膝关节韧带损伤的MRI诊断

目的:探讨膝关节韧带损伤的MRI表现及诊断价值。方法:36例临床怀疑膝关节损伤的患者于关节镜及手术前行MRI检查,以关节镜结果作为金标准,前瞻性分析膝关节韧带损伤的MRI表现及诊断价值。结果:关节镜证实前交叉韧带损伤21例,其中完全撕裂15例,部分撕裂6例,后交叉韧带损伤12例,正常患者15例。MRI诊断前交叉韧带损伤的敏感度为95.2%,特异度为80%,准确度为88.9%;诊断后交叉韧带损伤的敏感度为100%,特异度为95.8%,准确度为97.2%。结论:MR1是诊断膝关节韧带损伤的理想检查方法,具有较高的临床应用价值。     

膝关节急性前交叉韧带撕裂的常见MRI征象分析

目的 :分析膝关节急性前交叉韧带(anterior cruciate ligament,ACL)撕裂的MRI征象,提高对ACL撕裂的术前诊断和评估能力。方法:回顾性分析117例经关节镜或手术证实急性ACL撕裂患者的临床及影像学资料,分析其MRI征象。结果:117例MRI直接征象主要为ACL纤维中断或部分不连续、弥漫性增粗并信号增高、走行异常、胫骨附着处撕脱骨折;间接征象主要为胫、股骨外侧髁的"对吻性"骨挫伤或骨折、后交叉韧带曲率增大、胫骨前移位、内侧副韧带损伤、内侧半月板撕裂。评估分析5种MRI直接征象得出,ACL走行异常具有相对高的诊断敏感度和特异度;5种MRI间接征象均诊断特异度高而敏感度低。结论 :MRI直接征象能较准确地诊断急性ACL撕裂,并评估其撕裂程度,可作为主要诊断依据;而MRI间接征象特异度较高、敏感度相对较低,不能作为主要诊断依据,但对明确诊断具有较大帮助,可作为辅助诊断依据。     

前交叉韧带部分撕裂最大屈曲侧卧位MR成像效果

 目的 探讨前交叉韧带部分撕裂最大屈曲侧卧位MR成像效果。方法 将临床诊断为前交叉韧带部分撕裂的324例患者按照患者受伤到接受磁共振检查间期长短分成亚急性组、中间组、慢性组;所选患者都在接受常规体位及特殊体位膝关节MR检查后进行了关节镜检查。三位放射科医师对常规膝关节MR检查图像进行盲评,所得诊断结果列为A组,3个月后给相同的3位放射科医师提供膝关节常规体位检查图像和侧卧并最大屈曲位图像进行盲评,所得诊断结果列为B组。以关节镜结果为金标准,比较诊断符合率的差异。结果 B组对前交叉韧带部分撕裂的诊断率和关节镜结果更接近(Z=-0.732,P=0.47),阳性检出率明显高于MR常规体位组(P<0.001),尤其对处于中间期部分撕裂患者敏感度及特异度更高(敏感度25.64%,特异度94.73%)。结论 前交叉韧带部分撕裂最大屈曲侧卧位MR成像可提高诊断符合率。
     

膝关节交叉韧带损伤的MRI诊断

目的 :探讨MRI对膝关节交叉韧带损伤的诊断价值。方法 :回顾性分析 2 5例经手术或关节镜证实的前、后交叉韧带损伤患者 ,MR检查采用SE、TSE矢状位、冠状位及横断位T1WI、T2 WI及STIR。结果 :2 5例交叉韧带损伤中 ,部分性撕裂 16例 ,完全性撕裂 9例。MRI诊断交叉韧带部分性撕裂和完全性撕裂的符合率分别为 87.5 %和 88.9%。结论 :MR能较准确地诊断膝关节交叉韧带损伤及其并发症 ,为临床制订治疗方案提供可靠依据。     

MRI检查对半月板桶柄状撕裂的诊断价值研究

目的:探讨MR影像在膝关节半月板桶柄状撕裂(Bucket Handle Tear,BHT)中的诊断价值及MRI诊断BHT的观察方法。方法:采用敏感度、特异度等指标,盲法回顾分析130例同时行MRI及关节镜(Arthroscope,AS)检查治疗的膝关节损伤患者诊断结果,其中以经关节镜诊断BHT76例作为金标准,评价项目包括:①原始报告诊断;②中央移位的半月板碎片;③双后交叉韧带征;④蝶结消失征。结果:原始报告诊断BHT敏感度为43%,特异度为87%。中央移位的半月板碎片敏感度为72%,特异度为87%。双后交叉韧带征敏感度为31%,特异度为97%。蝶结消失征敏感度为71%,特异度为69%。结论:采用MRI诊断BHT时,中央移位的半月板碎片的特异度和敏感度均较高,而蝶结消失征的敏感度高,特异度低,双后交叉韧带征的特异度最高,敏感度最低。     

