前交叉韧带损伤:3.0TMR影像与关节镜对照分析

目的分析膝关节前交叉韧带损伤的3．0TMRI特征，并与关节镜手术结果对照。方法回顾性分析来我院行3．0T MR膝关节检查的36例前交叉韧带损伤患者的40个膝关节，全部病例经关节镜检查确诊。应用3．0T MR机（Philips Achieva型），膝关节专用线圈，进行斜矢状位TSE T1WI、TSE T2WI、PD-SPIR和冠状位、轴位TSE T2WI扫描。前交叉韧带损伤分为完全断裂、撕裂（部分断裂）及胫骨端撕脱。将膝关节前交叉韧带损伤的3．0T MR影像特征与关节镜手术结果进行对照分析。结果前交叉韧带完全断裂MRI直接征象表现为韧带连续性中断，断端肿胀（21／25），间接征象为交叉韧带过度弯曲、T2WI和PD-SPIR股骨髁间窝外侧骨挫伤；MRI与关节镜诊断完全符合率为84．00％。前交叉韧带撕裂（部分断裂）MRI直接征象为ACL矢状T2WI和PD-SPIR显示形态不规则、部分撕裂，ACL局部肿胀增粗，信号增高，仍可见连续存在的纤维低信号；MRI与关节镜诊断完全符合率为66．67％。前交叉韧带胫骨端撕脱MR检查直接征像为胫骨近端可见T1WI、T2WI低信号撕脱骨片（3／3），ACL水肿、形态不规则，周围可见出血、积液，MRI与关节镜诊断符合率为100％。结论高场强3．0TMR膝关节诊断的多平面、多序列影像相结合可形成ACL立体影像观，结合临床能够有效诊断ACL损伤。

Anterior cruciate ligament injuries: comparative study on 3.0T MRI versus arthroscope

Objective To study the features of injured anterior cruciate ligament(ACL) of knees with 3.0T MRI compared with foundings of arthroscope. Methods MRI of 36 patients with 40 keens ACL injuries confirmed by arthroscopy were reviewed retrospectively. Oblique Sagittal imaging of T1W, T2W and PD fat-suppressed sequence, coronal and axial imaging of T2W were performed respectively. 3.0T MRI features of ACL injuries included 3 types: complete disruption, tearing (partial disruption) and avulsion of tibia metaphysis. MRI characteristics were compared with arthroscopy results. Results Complete disruption of ACL was detected in 25 keens, with disrupted ligament and broken ends swelling in 21 (21/25) as direct signs, and the twist of posterior cruciate ligaments, the bone bruise of lateral condyle of distal femur in all of 25 cases in both T2WI and PD-SPIR sequence as indirect signs. The coincidence rate of MRI and arthroscopy was 84.00%. The tearing (partial disruption) of ACL was detected in 12 knees, with the irregular form and partial disruption of ACL on T2WI and PD-SPIR in 4 (4/12) and partial swelling and signal increase in 8 (8/12) as indirect signs. The coincidence rate of MRI and arthroscopy was 66.67%. The avulsion of tibia epiphysis was shown on MRI in 3 patients. Hypo-intensity signal avulsion fragments in T1WI and T2WI were shown in the proximal tibia as direct signs with ACL swelling, irregular form, hemorrhage and effusion around. The coincidence rate of MRI and arthroscopy was 100%. Conclusion Combining with the clinical examination, 3.0T MRI could provide efficient diagnosis information for ACL with stereoscopic view by multi-plane and multi-sequencing imaging.