磁化传递减影图像对膝关节退行性骨关节病的诊断价值

目的分析膝关节退行性骨关节病骨髓水肿与疼痛的关系，探讨磁化传递对比梯度回波T2加权序列（MTC-GRET2WI）减影图像对骨髓水肿及软骨损伤的诊断价值。方法对122例临床诊断退性行骨关节病的病例进行MR检查；其中42例病例、行关节镜探查手术。根据患者近期临床症状，根据有、无膝关节疼痛症状分为两组，两组骨髓水肿的发生率行x0检验；MTC-GRET2W、FSE序列T1WI、T2WI显示骨髓水肿的效果比较用Wi1coxon秩和检验：MTC-GRE T2WI、T2WI序列显示软骨损伤的比较，用配对x2检验。结果122例患者中有疼痛症状病例组骨髓水肿发生率71．79％（56／78）；无疼痛症状组，骨髓水肿发生率2O．45％（9／44）。两组差异有统计学意义（X2=29．79，P〈0．05）。MTC-GRET2W与FSE序列T1WI及T2WI的骨髓水肿显示效果的比较，差异有统计学意义（T1WI与T2WI，Z=一0．327，P〉0．05：MTC-GRET1W与T1WI，Z=一7．706，P〈0．05；MTC—GRET2w与T2WI比较，Z：一7．295，P〈0．05）。以关节镜为标准，MTC-GRET2WI和T2WI序列诊断膝关节软骨损伤的KaPPa值分别为0．86和0．74，MTC-GRE检查结果与关节镜显示结果一致性好：MTC-GRE敏感度91．1％，特异度96．5％，T2WI敏感度76．9％，特异度95．7％，差异有统计学意义（X2=4．75，P〈O．05）。结论膝关节退变的急性期疼痛与骨髓的水肿密切相关，MTC-GRET2WI序列能清楚显示骨髓水肿；该序列还能够准确判断关节软骨的损伤，有较大临床应用价值。

Magnetization Transfer Subtraction Pic- ture in the Diagnosis of Degenerative Os- teoarthritis of the Knee

Objective 3b study the relation of the ache and the marrow edema of the bone and to investigate the diagnostic value of Magnetization transfer contrast gradi- ent echo T2-weighted sequence （MTC-GRE T2WI） subtraction picture in the mar- row edema of the bone and the cartilage injmy in osteoarthritis of the knee. Methods MR examinations were performed in 122 cases with clinical diagnosed osteoarthritis of the knees, According to the near term clinical symptom include the ache and no ache, the cases were divided into two groups. The independent sample t-test was applied to compare the marrow edema incidence rates of two groups, the compare of the effects of marrow edema displayed by MTC-GRE T2W, FSE sequence T1 WI and T2WI were statistically analyzed with x2-test. The compare of cartilage harm displayed by MTC-GRE T2W and T2WI were statistically analyzed with paired x2- test. Resuits In 122 cases, 78 cases had ache symptom, the marrow edema is in 56 cases and incidence rate was 71.79% ; 44 cases had no ache symptom, the marrow edema is in 9 case and the incidence rate was 20.45%. Significant difference was found between two group （x2=29.79, p〈0.05）. The effects of marrow edema displayed by MTC-GRE T2W. FSE sequence T 1WI, T2WI were significant difference （T 1WI and T2WI, z=-0.327, p 〉 0.05; MTC-GRE T2W and TIW1, z=-7.706, p〈0.05： MTC- GRE T2W aud T2WI, z-=-7.295, p〈0,05）. Compared with the arthroscopy, the Kappa with MTC-GRE T2WI and T2WI were respectively 0.86 and 0.74. The correlation between MTC-GRE T2WI and arthroscopy is better. The sensitivity, peculiarity with MTC-GRE T2WI was respectively 91.1%, 96.5%; the sensitivity, peculiarity with T2WI was respectively 76.9%, 95.7%. The difference was signifi- cant between two sequences （x2=4.75, P〈0.05）. Conclusion The ache in osteoarthri- tis of the knee is related with the marrow edema of the bone. MTC-GRE T2WI sequence digital subtraction picture can display marrow edema and the harm of crite- rion joint cartilage accurately, has more value in clinical application.