膝关节MR运动成像对前交叉韧带损伤的诊断研究

<正>膝关节前交叉韧带(anterior cruciate ligament,ACL)对于维持膝关节的稳定至关重要。MRI能在1～2个连续的层面上全程显示后交叉韧带情况,对后交叉韧带的诊断相对简单且明确;但MRI有时难以在1个层面完整显示ACL的全程图像,且ACL的部分损伤及陈旧性损伤目前的诊断符合率均还较低。本文将探讨膝关节MR运动成像对ACL损伤的诊断价值。     

膝关节交叉韧带低场强MRI表现及其损伤诊断

目的 :研究膝关节正常交叉韧带MRI特点和交叉韧带损伤的的MRI表现。方法 :对 2 0 0例正常膝关节交叉韧带的MRI进行回顾性分析 ,对 2 5例临床可疑交叉韧带损伤患者的MRI资料和关节镜检查行对比研究。结果 :正常膝关节矢状位MRI上显示交叉韧带最佳 ,冠状位和横断位作为补充 ,交叉韧带损伤的MRI表现为韧带连续性中断、局灶性或弥漫性肿胀、信号强度增高及断端移位 ;以关节镜检查结果为标准 ,MRI诊断交叉韧带损伤的敏感度为 91.3 % ,特异度为 91.6% ,符合率为 91.4%。结论 :MRI多方位扫描是一种准确诊断交叉韧带损伤的方法 ,矢状位显示交叉韧带最佳。     

膝关节韧带损伤的MRI表现及诊断价值

目的探讨膝关节韧带损伤的MRI表现及诊断价值。方法选取我院检查就诊的膝关节韧带损伤患者80例,患者均接受MRI检查,以关节镜检的结果作为对比标准及损伤情况的诊断符合率。结果 MRI对膝关节韧带损伤的诊断敏感度、特异度、准确度、阳性预测值、阴性预测值分别为95.77%,89.65%,95.00%,97.06%,75.00%。MRI对后交叉韧带、外侧副韧带、前交叉韧带、内侧副韧带等损伤情况的诊断符合率分别为92.86%,95.45%,98.25%,90.48%。结论MRI检查膝关节韧带损伤可以清晰地显示出韧带损伤和骨挫伤部位。     

MRI评价膝关节半月板的桶柄状撕裂

目的 明确5种MRI征象对膝关节半月板桶柄状撕裂的诊断价值。方法 回顾135例患者139个经关节镜证实的膝关节MR图像，其中19个存在半月板桶柄状撕裂。在均不告知关节镜结果的条件下，由2名有经验的放射医生对所有图像进行独立读片，差异协商解决。每个膝关节均记录如下5种MRI征象：双后交叉韧带征(双PCL征)、半月板翻转征、空领结征、碎块内移征和外周残半月板征。分别计算每种征象诊断半月板桶柄状撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果 5种征象的诊断敏感度分布于52．6％和89．5％之间，特异度分布于83．3％和98．3％之间，阳性预测值分布于42．9％和88．2％之间，阴性预测值分布：于92．7％和98．3％之间，准确度分布于82．7％和96．4％之间。“碎块内移征”和“外周残半月板征”的诊断敏感度最高，“双PCL征”的诊断特异度和阳性预测值最高，而“碎块内移征”具有最高的阴性预测值和诊断准确度。结论 半月板桶柄状撕裂在MRI上可以有多种表现，各种征象对诊断的能力有所不同。     

探讨半月板边缘部垂直撕裂与前交叉韧带损伤的关系

目的 探讨半月板边缘部垂直撕裂对诊断前交叉韧带(ACL)损伤的价值.方法 回顾性分析经关节镜证实的149例半月板撕裂的膝关节MRI结果,判断半月板撕裂的形态、位置以及前交叉韧带的情况.结果 149例半月板撕裂膝关节中,34个膝关节共36个半月板撕裂(其中2个膝关节内、外侧半月板同时撕裂),MRI显示为半月板边缘部垂直撕裂类型,其中29个膝关节同时伴有前交叉韧带损伤.其余115个膝关节,MRI显示为其他半月板撕裂类型,其中49例膝关节同时伴有前交叉韧带损伤.膝关节半月板边缘部垂直撕裂类型与其他的半月板撕裂类型比较,其合并前交叉韧带损伤的发生率分别为85.3%及42.6%,两者间具有显著性差异(χ2=19.2,P＜0.01).半月板边缘部垂直撕裂提示膝关节前交叉韧带损伤的敏感性、特异性和阳性似然比分别为37.2%、93.0%和5.3.结论半月板边缘部垂直撕裂大部分合并有ACL损伤.     

