磁共振二维常规序列成像对膝关节软骨缺损的诊断价值

目的观察磁共振二维快速自旋回波(fast-spin-echo,FSE)序列对膝关节软骨缺损的显示及分级,利用更科学地统计学方法评价其诊断价值。材料与方法行膝关节磁共振检查的患者中,顺序选取了40名有关节镜软骨评分的患者。三位经验丰富的放射科医师盲评40例膝关节FSE序列(T1/T2/质子密度)图像并对软骨缺损进行分级。以关节镜结果为标准,计算FSE序列对膝关节软骨缺损检出的敏感度、特异度、准确度。应用Kappa一致性检验分析FSE图像与关节镜评分的一致性,同时分析三位阅片者之间的评分一致性。结果二维FSE序列对膝关节软骨缺损的检出有较高的敏感度、特异度和准确度分别为81%、85.4%和83.5%。FSE图像与关节镜评分结果相比,表现了中等到好的一致性,Kappa=0.557-0.676(P0.001)。各位阅片者两两间对膝关节软骨缺损的评分表现了很好的一致性,Kappa=0.672-0.718(P0.001)。结论二维FSE序列对膝关节软骨显示良好,对软骨缺损分级有较高的诊断价值。同时,该序列对于软骨缺损评分具有较高的阅片者间一致性,更能体现此序列的诊断价值。

The Evaluation of Two-dimensional Routine MR Imaging in Diagnosis of Articular Cartilage Defect of the Knee

Objective To evaluate two-dimensional fast-spin-echo （FSE） imaging in the displaying of knee cartilage defect with more accurate statistical analysis.Materials and Methods Forty patients were consecutively selected who performed arthroscopy after the MRI examination. Three experienced radiologists, blinded to arthroscopy report, reviewed FSE images and graded knee cartilage defects. By using arthroscopy as the reference standard, the sensitivity, specificity and accuracy of FSE imaging for detecting all knee cartilage lesions were calculated. Kappa statistic was used to measure inter-observer agreement and agreement between the grade at arthroscopy and the grade assigned at FSE imaging.Results Two-dimensional FSE imaging had good sensitivity, specificity and accuracy for detecting knee cartilage defects （81%,85.4% and 83.5%, respectively）. Inter-observer agreement and The agreement between the grade assigned at arthroscopy and the grade at FSE imaging were moderate to substantial （Kappa=0.557-0.676, P〈0.001） and the inter-observer agreement were substantial （Kappa=0.672-0.718,P〈0.001）. Conclusion Two-dimensional FSE imaging has good diagnostic performance for evaluating the articular cartilage of the knee in clinical patients. This sequence has high inter-observer agreement which shows diagnostic performance better.