膝关节软骨病变磁共振成像序列的研究

目的通过比较四种磁共振（MR／）成像序列诊断膝关节软骨病变的准确性，探讨各序列的优缺点，评价诊断软骨病变的最佳序列。方法31例36侧膝关节镜检查患者，将每侧膝关节软骨面分为5个区域。MR／成像采用快速自旋回波T1加权序列（TIWI-TSE）、脂肪抑制T2加权快速回波序列（T2WI-TSE—SPIR）、脂肪抑制质子密度快速自旋回波序列（PDW—TSE—SPIR）、扰相三维脂肪抑制梯度回波系列（3D-WATSC）四个序列。按Recht标准分级诊断180个关节软骨面，分别与膝关节镜分级诊断结果对照。MRI各序列诊断价值的真实性指标为敏感度、特异度、准确度，一致性指标用Kappa值。结果以关节镜诊断为标准，各序列诊断软骨病变的敏感度、特异度、准确度、Kappa值分别为：T1WI-TSE序列诊63．8％、95．3％、78．8％、0．403；RWI-TSE—SPIR序列56．3％、97．6％、76．1％、0．353；PDW-TSE．SPIR序列79．8％、93．0％、86．1％、0．642；3D—WATSC序列96．8％、88．3％、92．8％、0．812。结论3D．WATSC序列诊断膝关节软骨病变的准确度及Kappa值均优于其它序列，与关节镜诊断结果具有一致性，是诊断膝关节软骨病变的最佳扫描序列。

Study on MRI sequences in the diagnosis of articular cartilage injury of the knee joint

Objective To compare the accuracy of the four sequences of MRI in the diagnosis of articular cartilage injury of the knee and to investigate the advantage and shortage of the four sequences. In order to evaluate the most adequate sequence in detecting articular cartilage injury of the knee. Methods 36 knee joints of 31 patients,underwent MRI scanning prior to arthroscopy included T1WI-TSE,T2 WI-TSE-SPIR, PDW-TSE-SPIR,3D-WATSC. Divided each knee side of every cartilage into five parts. Investigated and diagnosed the 180 articular cartilage surface according to Recha criteria by detecting and compared with arthroscopic examination respectively. The accurate criteria of the four sequences of MRI was sensitivity, specificity, accuracy. The criteria of correlation was the value of Kappa.Results Compared with the arthroscopic result which was the gold standard, the sensitivity, specificity, accuracy and Kappa value of the T1 W-TSE sequence was 63.8％ ,95.3％ ,78.8％ and 0. 403 respectively;The sensitivity,specificity ,accuracy and Kappa value of the T2WI-TSE-SPIR sequence was 56.3％ ,97.6％ ,76.1％ and 0. 353 respectively.The sensitivity,specificity,accuracy and Kappa value of the PDW-TSE-SPIR sequence was 79. 8％, 93.0％ ,86. 1％and 0. 642 respectively; The sensitivity, specificity, accuracy and Kappa value of the 3D-WATSC was 96. 8％,88. 3％ ,92.8％ and 0. 812 respectively. Conclusion The accuracy and Kappa values of Fat-suppressed three-dimensiunal fast spoiled gradient-echo sequence (3D-WATSC)was superior to other sequences in the diagnosis of articular cartilage injury of the knee. The correlation between 3D-WATSC and arthroscopy in detecting cartilage injury was remarkable. 3D-WATSC had been deemed the most adequate sequence in detecting articular cartilage injury of the knee.