物理检查和MRI检查在前交叉韧带完全断裂中的诊断价值

目的 比较并评价物理检查、MRI检查对前交叉韧带(ACL)完全断裂的诊断价值.方法 回顾性分析2005年8月-2006年4月因单侧膝关节外伤、初诊怀疑为单纯膝关节韧带断裂或伴有半月板损伤而需入院手术的患者115例,于入院时分别行MRI检查及物理检查,后者包括前抽屉试验、Lachman试验、轴移试验.并于3日内对所有患者行关节镜检查.以膝关节镜检查为金标准,运用临床流行病学方法对各诊断试验的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度进行评价和比较. 结果 经关节镜检查证实,115例患者中确诊为ACL完全断裂的有41例,物理检查和MRI检查比较,灵敏度为95.1%、92.7%,特异度为87.8%、97.3%,阳性预测值为81.3%、95.0%,阴性预测值为97.0%、96.0%,准确度为90.4%、95.7%,阳性似然比为7.80,34.33,阴性似然比为0.06,0.08. 结论 在诊断ACL完全断裂方面,MRI与物理检查相比具有更高的诊断价值,但是,专业规范的物理检查也可以获得较高的诊断价值,因此在l临床实践中不应被忽视.     

Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries. Anatomical and pathoanatomical correlations

Traumatic injury to the knee remains a diagnostic and therapeutic challenge. Magnetic resonance imaging (MRI) has been applied to musculoskeletal pathoanatomy and has been shown to be an effective tool for definition and characterization of knee pathology. A systematic approach is taken to establish anatomical and pathoanatomical correlations, as well as the role of MRI in the management of knee injuries. Imaging was performed at the UCLA Medical Center using a permanent magnet system and a combination of solenoidal surface coils and thin-section, high-resolution scanning techniques. Images depict structural anatomical and spatial details of the knee that correlate well with corresponding cadaveric cryosections. To determine pathoanatomical correlations and the efficacy of MRI, 105 patients with preoperative diagnoses of meniscal tears, anterior and posterior cruciate ligament tears, tibial plateau fracture, and patella and quadriceps injuries were imaged. Results indicated that for the medial meniscus MRI demonstrated a 95.7% sensitivity, 81.8% specificity, 90% accuracy, 88.2% positive predictive value (PPV), and 93.1% negative predictive value (NPV). Imaging of the lateral meniscus demonstrated a 75% sensitivity, 95% specificity, 91% accuracy, 80% PPV, and 94% NPV. MRI of the ACL revealed 100% sensitivity, specificity, accuracy, positive and negative predictive values. MRI is a noninvasive tool which uses no ionizing radiation and can accurately define and characterize anatomy and pathoanatomy. This study indicates that MRI in conjunction with clinical evaluation can contribute to treatment decision-making processes and assist in preoperative planning. An algorithm demonstrating the potential clinical use of MRI is presented.     

The value of magnetic resonance imaging in our current management of ACL and meniscal injuries

Magnetic resonance imaging (MRI) is frequently used in the diagnosis of anterior cruciate ligament (ACL) and meniscal injuries. The aim of this retrospective study was to determine the reliability and value of MRI in our management of ACL and meniscal tears. 138 patients who had undergone a MRI to confirm or refute the clinical diagnosis of an ACL or meniscal tear were identified. Those who had subsequently undergone arthroscopy were selected. MRI findings and clinical diagnosis were compared with those at arthroscopy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of clinical diagnosis and MRI were then calculated. The overall accuracy for MRI was 91, 68 and 86% for detecting ACL, medial meniscal and lateral meniscal tears, respectively. Accuracy for clinical diagnosis was 90 and 64% for ACL and meniscal tears, respectively. In contrast to other series, our results indicate a lower accuracy of MRI in detecting pathology, especially of the ACL and medial meniscus. We noted a low sensitivity, specificity and positive predictive value but a high negative predictive value rendering MRI most useful as a negative diagnostic tool. We suggest that where symptoms and clinical findings support one of these diagnoses and arthroscopic therapeutic intervention is contemplated, that MRI scanning is not always beneficial. Our current practice of requesting scans to routinely confirm the diagnosis should be altered. Unnecessary MRI scanning increases the financial burden and delays patient treatment. No funding has been received from any sources and no conflicts of interests are stated in the submission of this article.     

