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。
Abstract
Objective To investigate whether MR imaging of knees in a side-lying and buckling to maximum position can improve the diagnostic rate of anterior cruciate ligament (ACL) partial tear.Methods Three hundred and twenty-four patients who were diagnosed with ACL partial tear were included in this study. According to the difference of intervals between the time of injury and the time for MR imaging, these patients were divided into three groups: the subacute, intermediate and chronic groups. All the patients underwent MR imaging in both the routine, side-lying and buckling to maximum position, and knee arthroscopy was performed after the MR scan. Three radiologists were invited to make a diagnosis through blind evaluation of the MR images acquired in the routine knee position. The diagnostic results were saved as group A. The MR images of the routine and side-lying and buckling to maximum position of knees were subjected to blind evaluation by another three radiologists after three months, and the diagnostic results were saved as group B, with the results of knee arthroscopy as reference. The difference between these two groups was analyzed statistically.Results The diagnostic rate of group B was comparable to the result of knee arthroscopy. The positive diagnostic rate of group B was much higher than that of group A.Conclusions MR imaging in the side-lying and buckling position of the knee can improve the diagnostic rate of patients with anterior cruciate ligament partial tear, and this MR imaging method is more sensitive for diagnosing patients with ACL partial tear more than 3 months after injury.
关键词
前交叉韧带撕裂 /
膝关节损伤 /
磁共振成像 /
特殊体位
Key words
anterior cruciate ligament /
magnetic resonance imaging /
knee injury /
special knee position
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参考文献
[1] McCauley T R,Moses M,Kier R,et al.MR Diagnosis of Tears of Anterior Cruciate Ligament of the Knee: Importance of Ancillary Findings[J].AJR,1994,162(7):115-119.
[2] McNally E G,Nasser K N,Dawson S,et al.Role of magnetic resonance imaging in the clinical management of the acutely locked knee[J].Skeletal Radiol,2002,31(4):570-573.
[3] Roychowdhury S, Fitzergerald S W,Sonin A H,et al.Using MR Imaging to Diagnose PartialTears of the Anterior Cruciate Ligament: Value of Axial Images[J].AJR, 1997,168(11):1487-1491.
[4] Chen W T, Shih T T, Tu H Y, et al. Partial and complete tear of the anterior cruciate ligament[J]. Acta Radiol,2002,43(9):511-516.
[5] Hofbauer M, Muller B, Murawski C D, et al. Theconcept of individualized anatomic anterior cruciateligament(ACL) reconstruction[J].KSSTA, 2014,22(5):979-986.
[6] Ng A W,Lee R K,Ho E P,et al.Anterior cruciateligament bundle measurement by MRI[J].Skeletal Radiol,2013,42(6):1549-1554.
[7] 刘彩龙,赵金忠,陈 雷,等.自体胭绳肌腱和同种异体半腱肌腱双束重建前十字韧带的比较研究[J].中华骨科杂志,2010,30(3):255-259.
[8] Davies N H, Niall D, King L J, et al. Magnetic resonance imaging of bone bruising in the acutely injured knee-short-term outcome[J]. Clin Radiol,2004,59(12):439-445.
[9] Bretlau T, Tuxoe J,Larsen L,et al.Bone bruise in the acutely injured knee[J].KSSTA,2002,10(4):96-101.
[10] Borbon C A, Mouzopoulos G, Siebold R. Why perform an ACL augmentation?[J]. KSSTA,2012,20(7):245-251.
[11] 沈 灏,蒋 矗,赵金患,等.陈旧性前十字韧带损伤的诊断[J].中华骨科杂志,2002, 22(3):150-153.
[12] Katahira K, Yamashita Y, Takahashi M, et al. MR Imaging of the Anterior Cruciate Ligament: Value of thin Slice Direct Oblique coronal Technique[J]. Radiat Med,2001,19(8):1-7.
[13] Hong S H, Choi J Y, Lee G K, et al.Grading of ACL injury: Diagnostic efficacy of oblique coronal MRI of the knee[J].J Cat,2003,27(5):814-819.
[14] Padulo J, Oliva F, Frizziero A, et al. Muscles, Ligaments and Tendons Journal. Basic principles and recommendations in clinical and field science research: 2016 update[J]. MLTJ.2016,6(1):1-5.
[15] Delin C, Silvera S, Coste J, et al. Reliability and diagnostic accuracy of qualitative evaluation of diffusion-weighted MRI combined with conventional MRI in differentiating between complete and partial anterior cruciate ligament tears[J].Eur Radiol, 2013,23(10):845-854.
[16] Breitenseher M J, Mayerhoefer M E. Oblique MR Imaging of the Anterior Cruciate Ligament Based on Three-Dimensional Orientation[J].Magnetic Res Imaging,2007,26(7):794-798.
[17] 马贺骥,谭 威,何翠菊,等.膝关节前交叉韧带损伤的MRI成像方法及诊断研究[J].中国临床医学影像杂志,2006,17(6):341-343.
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