腘肌及胭肌腱损伤的MR诊断

目的 回顾性分析胭肌及胭肌腱损伤的MR表现,了解其影像学特征,提高诊断和鉴别诊断水平,减少误诊率.方法 患者共26例,均行膝关节外旋15°的矢状位快速自旋回波T1WI序列、矢状位脂肪抑制STIR序列和冠状位自旋回波T2 WI及质子相双回波序列扫描.结果 26例患者中,单纯胭肌损伤为11例,胭肌腱损伤5例,胭肌及腘肌腱同时损伤者为10例.胭肌及腘肌腱的损伤,以矢状位脂肪抑制STIR序列及冠状位自旋回波T2WI序列显示病变最为清楚,可显示胭肌急慢性损伤水肿所致的长T2高信号,同时可显示胭肌腱撕裂所致的连续性中断.轴位快速自旋回波T2加权序列也可清楚显示胭肌损伤所致信号异常.结论 MR成像是显示胭肌及胭肌腱损伤最佳的影像学手段,通过常规方位扫描图像可做出准确的诊断.     

不同MRI组合序列及扫描方位对肩袖损伤诊断分级及脂肪浸润评分的影响

目的：探讨不同磁共振成像（MRI）组合序列及扫描方位对肩袖损伤诊断分级及脂肪浸润评分的影响。 方法：选择蚌埠医学院附属连云港市第二人民医院2018年1月至2019年1月收治的100例经临床诊断为肩袖损伤患者作为研究对象,对患者进行不同MRI组合序列及扫描方位,进行肩袖损伤的诊断和肩袖损伤脂肪浸润程度评分。 结果：斜冠状位MRI对肩胛袖损伤的检出率最高,斜冠状位SITR序列在肩关节检查中对肩袖损伤显示最佳（χ²=19.425,P<0.001）;斜冠状位SITR序列对肩胛袖损伤中冈上肌肌腱（51例）、冈下肌肌腱（34例）、肩胛下肌肌腱（15例）检出例数均明显高于斜冠状T₁WI检出序列数（12、28、6例）和T₂WI的检出例数（37、19、9例）。斜冠状术前MRI肩袖脂肪浸润程度评分较术中明显升高[（2.58±0.23）分vs.（1.72±0.17）分],差异有统计学意义（t=7.320,P=0.002）。 结论：斜冠状位SITR序列在肩袖损伤的诊断分级及脂肪浸润程度评分均优其他序列,对肩袖损伤的诊断率较高,更有助于提高诊断正确率。     

MR 3D-FIESTA序列在显示肩关节周围韧带的价值

目的:探讨磁共振3D-FIESTA序列对正常肩关节周围韧带的显示能力.方法:对30例健康志愿者的双侧肩关节行MR不同序列的扫描.3D-FIESTA序列图像进行多平面重组,观察其周围韧带.分别测量脂肪、肌腱的信号强度及背景信号强度标准差,计算肌腱与脂肪的对比噪声比(CNR),比较3D-FIESTA序列与常规T1WI、PDWI,T2WI脂肪与肌腱的CNR.由两名主治医师观察3D-FIESTA轴位与T1WI轴位、3D-FIESTA重建图像与PDWI斜冠状位图像对喙肩韧带、喙锁韧带、喙肱韧带的显示效果.结果:3D-FIESTA序列上脂肪与肌腱的CNR与T1WI无差异(P=0.295),而高于T2WI和PDWI,P值分别为0.000、0.000.3D-FIESTA序列轴位图像显示喙肩韧带优于常规序列,多平面重组图像显示喙肩韧带;喙锁韧带;喙肱韧带优于常规序列.结论:3D-FIESTA序列图像可以清楚显示喙肩韧带、喙锁韧带及喙肱韧带,具有较高的临床应用价值.     

MRI不同的扫描序列对肩袖撕裂的诊断价值

目的 探讨MRI在肩袖撕裂的诊断中最佳序列的选择.方法 对22例24肩关节疼痛患者,使用1.5T MR扫描仪进行肩关节磁共振检查,所有患者均采用SE/T1WI、FSE/T2WI、GRE/T2*、STIR及PDWI扫描,比较SE/T1WI、FSE/T2WI、GRE/T2*、STIR及PDWI序列在诊断肩袖撕裂诊断中的敏感性.结果 22例患者24肩关节经手术及临床治疗证实肩袖完全撕裂5例、肩袖部分撕裂15例、肩袖结构完整者4例,在SE/T1WI、FSE/T2WI序列分别为1例、16例、7例;PDWI组为6例、14例、4例;STIR序列为8例、12例、4例.结论 PDWI在提高肩袖撕裂诊断敏感性上是最好的成像序列.     

