常规MRI与MR关节造影诊断肩袖撕裂的初步对比研究

目的 比较3.0T常规MRI和MR关节造影检查对肩袖撕裂的诊断价值.方法 分析48例肩关节病变患者的常规MRI和MR关节造影检查资料,确定肩袖有无撕裂并进行分型.其中4例行肩关节镜检查.采用配对x2检验比较两种检查方法诊断肩袖撕裂的差异性.结果 常规MRI显示冈上肌腱全层撕裂6例,冈上肌腱部分撕裂9例;MR关节造影显示冈上肌腱全层撕裂7例,冈上肌腱部分撕裂8例.常规MRI和MR关节造影检查方法对肩袖全层撕裂诊断有6例相同,1例常规MRI诊断无撕裂MR关节造影诊断为撕裂;对肩袖部分撕裂的诊断有7例相同,3例不同,其中2例常规MRI诊断为撕裂而MR关节造影诊断为无撕裂,1例常规MRI诊断为无撕裂而MR关节造影诊断为撕裂;两种检查方法对肩袖全层撕裂(x2=0.000,P＞0.05)及部分撕裂(x2=o.000,P＞0.05)的诊断差异无统计学意义.结论 初步显示3.0T常规MRI对肩袖全层撕裂和肩袖部分撕裂的诊断能达到MR关节造影的诊断效果,同时可以显示肩袖撕裂伴发的各种异常.     

肩袖损伤的MRI诊断比较研究

目的:比较常规MRI和MRI间接关节造影检查对肩袖撕裂伤的诊断价值.方法:搜集2002年11月～2006年8月共40例肩袖损伤病例,20例行常规MRI检查,20例行MRI间接关节造影检查.以肩关节镜作为诊断标准,比较两种影像学方法诊断肩袖损伤的敏感性和特异性.结果:肩袖完全撕裂中,常规MRI检查的敏感度为45.5%,特异度为66.7%,准确度为55%;MRI间接关节造影的敏感度为92.3%,特异度为85.7%,准确度为90%.肩袖不全撕裂中,常规MRI检查敏感度为57.1%,特异度为53.8%,准确度为55%;而间接关节造影敏感度为83.3%,特异度为92.8%,准确度则为90%.经Fisher确切概率统计法统计,MRI间接关节造影诊断肩袖全层撕裂敏感性及准确性明显高于常规MRI(P＜0.05),在诊断肩袖部分撕裂时,MRI间接关节造影的特异性及准确性明显高于MRI(P＜0.05).结论:MRI间接关节造影较常规MRI诊断肩袖撕裂准确性较高.同时对盂唇等其它病变诊断有帮助.     

肩关节造影及液压扩张疗法治疗冻结肩的临床研究

目的 探讨肩关节造影及液压扩张法治疗冻结肩的关节造影表现、评价治疗作用和影响疗效的相关因素,材料和方法 对19例经我院骨科确诊为冻结肩的病人进行肩关节造影并同时进行液压扩张治疗,观察造影表现和临床随诊、评价其症状缓解和关节功能恢复情况。结果 19例冻结肩均有关节容量的缩小,平均容量仅6.5ml,其中腋隐窝缩小、消失者14肩（73％）;肱二头肌长头腱鞘不显影或育盈不良者15肩（79％）;肩胛肌下滑囊缩小者10肩（53％）;关节囊边缘不规整者7肩（37％）。液压扩张治疗优效率：轻、中型100％,重型70％。结论 液压扩张疗法治疗冻结肩,并辅以积极的术后功能锻练是安全、经济而有效的方法,能达到缓解临床症状、恢复关节功能的目的。     

Contrast enhanced cartilage imaging: Comparison of ionic and non-ionic contrast agents

Our objective was to compare relaxation effects, dynamics and spatial distributions of ionic and non-ionic contrast agents in articular cartilage at concentrations typically used for direct MR arthrography at 1.5T. Dynamic MR-studies over 11h were performed in 15 bovine patella specimens. For each of the contrast agents gadopentetate dimeglumine, gadobenate dimeglumine, gadoteridol and mangafodipir trinatrium three patellae were placed in 2.5mmol/L contrast solution. Simultaneous measurements of T(1) and T(2) were performed every 30min using a high-spatial-resolution "MIX"-sequence. T(1), T(2) and DeltaR(1), DeltaR(2) profile plots across cartilage thickness were calculated to demonstrate the spatial and temporal distributions. The charge is one of the main factors which controls the amount of the contrast media diffusing into intact cartilage, but independent of the charge, the spatial distribution across cartilage thickness remains highly inhomogeneous even after 11h of diffusion. The absolute DeltaR(2)-effect in cartilage is at least as large as the DeltaR(1)-effect for all contrast agents. Maximum changes were 5-12s(-1) for DeltaR(1) and 8-15s(-1) for DeltaR(2). This study indicates that for morphologically intact cartilage only the amount of contrast agents within cartilage is determined by the charge but not the spatial distribution across cartilage thickness. In addition, DeltaR(2) can be considered for quantification of contrast agent concentrations, since it is of the same magnitude and less time consuming to measure than DeltaR(1).     

