MR关节造影评价肩关节损伤并与关节镜对照研究

目的以关节镜诊断结果为对照,研究探讨磁共振关节造影对肩袖及关节盂唇损伤的诊断价值,以期为提高肩关节损伤的诊断准确性提供指导依据。方法收集我院就诊的120例肩关节损伤患者,所有患者均接受常规肩关节MR扫描、MR关节造影检查、肩关节镜检查,分析常规MR、MR关节造影、关节镜检查的诊断结果,以关节镜诊断结果为金标准,计算和比较常规MR、MR关节造影对肩袖损伤、盂唇损伤的诊断灵敏度、特异度、准确性,再采用Kappa一致性检验,分析常规MR、MR关节造影诊断结果与关节镜诊断结果之间的一致性。结果以关节镜诊断结果为对照,MR关节造影对肩袖损伤的诊断灵敏度、特异度、准确性分别为97.70%、96.97%、97.50%,常规MR对肩袖损伤的诊断灵敏度、特异度、准确性分别为89.66%、81.82%、87.50%;MR关节造影对盂唇损伤的诊断灵敏度、特异度、准确性分别为95.83%、97.22%、96.67%,常规MR对肩袖损伤的诊断灵敏度、特异度、准确性分别为81.25%、84.72%、83.33%;经比较,MR关节造影对肩袖损伤、盂唇损伤的诊断灵敏度、特异度、准确性均高于常规MR(P<0.05)。经一致性检验,MR关节造影对肩袖损伤、盂唇损伤的诊断结果与关节镜诊断结果之间的一致性均达到良好(Kappa分别为0.719、0.725),而常规MR对肩袖损伤、盂唇损伤的诊断结果与关节镜诊断结果之间的一致性仅为中等(Kappa分别为0.531、0.547)。结论在肩关节损伤诊断中,采用MR关节造影检查可获得与关节镜相当的诊断结果,可准确检出肩袖损伤和盂唇损伤。

Evaluation of Shoulder Joint Injury by MR Arthrography and a Comparative Study with Arthroscopy

Objective To study the diagnostic value of magnetic resonance arthrography(MRA) in the diagnosis of rotator cuff and glenoid lip injury. Methods A total of 120 patients with shoulder injuries were treated in our hospital. All the patients were examined by MR arthrography and arthroscopy. The diagnostic results of MR arthrography and arthroscopy were analyzed. The diagnostic sensitivity, specificity and accuracy of conventional MR arthrography in the diagnosis of rotator cuff injury and glenoid labrum injury were calculated and compared with the golden standard of arthroscopic diagnosis. Kappa consistency test was used. Results The diagnostic sensitivity and specificity of MR arthrography in the diagnosis of rotator cuff injury were compared with those of arthroscopy. The diagnostic sensitivity, specificity and accuracy of conventional MR in the diagnosis of rotator cuff injury were 89.66%, 81.82% and 87.50%, respectively.;The sensitivity, specificity and accuracy of MR arthrography in the diagnosis of glenoid lip injury were 95.83% and 97.22% and 96.67%. The sensitivity and specificity of conventional MR in diagnosis of rotator cuff injury was 81.25% and 84.72%, respectively. The sensitivity, specificity and accuracy of MR arthrography in the diagnosis of rotator cuff injury and glenoid lip injury were higher than that of conventional MR(P<0.05). The agreement between the diagnostic results of pelvic lip injury and arthroscopy was good. The Kappa was 0.719 and 0.725, respectively, while conventional MR showed rotator cuff injury. The diagnostic results of glenoid lip injury were not as good as those of arthroscopic diagnosis, Kappa were 0.531 and 0.5470. Conclusion MR arthrography can be used to detect the rotator cuff injury and glenoid lip injury.