肩袖MRI:梯度回波和快速自旋回波的比较

目的 评价梯度回波T2*WI对肩袖病变的诊断价值。资料与方法 对35例可疑肩袖损伤的病例进行前瞻性MRI检查，对比分析斜冠状位T2*WI和脂肪抑制快速自旋回波T2WI（FS TSET2WI）对肩袖病变的诊断价值。结果 T2*WI和FS TSE T2WI对肩袖损伤的评价具有较好的诊断一致性，Kappa值为0.746。不管是对总的肩袖撕裂，还是对于肩袖全层撕裂，T2*WI的诊断敏感性和阴性预测值均高于FS TSE T2WI，但其诊断特异性和阳性预测值降低。结论 T2*WI和FS TSE T2WI对于肩袖损伤的评价具有较好的诊断一致性。     

盂肱下韧带MR影像对冻结肩的诊断价值

目的探讨盂肱下韧带MR表现对冻结肩的诊断价值。方法分析我院间141例肩关节MR影像,将临床诊断为冻结肩48例患者作为冻结肩组、经关节镜证实的肩袖部分撕裂37例患者作为肩袖撕裂组、正常对照组56例。在斜冠状位T_2WI脂肪饱和序列上评估盂肱下韧带T_2信号强度、有无关节囊外高信号层并测量盂肱下韧带厚度。结果盂肱下韧带T_2WI脂肪饱和序列上呈高信号:冻结肩组41例、肩袖撕裂组5例、对照组5例,其诊断冻结肩的准确性88%、敏感性85%、特异性89%、阳性预测值80%、阴性预测值92%;斜冠状位T_2WI脂肪饱和序列上盂肱下韧带厚度:冻结肩组(n=48)(5.22±1.03)mm、肩袖撕裂组(n=37)(3.95±0.69)mm、对照组(n=56)(3.96±0.72)mm,冻结肩组厚度明显大于肩袖撕裂组、对照组,差异比较具有统计学意义(P0.001),肩袖撕裂组与对照组差异比较无统计学意义(P0.05)。结论盂肱下韧带T_2WI脂肪饱和序列上信号增高、增厚表现有助于冻结肩诊断。     

眼眶MR成像IDEAL技术脂肪抑制效果和图像质量评价研究

目的:对比分析眼眶三点法非对称回波水脂分离成像(IDEAL)与短反转时间反转恢复序列(STIR)和化学饱和法的脂肪抑制效果和图像质量,探讨IDEAL在眼眶成像中的应用价值.方法:共260例患者进行眼眶MRI扫描,包括143例分别采用化学饱和法(41例)、STIR(52例)和IDEAL(50例)序列行冠状面T2 WI,以及50例和67例分别采用化学饱和法和IDEAL序列行增强后冠状面T1 WI扫描.对眼眶、鼻窦各解剖部位的图像质量和脂肪抑制效果进行主观评分,并且测量颞肌、内直肌和外直肌的信噪比,比较三种脂肪抑制技术的脂肪抑制效果和图像质量.结果:IDEAL组T2 WI对外直肌、内直肌、视神经和海绵窦的图像质量评分高于化学饱和法T2 WI(P＜0.05),对眼眶及邻近骨骼的脂肪抑制效果评分高于化学饱和法T2WI(P＜0.05),但对颞肌间隙脂肪抑制效果的评分低于化学饱和法T2WI(P=0.004).IDEAL T2WI对眼外肌、视神经、海绵窦的图像质量评分高于STIR序列(P＜0.05),对鼻甲、上颌窦内壁的图像质量评分低于STIR序列(P＜0.05);对眼眶、蝶骨大翼和颧骨的脂肪抑制效果评分高于STIR序列(P＜0.05),对颞肌间隙脂肪抑制效果评分低于STIR序列(P=0.000).IDEAL T2WI上颞肌的信噪比高于化学饱和法T2 WI(P=0.013),颞肌、内直肌和外直肌的信噪比高于STIR序列(P=0.000).增强后IDEAL T1WI对内直肌、下直肌、上颌窦内壁的图像质量评分高于化学饱和法T1WI(P＜0.05),对中鼻甲的图像质量评分低于化学饱和法(P＜0.05);对颞肌间隙和翼腭窝的脂肪抑制效果评分高于化学饱和法(P＜0.05),对肌锥外间隙脂肪抑制效果评分低于化学饱和法(P＜0.05).结论:IDEAL对眶内及眶周结构的显示效果优于化学饱和法和STIR序列,是目前眼眶MRI的最佳脂肪抑制技术.     

