3D-MRI在膝关节前交叉韧带损伤与半月板撕裂诊断中的应用评价

发布时间：2018-03-04 18:07

本文选题：磁共振成像　切入点：前交叉韧带　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：引言膝关节损伤特别是前交叉韧带(anterior cruciate ligament,ACL)及半月板损伤是一种常见病和多发病,可导致关节的疼痛、肿胀、功能障碍,甚至运动功能的减低。准确诊断ACL损伤、半月板的撕裂及明确撕裂类型有助于临床治疗方法的选择、手术方案的制定及预后的评价。MRI具有优良的软组织分辨率和空间分辨率,已成为评价膝关节损伤的最常用的、无创性检查方法。常规2D-MRI已广泛应用于临床检查,但较厚的层厚和部分容积效应会掩盖细微的病变。3D-MRI所获取的容积数据能够进行多层面重组(multi-plane reformation,MPR),有助于病变的诊断和发现细微的病变。研究目的1.评价3D-MRI PDWI-SPAIR序列在诊断ACL损伤方面的应用。2.评价3D-MRI PDWI-SPAIR序列在诊断半月板撕裂方面的应用。研究对象与方法收集并分析2013年12月至2016年5月在我院行MRI检查,并经关节镜证实的100名患者104个膝关节的临床、关节镜及MR资料。采用3D-MRI PDWI-SPAIR图像对ACL行薄层MPR斜冠状位与横断面重建,对半月板行薄层MPR横断面、冠状面重建。与关节镜结果对照,比较2D-MRI与3D-MRI PDWI-SPAIR序列对ACL损伤诊断的敏感性、特异性和准确性,评价3D-MRI PDWI-SPAIR在ACL损伤分级诊断中的应用;评价3D-MRI PDWI-SPAIR序列及其MPR重建对半月板撕裂及不同撕裂类型诊断的应用。结果与关节镜结果对照,2D-MRI与3D-MRI诊断ACL损伤总的敏感性分别为88与93.4%、总特异性分别为71.4%与92.9%、总准确性分别为83.6%与93.3%。经Kappa检验,2D-MRI与关节镜诊断ACL损伤的结果有中度一致性,K=0.591;3D-MRI与关节镜诊断ACL损伤的结果有极好的一致性,K=0.835。1.与关节镜结果对照,2D-MRI与3D-MRI诊断ACL 3级损伤的敏感性分别为81.8%与94%、特异性分别为94.3%与97.2%、准确性分别为90.3%与96.2%;诊断ACL 2级损伤的敏感性分别为68%与84%、特异性分别为89.8%与97.5%、准确性分别为84.6%与94.2%;诊断ACL 1级损伤的敏感性分别为66.7%与88.9%、特异性分别为91.8%与98.9%、准确性分别为87.5%与97.1%。2.与关节镜结果对照,2D-MRI、3D-MRI MPR重建对半月板撕裂诊断的敏感性分别为77.2%、91.8%,特异性分别为88%、96%,准确性分别为79.8%、92.8%。经Kappa检验,2D-MRI与关节镜诊断半月板撕裂的结果有中度一致性,K=0.541;3D-MRI与关节镜诊断半月板撕裂的结果有极好的一致性,K=0.817。3.与关节镜结果对照,2D-MRI、3D-MRI对半月板各种撕裂类型诊断的敏感性分别为:复合裂75.0%、89.6%,水平裂85.0%、95.0%,纵行撕裂83.3%、90.0%,斜行撕裂82.9%、95.1%,桶柄状撕裂83.3%、l00%,放射状撕裂85.7%、100%。结论1.与常规2D-MRI相比,3D-MRI诊断ACL损伤具有更高的敏感性、特异性和准确性,有效减少了假阳性及假阴性;但对于慢性韧带损伤,3D-MRI仍易导致漏诊,需密切结合病史、临床体格检查。2.采用4级法(0-3级)作为ACL损伤的分级诊断标准,有助于临床诊疗方案的有效制订。在1-3级ACL损伤的分级诊断中,3D-MRI的敏感性、特异性和准确性均高于 2D-MRI。3.急性ACL损伤组内骨挫伤、内侧副韧带损伤、关节积液的发生率明显高于慢性组。慢性ACL损伤组内半月板撕裂、软骨损伤的发生率明显高于急性组。4.与常规2D-MRI比较,3D-MRI对半月板撕裂具有较高的敏感性、特异性和准确性,且能更准确评价半月板撕裂类型,可为临床治疗方案的选择和手术方案的制定提供更多信息。
[Abstract]:The introduction of knee injury especially the anterior cruciate ligament (anterior cruciate, ligament, ACL) and meniscus injury is a common disease that can lead to joint pain, swelling and dysfunction, and even reduce the motor function. The accurate diagnosis of ACL injury, meniscus tear and tear type helps to clear the selection of clinical treatment methods the formulation and operation scheme, prognosis evaluation of.MRI with soft tissue resolution and excellent spatial resolution, has become the most commonly used evaluation of knee joint injury, noninvasive method. The conventional 2D-MRI has been widely used in clinical examination, but the volume data of thick layer thickness and partial volume effect will cover the subtle lesions.3D-MRI get to level (multi-plane reformation, MPR) restructuring, is helpful to the diagnosis of the lesions and detect subtle lesions. The purpose of the study is to evaluate the 3D-MRI sequence in PDWI-SPAIR 1. Application of.2. evaluation of 3D-MRI PDWI-SPAIR sequence in the diagnosis of ACL injury in the diagnosis of meniscus tear. The research objects and methods were collected and analyzed from December 2013 to May 2016 in our hospital MRI examination and confirmed by clinical arthroscopy in 100 patients with 104 knee joints, joint mirror and MR data using 3D-MRI PDWI-SPAIR image on ACL. Thin layer MPR oblique coronal and axial reconstruction, the meniscus were thin MPR sections, coronal reconstruction. Compared