Bone injury associated with anterior cruciate ligament and meniscal tears: assessment with bone single photon emission computed tomography

RATIONALE AND OBJECTIVES: Acute injury of the menisci and ligaments about the knee joint is often associated with accompanying bone injury. The role of bone single photon emission computed tomography (SPECT) was assessed in this clinical setting. MATERIALS AND METHODS: Knee SPECT was performed in 94 patients with suspected ACL, meniscal tear, or both and was correlated with arthroscopy (n = 74), magnetic resonance imaging (MRI) (n = 37), or both. Scintigraphic findings were categorized based on their anatomic location and on uptake intensity (0-3 grade scale). RESULTS: Correlation with arthroscopy: Eleven patients had a normal arthroscopy of which in 10, SPECT images detected no abnormality. Sixty-three patients had abnormal arthroscopic findings, whereas all had abnormal SPECT studies. Thirty-eight patients had an anterior cruciate ligament (ACL) tear on arthroscopy. In this type of injury SPECT images detected increased uptake in the posterior aspect of the lateral tibial plateau (LTPp) with a positive predictive value (PPV) of 93% and a negative predictive value (NPV) of 97%. In 55% of the patients, increased uptake was also detected in the region of the middle sulcus of the lateral femoral condyle (LFCm): a "kissing" pattern. Tear of the medial meniscus was diagnosed by arthroscopy in 43 patients. SPECT images detected increased uptake in the medial tibial plateau (MTP) with a PPV of 78% and a NPV of 83%. Correlation with MRI: all seven cortical fractures seen on MRI were detected on SPECT. Twenty-eight patients had MRI findings suggestive of an ACL injury. Accompanying bone bruises were seen in 18 of them (64%). On SPECT images, all 28 patients with an ACL tear had increased uptake in the LTPp. Intensity of uptake in patients with associated bone bruise, however, was significantly higher; mean intensity grade 2.4 +/- 0.7 in case of accompanying bone bruise compared with 1.4 +/- 0.8 in case of an ACL tear without associated bone injury, P< 0.01. CONCLUSION: Results of the study suggest that bone SPECT is valuable in acute knee trauma for assessment of ACL, meniscal tears, or both and for detection of associated bone injury.     

The role of magnetic resonance imaging (MRI) in assessment of ACL graft failure

Objective

The aim of this work is to assess the role of MRI in the diagnosis of ACL graft failure and detection of complications that may follow ACL reconstruction.

LI-RADS MRI分类标准对肝细胞癌的诊断效能

目的：探讨肝脏影像报告和数据管理系统（LI-RADS）MRI 分级诊断标准对肝细胞癌（HCC）的诊断价值。方法：回顾性分析88例肝脏病变患者的上腹部MRI资料,并根据LI-RADS分类标准对病变进行分析评估,并与临床客观诊断结果进行比较。结果：88例患者MRI共发现117个病灶,其中LI-RADS 1～5类病灶99个：1类和2类病灶25个,临床客观诊断结果均为良性（阴性预测值为100％）;3类病灶3个,其中1个为HCC（阳性预测值为33．3％）;4类病灶8个,其中5个为 HCC（阳性预测值为62．5％）;63个5类病灶中61个为 HCC（阳性预测值为96．8％）。受试者工作特征（ROC）曲线下面积为0．96（P＜0．001）。若将LI-RADS 1～2类病灶归为阴性,3～5类归为阳性,LI-RADS对诊断 HCC的总符合率为92．9％（92／99）,敏感度为100％（67／67）,特异度为78．1％（25／32）,阳性预测值为90．5％（67／74）,阴性预测值为100％（25／25）。若将LI-RADS 3类病灶排除,1～2类病灶归为阴性,4～5类病灶归为阳性,LI-RADS对 HCC的诊断符合率为94．8％（91／96）,敏感度为100％（66／66）,特异度为83．3％（25／30）,阳性预测值为93．0％（66／71）,阴性预测值为100％（25／25）。结论：LI-RADS分类标准对HCC的MRI诊断具有很好的诊断效果,有利于提高MRI诊断报告的准确性。     

Diagnostic accuracy of MRI knee in reference to arthroscopy in meniscal and anterior cruciate ligament injuries

Objective

Data regarding the diagnostic accuracy of Magnetic Resonance Imaging (MRI) are contradictory. The aim of this study was to find the accuracy of MRI knee against arthroscopy, in cases of meniscus and Anterior Cruciate Ligament (ACL) injuries. To the best of our knowledge, this is the largest Indian study comparing MRI knee with arthroscopy comprehensively.

Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings

AIM: To assess the accuracy of 3T magnetic resonance imaging (MRI) in the evaluation of meniscal and anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: Sixty-one consecutive patients were identified who were referred for evaluation of suspected intra-articular pathology with a 3T MRI and who, subsequently, underwent an arthroscopic procedure of the knee were included for the study. Two musculoskeletal radiologists interpreted the images. The sensitivity, specificity, positive predictive value, and negative predictive value were then calculated for the MRI versus the arthroscopic findings as a reference standard. RESULTS: The sensitivity and specificity for the overall detection of meniscal tears in this study was 84 and 93%, respectively. The results for the medial meniscus separately were 91 and 93% and for the lateral 77 and 93%. The evaluation of ACL integrity was 100% sensitive and specific. The meniscal tear type was correctly identified in 75% of cases and its location in 94%. CONCLUSION: This study demonstrates good results of 3T MRI in the evaluation of the injured knee. Caution should still be given to the interpretation on MRI of a lateral meniscus tear, and it is suggested that the standard diagnostic criteria of high signal reaching the articular surface on two consecutive image sections be adhered to even at these higher field strengths.     

High-resolution ultrasonography (HRUS) of the meniscal cyst of the knee: Our experience

PURPOSE: This study was undertaken to assess the diagnostic accuracy of high-resolution ultrasonography (HRUS) in the detection of meniscal cysts. MATERIALS AND METHODS: Over a 2-year period, 1,857 patients underwent magnetic resonance imaging (MRI) of the knee for traumatic or degenerative disorders. All patients with MRI evidence of a meniscal cyst were studied by HRUS. HRUS was also performed on an equal number of patients without MRI evidence of meniscal cyst who were used as a control group. All HRUS examinations were conducted by a radiologist blinded to the MRI findings. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HRUS were assessed with reference to MRI. All patients underwent surgery, and the resected masses were studied by histological examination. RESULTS: MRI allowed identification of a meniscal cyst in 52 patients. HRUS enabled correct detection of the meniscal cyst in 49/52 cases. In the control group, HRUS excluded the presence of meniscal cysts in all cases. HRUS had a sensitivity, specificity, PPV and NPV of 94.23%, 100%, 100% and 94.54%, respectively, for the detection of meniscal cysts. CONCLUSIONS: HRUS is a fairly reliable technique in the detection, characterisation and differentiation of the different forms of meniscal cyst.     

肩关节损伤MRI与关节镜的对比分析

目的探讨常规MRI对肩关节损伤的诊断价值。方法回顾性分析因肩关节损伤行常规MRI和关节镜检查的55例病人资料,MRI观察指标包括肩袖、盂唇形态及信号,有否肩峰下撞击及骨性损伤。以肩关节镜为诊断金标准,统计MRI对不同类型肩关节损伤的诊断结果,并分别计算MRI的诊断敏感度、特异度和准确度。采用Kappa检验分析MRI与肩关节镜诊断结果的一致性。结果肩关节损伤的MRI征象中分别有25%部分肩袖撕裂、13.3%Bankart’s损伤、20%盂唇上部前后方向(SLAP)损伤和11.6%肩峰下撞击漏诊。MRI诊断损伤性病变的特异度及肩袖全层撕裂(100%)、骨性损伤(100%)、肩峰下撞击(88%)和Bankart’s损伤(87%)的敏感度较高,诊断SLAP损伤(75%)和肩袖部分撕裂(75%)的敏感度较低;诊断肩袖全层撕裂(100%)和骨性损伤(100%)的准确度最高,其次是Bankart’s损伤(96%),诊断SLAP损伤(89%)的准确度较低。MRI和关节镜诊断肩袖全层撕裂、骨性损伤的κ值为1,结果完全一致,诊断Bankart’s损伤的κ值为0.904,一致性较好,诊断肩袖部分撕裂、SLAP损伤和肩峰下撞击的κ值虽稍低,但均0.75,一致性也较好,P均0.05。结论 MRI是有效诊断肩关节损伤的影像方法,但对SLAP损伤和肩袖部分撕裂的诊断准确度有待提高。