磁共振成像对冈上肌腱损伤分级的评估效能

目的：探讨磁共振成像对冈上肌腱损伤分级的评估效能。方法回顾性分析84例肩部疼痛患者的临床症状、肩关节磁共振扫描方法以及影像表现。结果磁共振斜冠状位诊断冈上肌腱损伤1级40例,2级28例,3级16例;横断位1级59例,2级10例,3级15例;斜矢状位1级65例,2级9例,3级10例。斜冠状位质子压脂序列显示冈上肌腱损伤磁共振分级与临床诊断符合率最高。结论肩关节磁共振扫描能清晰显示冈上肌腱损伤的范围、程度,并进行分级,对临床治疗方法的选择有重要帮助。     

正常骶髂关节软骨MRI成像分析

目的 探讨MRI显示正常骶髂关节软骨的最佳序列.方法 收集40例健康志愿者80侧骶髂关节软骨MRI扫描资料,其中男28例,女12例,年龄18~45岁,平均为29.36岁.均使用Philips Intera Achieva 1.5T 双梯度扫描仪,扫描序列包括轴位T1WI、T2WI、STIR、3D-WATS及斜冠状位T2WI.由2名资深医生对每侧骶髂关节软骨在不同序列显示情况进行分组评价,分为清晰、基本清晰、不清晰3组,统计处理各组间显示率差异.结果 40例健康志愿者80侧骶髂关节软骨在T1WI、T2WI、STIR、3D-WATS序列均可不同程度的显示,其中清晰组在各个序列的显示率为18.75%、0.00%、8.75%、93.75%,其中3D-WATS与T1WI、T2WI、STIR序列比较P＜0.05;T1WI、T2WI、STIR序列各组间比较P＞0.05.结论 3D-WATS序列是显示骶髂关节软骨的最佳序列.     

MRI在肩袖钙化性肌腱炎诊断中的应用价值

目的探讨MRI在肩袖钙化性肌腱炎诊断中的应用价值,为临床诊断及手术治疗提供影像学依据。方法回顾性分析21例经临床手术证实为钙化性肌腱炎的患者的影像学资料,所有患者均行MRI检查及X线检查。结果 1)21例X线片显示明确钙盐沉积的病例中,MRI对钙盐沉积的的显示率为86%,于T_1WI及PDWI-FS图像17例钙盐沉积呈低信号,1例呈高低混杂信号,钙盐沉积所累及肌腱相邻区域损伤;2)在钙盐沉积部位中,12例为冈上肌肌腱,3例为冈下肌肌腱,4例同时累及冈上、冈下肌肌腱,1例为肩胛下肌肌腱,1例同时累及冈上、肩胛下肌肌腱;3)21例均合并肩袖损伤,累及冈上肌肌腱者为20例,部分撕裂者为9例;累及肩胛下肌腱者为8例;累及冈下肌腱者为4列;4例合并肱二头肌长头肌腱损伤。结论 MRI在显示细小钙化方面不如X线,单一MRI检查对于钙化性肌腱炎的诊断是不充分的,但MRI对于肌腱炎及钙化物沉积位置的显示要优于X线检查,对临床诊断及手术治疗有较大的诊断价值。     

Comparison of fat-suppressed T2-weighted fast spin-echo sequence and modified STIR sequence in the evaluation of the rotator cuff tendon