with the results of arthroscopy, comparison of 2D-MRI and 3D-MRI PDWI-SPAIR sequence on ACL damage diagnostic sensitivity, specificity and accuracy of 3D-MRI PDWI-SPAIR application, evaluation grading in the diagnosis of ACL injury; evaluation of 3D-MRI PDWI-SPAIR sequence and MPR reconstruction application of different types of meniscal tear and tear. The diagnosis and arthroscopic findings, 2D-MRI and 3D-MRI in the diagnosis of ACL damage sensitivity of the total Were 88 and 93.4%, the overall specificity were 71.4% and 92.9%, the total accuracy is 83.6% and 93.3%. respectively by Kappa test, the results of 2D-MRI and arthroscopy in the diagnosis of ACL injury with moderate consistency, K=0.591; the results of 3D-MRI and arthroscopy in the diagnosis of ACL injury has excellent consistency, K= 0.835.1. and arthroscopic findings, the sensitivity of 2D-MRI ACL and 3D-MRI diagnosis of grade 3 injuries were 81.8% and 94%, the specificity was 94.3% and 97.2%, accuracy were 90.3% and 96.2%; the sensitivity of diagnosis of ACL grade 2 injury were 68% and 84%, the specificity was 89.8% and 97.5%, accuracy were 84.6% and 94.2%; the sensitivity of diagnosis of ACL grade 1 injury were 66.7% and 88.9%, the specificity was 91.8% and 98.9% respectively, the accuracy control, and the results of 87.5% 97.1%.2. and arthroscopic MPR reconstruction of 2D-MRI, the sensitivity of 3D-MRI diagnosis of meniscus were 77.2%, 91.8%,. Specific were 88%, 96%, the accuracy was 79.8%, 92.8%. by Kappa test, 2D-MRI and arthroscopy in the diagnosis of meniscal tear results with moderate consistency, K=0.541 consistency; 3D-MRI and arthroscopy in the diagnosis of meniscal tear results are excellent, the control results of K=0.817.3. and arthroscopy, sensitivity of 3D-MRI to 2D-MRI, various types of diagnosis of meniscus tear. Is that a composite split 75% 89.6%, 85%, 95%, horizontal fissure, longitudinal tear in 83.3%, 90%, 95.1%, 82.9% oblique tear, bucket handle tear 83.3%, l00%, 85.7% 100%. radial tear, the conclusion of 1. compared with the conventional 2D-MRI, 3D-MRI diagnosis of ACL injury has higher sensitivity, specificity and accuracy of effective to reduce the false positive and false negative; but for chronic ligament injury, 3D-MRI still easily lead to misdiagnosis, should be closely combined with clinical history, physical examination by.2. 4 grades (grade 0-3) as the classification criteria for the diagnosis of ACL injury To formulate effective, contribute to the clinical diagnosis and treatment. In the classification level 1-3 ACL damage, 3D-MRI sensitivity, specificity and accuracy were higher than that of bone contusion in acute ACL injury group 2D-MRI.3., medial collateral ligament injury, joint effusion was significantly higher than that in chronic group. Chronic ACL injury group, meniscus tear, cartilage the incidence of injury was significantly higher than that of the acute group.4. and conventional 2D-MRI, 3D-MRI has a higher sensitivity of meniscal tear, specificity and accuracy, and can more accurately evaluate the meniscal tear type, can provide more information for the choice of clinical treatment and surgical plan formulation.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R686.5

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