Contrast reaction from hip arthrogram

Arthrography is considered a safe procedure with rare reactions to intra-articular contrast administration. Although the use of intra-articular contrast carries a small risk of reaction, no prior serious complications had been encountered in our experience with arthrography. We report a patient’s prolonged reaction to contrast media after an arthrogram of the hip. Literature review demonstrated no prior report of contrast media reactions to hip arthrography. Therefore, we decided to review the literature and report our case.     

颞下颌关节紊乱病关节造影—介入治疗

本研究通过造影操作同时完成对患者的治疗工作,提出“关节造影－介入治疗”的概念。方法随机选择ＴＭＤ行关节造影检查的３０例病人。其中滑膜炎表现并经关节造影诊断为不可复性盘前移位者１６例;临床上仅有开口受限或明显开口偏斜,经关节造影诊断为不可复性盘前移者１２例;     

超声和关节造影辅助下治疗儿童肱骨远端骨骺分离的临床疗效分析

目的:比较超声与关节造影辅助下闭合复位经皮内固定术治疗儿童肱骨远端骨骺分离的临床疗效。方法:收集2013年4月至2017年8月收治于华中科技大学同济医学院附属武汉儿童医院骨科的30例肱骨远端骨骺分离的患儿的相关资料。其中,男25例,女5例;平均年龄为20.7个月,年龄范围为10~38个月;患侧为左侧10例,右侧20例。...     

Direct magnetic resonance arthrography

Magnetic resonance (MR) arthrography has gained increasing popularity as a diagnostic tool in the assessment of intra-articular derangements. Its role has been studied extensively in the shoulder, but it also has been explored in the hip, elbow, knee, wrist and ankle. This article reviews the current role of direct MR arthrography in several major joints, with consideration of pertinent anatomy, techniques and applications.     

Gleno-humeral instabilities

The purpose of this review is to highlight the most efficient imaging exploratory techniques depicting shoulder instability, to describe its various forms and to point out the findings which can simulate instability. In anterior recurrent dislocation, surgery is indicated and the procedure essentially depends on the importance of glenoid rim lesions. In this case, a standard X-ray evaluation is usually sufficient. The CT arthrography or MRI techniques give more specific details as to the severity of the lesions, particularly soft tissues alterations; however, these data do not alter standard therapeutic protocol. In fixed posterior dislocations, CT scan represents the most pertinent technique to evaluate the size of the humeral head defect and to determine the therapeutic follow-up. In subtle forms of instability, diagnosis or instability direction are not clearly assessed clinically and standard X-ray evaluation is usually unremarkable. In this case, further exploration, such as CT arthrography, MR imaging or MR arthrography, are recommended to confirm the diagnosis of instability and to evaluate its direction. The technique of choice is undoubtedly MR arthrography. Atraumatic voluntary painless subluxations associated with hyperlaxity of the shoulder do not require any specific exploratory method because the findings are generally limited to a capacious axillary pouch. Received: 28 September 1998; Revised: 21 January 1999; Accepted: 22 March 1999     

弥散法MR膝关节造影可行性研究

目的评价MR对比剂静脉内注射、膝关节腔内弥散关节造影的可行性研究并寻找最佳检查参数. 资料与方法选取膝关节正常者24名,按常规方法进行扫描后再将其分为运动组和未运动组.每组再分为3小组.3个小组分别从静脉注入不同剂量的Gd-DTPA.注射完后未运动组受检者静卧于检查床,进行延迟扫描;运动组步行10 min后再进行扫描,并进行延迟.扫描结束后,对平扫和增强图像中的关节腔周围组织及关节腔内信号进行测量.采集后的数据按组归类,并进行统计处理,观察对比剂注射后关节腔内信号增加程度并选取最佳检查方法. 结果弥散法膝关节造影可使关节腔信号强度明显增加,与周围组织产生明显信号差,以采用注射剂量为0.2 mmol/kg体重,注射后受检者正常步行10 min后造影效果最佳. 结论弥散法MR膝关节造影可起到关节造影的效果,造影效果良好,是一种操作简单、危险性小、并发症少的检查方法.