OBJECTIVE: This study was performed to determine whether a modified version of the classic STIR sequence provides similar information about the integrity of the rotator cuff tendon as the commonly used fat-suppressed T2-weighted fast spin-echo sequence. SUBJECTS AND METHODS: Sixty-one consecutive MRI examinations of the shoulder in 57 patients were performed using a coronal oblique T1-weighted spin-echo sequence, a modified version of the STIR sequence, and a fat-suppressed T2-weighted fast spin-echo sequence. Three reviewers independently assessed the rotator cuff tendon using the coronal oblique modified inversion recovery sequence and T1-weighted spin-echo sequence. After a minimum of 4 weeks, reviewers assessed the rotator cuff tendon using the fat-suppressed T2-weighted fast spin-echo sequence and T1-weighted spin-echo sequence. The kappa statistic was used to measure the degree of concordance between interpretations when each sequence was used independently. The conditional probability that a full- and a partial-thickness tear would be diagnosed on both sequences was calculated. Image quality was assessed in a side-by-side comparison. RESULTS: The overall weighted kappa score was 0.82, which indicates excellent concordance between the two sequences. If a full-thickness tear of the rotator cuff tendon was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was a 94.1% probability that the same conclusion would be reached using the modified inversion recovery sequence. If a partial-thickness tear was found on the fat-suppressed T2-weighted fast spin-echo sequence, there was an 80.3% probability that the same conclusion would be reached with the modified inversion recovery sequence. Fat suppression in the modified inversion recovery sequence was superior to that in the T2-weighted fast spin-echo sequence in 26-39% of the examinations. CONCLUSION: The modified inversion recovery sequence and fat-suppressed T2-weighted fast spin-echo sequence provide similar information about the integrity of the rotator cuff tendon.     

肩关节肱二头肌肌腱损伤的MRI表现

目的:探讨MRI对肩关节肱二头肌长头肌腱损伤的诊断价值。方法:收集2006年1月～2010年8月共12例肩关节肱二头肌长头肌腱损伤的病例资料,回顾性分析患者的肩关节MR扫描图像,所有病例均经肩关节手术证实。结果:①12例肱二头肌长头肌腱断裂,其中部分撕裂4例,表现为肱二头肌长头腱增粗,T2W上可见局部高信号影,肌腱连续性存在;完全撕裂8例,表现为横断面上,结节间沟内未见肱二头肌长头腱显示,斜冠状面可见撕裂肌腱近端或远端呈波浪状。肱二头肌长头肌腱半脱位1例,表现为横断面上,肱二头肌长头肌腱向内侧移位,位于肱骨小结节前方;脱位2例,表现为横断面示空置的结节间沟,肱二头肌长头腱向内侧移位、位于肩胛下肌腱前方;②肱二头肌长头腱损伤伴随腱鞘积液2例,表现为横断面上肌腱被液性高信号影所环绕;伴随肩关节腔内积液12例;③12例肱骨结节间沟宽度≥8mm;深度<3mm、结节间沟变浅3例;3例内壁角<30°;④合并肩袖损伤7例,其中冈上肌腱撕裂5例,冈下肌腱撕裂1例,肩胛下肌肌腱撕裂1例;合并喙肱韧带损伤11例。出现肩峰撞击综合征10例。结论:MRI能够准确的诊断肩关节肱二头肌长头肌腱损伤,从而有助于临床手术方案的制定。     

肩袖全层撕裂的MRI表现

目的 总结肩袖全层撕裂的MRI表现。材料与方法 回顾性分析21例肩关节MR造影证实的肩袖全层撕裂的MR图像。结果 21例肩袖全层撕裂均发生在冈上肌腱。在T2W序列上,6例（28．9％）表现为冈上肌腱断裂并断裂端的回缩;12例（57．1％）表现为冈上肌腱变薄或增粗并伴有贯穿冈上肌腱全层的高信号;1例（4．7％）表现为冈上肌腱增厚并未贯穿全层的下表面高信号;2例（9．3％）冈上肌腱的形态和信号未见异常。结论 冈上肌腱的断裂并回缩以及冈上肌腱形态增粗或变细并伴 有贯穿肌腱全层的异常高信号为全层撕裂的主要MRI表现。     

MR evaluation of subscapularis tears.

