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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:

第23卷

期數(shù):

2011年06期

頁碼:

13-15

欄目:

臨床研究

出版日期:

2011-06-30

文章信息/Info

Title:

Evaluation on the value of magnetic resonance imaging in the diagnosis of cartilage lesions in knee joint

作者:

王平; 金哲峰

天津中醫(yī)藥大學(xué)第一附屬醫(yī)院,天津 300193

Author(s):

WANG Ping^*; JIN Zhe-feng.^*

The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300193,China

關(guān)鍵詞:

膝關(guān)節(jié) 軟骨疾病 磁共振成像 關(guān)節(jié)鏡檢查 回顧性研究

Keywords:

Knee joint;  Cartilage diseases;  Magnetic resonance imaging;  Arthroscopy;  Retrospective studies

摘要:

目的:評價磁共振成像各序列在膝關(guān)節(jié)軟骨損傷診斷中的價值,為臨床醫(yī)生診斷和治療膝關(guān)節(jié)軟骨損傷提供可靠的依據(jù)。方法:回顧性分析106例膝關(guān)節(jié)病變患者關(guān)節(jié)鏡術(shù)前磁共振成像的檢查結(jié)果與關(guān)節(jié)鏡檢查結(jié)果。將每個膝關(guān)節(jié)的軟骨面分成6個部分:髕骨、股骨滑車、股骨內(nèi)髁面、股骨外髁面、脛骨平臺內(nèi)側(cè)面和脛骨平臺外側(cè)面。根據(jù)關(guān)節(jié)鏡檢圖片和手術(shù)記錄對各個觀察面的軟骨損傷進行分級,并以此為標(biāo)準(zhǔn),評價術(shù)前MRI常規(guī)快速自旋回波T1加權(quán)像、快速自旋回波T2加權(quán)像及三維脂肪抑制擾相梯度回波3個序列對關(guān)節(jié)軟骨損傷的診斷和病變分級報告。采用診斷試驗的一致性檢驗對MRI各序列在膝關(guān)節(jié)軟骨損傷診斷中的價值進行評價。結(jié)果:在與關(guān)節(jié)鏡診斷的一致性上,快速自旋回波T1加權(quán)像序列和快速自旋回波T2加權(quán)像序列一致性中等(Kappa=0.534,P=0.000; Kappa=0.581,P=0.000); 三維脂肪抑制擾相梯度回波序列的一致性非常好(Kappa=0.850,P=0.000); 在敏感度和準(zhǔn)確度方面,三維脂肪抑制擾相梯度回波(96.5%,94.1%)>快速自旋回波T2加權(quán)像(62.8%,73.6%)>快速自旋回波T1加權(quán)像(51.6%,69.2%); 三者的特異度相差較小。結(jié)論:磁共振成像三維脂肪抑制擾相梯度回波序列診斷關(guān)節(jié)軟骨損傷病變,具有較高的準(zhǔn)確性和敏感度,與關(guān)節(jié)鏡診斷具有良好的一致性,是診斷關(guān)節(jié)軟骨損傷的較好方法。

Abstract:

Objective:To make an evaluation on the value of every sequence of magnetic resonance imaging(MRI)in the diagnosis of cartilage lesions in knee joint,and to provide the reliable basis for the clinicians in the diagnosis and treatment of knee cartilage lesions.Methods:MRI findings before arthroscopy and arthroscopic findings of 106 patients with knee lesions were analyzed retrospectively.Every chondral surface of knee joint was divided into the following 6 parts as patellar surface,surface of femoral trochlea,surface of medial condyle of femur,surface of lateral condyle of femur,medial surface of tibial plateau and lateral surface of tibial plateau.The degree of cartilage lesions of each observational surface was evaluated and classified according to arthroscopic pictures and operation records,and the results were regarded as the criteria to evaluate the reports of diagnosis and lesions classification for the articular cartilage injury affected from the following 3 sequences as T1-weighted images of conventional fast spin-echo(FSE-T1WI),T2-weighted images of conventional fast spin-echo(FSE-PD/T2)and three-dimensional fat-suppressed spoiled gradient echo(FS-3D-SPGR)in preoperative MRI.The values of every MRI sequence in the diagnosis of cartilage lesions in knee joint were evaluated by using the consistency check of diagnostic test.Results:FSE-T1WI sequence and FSE-PD/T2 sequence had mid-level consistency with the arthroscopic diagnosis respectively(Kappa=0.534,P=0.000; Kappa=0.581,P=0.000),while FS-3D-SPGR sequence had high-level consistency with the arthroscopic diagnosis(Kappa=0.850,P=0.000).On the aspect of sensitivity and accuracy,there was a relationship as:FS-3D-SPGR(96.5%,94.1%)>FSE-PD/T2(62.8%,73.6%)>FSE-T1WI(51.6%,69.2%); and there was a less difference in specificity among the 3 sequences.Conclusion:FS-3D-SPGR sequence in MRI is a better method in the diagnosis of knee cartilage lesions for its higher sensitivity and accuracy and good consistency with the arthroscopic diagnosis.

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更新日期/Last Update: 2011-06-30