肪信号影.6例乳腺癌于DWI上呈明显高信号,动态增强曲线呈早期信号快速上升,中晚期信号强度逐渐降低表现;4例发现腋窝淋巴结转移.4例乳腺良性病变,动态增强曲线呈逐渐上升改变.结论:3.0T磁共振结合体部相控阵线圈可显示隆胸材料的性质和分布,常规MRI扫描结合DWI和动态增强扫描对乳腺良恶性病变的鉴别诊断有重要临床价值.     

Grading medial collateral ligament injury: comparison of MR imaging and instrumented valgus-varus laxity test-device. A prospective double-blind patient study

Purpose: The role of MR imaging in grading medial collateral ligament (MCL) injury of the knee in comparison to other grading methods (clinical findings and instrumental measurement) is hardly documented in the literature. The purpose of this study is to compare the results of MR imaging in grading acute MCL injuries to the results of a clinical grading by an instrumented valgus-varus laxity tester (VVLT). Materials and methods: Twenty-one patients clinically suspected of acute MCL injury were tested by VVLT, a well documented and instrumented test-device. All patients subsequently underwent MR imaging of the knee. MCL injury was graded independently by VVLT and MR imaging using a classification method with reference to Petermann. Results: Ninteen patients had corresponding grading results by VVLT and MR imaging (kappa, 0.83; S.E., 0.10); 14 patients had a Grade I, four a Grade II and two patients had a Grade III MR imaged MCL injury. Associated lesions were also depicted on MR imaging (bone contusion (n = 3), ACL disruption (n = 2) and medial meniscal rupture (n = 1)). Conclusions: This study shows a very high degree of agreement between the results in grading acute MCL injuries with MR imaging and an instrumented valgus-varus laxity tester (VVLT). MR imaging depicted important, clinically undetected, additional lesions which can determine the treatment of MCL injury.     

膝关节损伤的MRI诊断

目的：探讨膝关节损伤的MRI特点、病理基础及临床意义。方法：分析52例膝关节损伤的MRI资料。结果：半月板损伤45例,MRI表现为黑色的半月板内出现结节状、线状、放射状裂隙样异常高信号,延伸达或未及关节软骨面两种,前交叉及后交叉韧带损伤24例,MRI表现为在条索状黑色韧带影中出现短T1长T2异常高信号,韧带变形,呈波浪状或不连续,胫骨移位,内、外侧副韧带损伤28例,表现为信号增高,形态增粗,边缘模糊,隐匿性骨折8例,表现为干骺端边界模糊的片状T1低信号影,T2信号多样,讨论：MRI对膝关节半月板、韧带损伤及隐匿性骨折的诊断有重要的临床意义,可对治疗方案的选择提供详尽的依据。     

离子型和非离子型MR对比剂在MR颈动脉动态增强中的应用

目的:探讨离子型和非离子型MR对比剂在MR颈动脉动态增强扫描中的应用价值。材料和方法:将2005-09~2006-06行颈动脉动态增强扫描的56例患者,随机分为A、B两组。A组28例,用离子型对比剂(Gd-DTPA),B组28例采用非离子型对比剂(Gd-DTPA-BMA)。用3.0TMR机行动态增强扫描。A、B两组的扫描参数相同。结果:56例均完成颈动脉动态增强扫描。两种对比剂的增强效果无明显差异(P>0.05)。两组对比剂不良反应中,A组1例出现恶心,B组1例出现发热症状的轻微不良反应外,两种对比剂在使用的安全性上无差异。结论:两种对比剂的增强效果及使用安全性无明显差异,非离子型对比剂是MR血管造影动态增强较为理想的对比剂。