PURPOSE: The purpose of this work was to describe the MR appearance of tears of the subscapularis tendon and compare the usefulness of different imaging planes as well as note the association of subscapularis tears with other rotator cuff tears and biceps tendon dislocations. METHOD: MR studies at 1.5 T over an 8 year interval were retrospectively assessed for the presence of a rotator cuff tear and/or tear of the subscapularis tendon. Images that showed a subscapularis tear were reviewed for the presence of a visible tear separately on the axial, coronal, and sagittal images. The MR studies were also evaluated for associated tears of the supraspinatus, infraspinatus, and teres minor muscles as well as biceps tendon dislocation and the "naked humerus sign" on coronal images. Last, clinical records and surgical reports were reviewed. RESULTS: Forty-five (2%) of 2,167 rotator cuff tears involved the subscapularis; 27% were partial and 73% were complete tears. Tears were best seen in the sagittal oblique plane. Almost all subscapularis tears were an extension of typical rotator cuff tears: supraspinatus in 35 patients (79%), extending into infraspinatus tears in 25 (56%) and into teres minor tears in 2 patients (4%). Bicipital dislocations were seen in 22 patients (49%), and three complete tears of the biceps (7%) were noted as well. The naked humerus sign was demonstrated in 31 patients (69%). Surgical reports that confirmed the MR findings were available for 15 patients. CONCLUSION: About 2% of rotator cuff tears involve the subscapularis tendon. Most subscapularis tears are extensions of supraspinatus tears and frequently involve the biceps tendon.     

The magic-angle effect of the supraspinatus tendon

CONTEXT: Rotator cuff injuries are common and result in either a tear or tendinopathy within the distal portion of the supraspinatus tendon. Magnetic resonance (MR) imaging shows the injury as a high signal region within the distal tendon. Similarly, a magic-angle effect also appears within healthy patients in this same region on T1- or proton density (PD)-weighted MR sequences. OBJECTIVE: This study was conducted to evaluate the prevalence of the magic-angle effect found with MR imaging within the supraspinatus tendon. METHODS: In this study, 300 consecutive patients were selected from those symptomatic patients referred for MR evaluation of the shoulder using a 1.5T unit and both PD and T2-weighted sequences. To eliminate patients with a real injury, the written reports were reviewed; those with positive findings for injury to the supraspinatus tendon were eliminated from the sample group, leaving 164 patients. Two radiographers independently examined the oblique coronal images nearest the center of the supraspinatus tendon and compared the signal on PD and T2-weighted images. Images found to have a higher signal with the PD sequence were classified as having the magic-angle effect since a real injury would be more likely to have a strong signal on T2-weighted images. RESULTS: Of the 164 patients evaluated, both reviewers found the same 8 patients to have the magic-angle effect. SUMMARY: Based on these results, our study suggests the artifact will appear in 5% of healthy patients and may lead to false-positive results on oblique coronal PD-weighted images through the supraspinatus tendon. In comparison with previous studies that have shown a much greater incidence rate, our findings also suggest that external rotation of the arm greatly reduces the incidence of the magic-angle effect.     

Shoulder after rotator cuff repair: MR imaging findings in asymptomatic individuals--initial experience

PURPOSE: To assess the magnetic resonance (MR) imaging appearance of the successfully repaired rotator cuff in an asymptomatic population. MATERIALS AND METHODS: Fifteen subjects who had undergone clinically successful rotator cuff repair were included in the study. All underwent functional testing of the affected shoulder and had good to excellent scores on the Constant scale. Standard MR imaging sequences were performed at 1.5 T, including oblique coronal fast spin-echo T2-weighted MR imaging with fat saturation. RESULTS: Three (10%) of 30 supraspinatus and infraspinatus tendons had normal signal intensity, and 16 (53%) had mildly increased signal intensity on fast spin-echo T2-weighted fat-saturated images, compatible with tendonitis or tendinosis. Three partial and four complete tears of the supraspinatus tendon and two partial and two complete tears of the infraspinatus tendon were seen. Other findings included subacromial-subdeltoid effusion (10 subjects), joint effusions (five subjects), and bone marrow edema (six subjects). CONCLUSION: Postoperative signal intensity changes consistent with tendonitis or tendinosis were common, and clinically "silent" partial and complete rotator cuff tears were seen. Such postoperative MR imaging findings should be interpreted with caution, and meticulous correlation with symptoms and clinical results is recommended.