急慢性膝关节软骨损伤的MRI对比研究

发布时间：2018-10-16 19:19

【摘要】：目的:以膝关节镜检查结果作为金标准,分析评价并比较磁共振成像(Magnetic resonance imaging,MRI)的三维扰相梯度回波脂肪抑制序列(three-dimensional fat suppress spoiled gradient recalled echo,3D-FS-SPGR)及三维稳态采集快速成像序列(three-dimensional fast imaging employing steady state acquisition,3D-FIESTA)两种特殊序列,对于显示膝关节软骨损伤的特异性、敏感性及准确度;对照膝关节镜分级结果,利用T2-mapping序列比较受损软骨与正常软骨T2值变化以及急慢性关节软骨损伤的T2值差异,总结急性膝关节软骨损伤和慢性膝关节软骨损伤的MRI影像学表现的差异性。方法:收集即将行关节镜检查的关节共50个,其中急性损伤20个,骨关节炎(osteoarthritis,OA)30个。同时选取20个正常膝关节作为对照组,行MRI特殊序列检查,将获得的图像数据结合后处理图像对膝关节软骨损伤程度及相应的观察指标进行统计学分析。结果:3D-FS-SPGR、3D-FIESTA均可以较好的显示关节软骨的损伤并对于关节软骨损伤程度作出评价,以3D-FS-SPGR显示地更为清晰。T2-mapping序列敏感性高,可以显示关节镜检查未发现任何形态异常的关节软骨成分的改变,从而判断关节软骨的损伤,但该序列特异性较差,对于关节软骨损伤程度难以作出评价。同一膝关节髌骨被覆软骨T2值均低于股骨软骨及胫骨平台软骨T2值,而股骨软骨及胫骨平台软骨的平均T2值差异不明显。外伤与OA所致的关节软骨损伤在同一部位T2值并无显著差异。急性关节软骨损伤以II、III级损伤为多,以股骨内侧髁、胫骨内侧髁好发,慢性关节软骨损伤亦多发生在股骨内侧髁及胫骨内侧髁,以III、IV级损伤多见。结论:3D-FSPGR、3D-FIESTA、T2-mapping三种序列在显示膝关节软骨损伤方面各有优缺点。急、慢性关节软骨损伤的影像学表现具有差异性。
[Abstract]:Objective: to take the results of knee arthroscopy as gold standard. Three dimensional scrambling gradient echo fat suppression sequence (three-dimensional fat suppress spoiled gradient recalled echo,3D-FS-SPGR) and three dimensional steady-state acquisition fast imaging sequence (three-dimensional fast imaging employing steady state acquisition,3D-FIESTA) were analyzed and compared. In order to show the specificity, sensitivity and accuracy of articular cartilage injury, the difference of T2 value between damaged cartilage and normal cartilage and acute and chronic articular cartilage injury was compared by T2-mapping sequence compared with the results of knee arthroscopic grading. To summarize the difference of MRI imaging findings between acute and chronic knee cartilage injury. Methods: 50 joints were collected for arthroscopy, including 20 acute injuries and 30 osteoarthritis (osteoarthritis,OA). At the same time, 20 normal knee joints were selected as the control group, and the special MRI sequence was performed. The degree of cartilage injury and the corresponding observation indexes were analyzed statistically by combining the obtained image data with post-processing images. Results: 3D-FS-SPGRGR3D-FIESTA could show the injury of articular cartilage and evaluate the degree of articular cartilage injury. The 3D-FS-SPGR was more clear and the sensitivity of T2-mapping sequence was higher than that of 3D-FS-SPGRGR3D-FIESTA. Arthroscopic examination can show that there is no change of articular cartilage component which is abnormal in shape, so as to judge the damage of articular cartilage, but the specificity of the sequence is poor, so it is difficult to evaluate the degree of articular cartilage injury. The T2 value of patellar coated cartilage of the same knee joint was lower than that of femur cartilage and tibial plateau cartilage, but the mean T2 value of femoral cartilage and tibial plateau cartilage had no significant difference. There was no significant difference in T 2 value between trauma and OA induced articular cartilage injury. Most of acute articular cartilage injuries were II,III grade injuries. Medial femoral condyle and medial tibial condyle were the most common injuries. Chronic articular cartilage injuries also occurred in medial femoral condyle and medial tibial condyle. III,IV grade injuries were more common. Conclusion: 3 D-FSPGRG 3 D-FIESTAN T 2-mapping has advantages and disadvantages in displaying cartilage injury of knee joint. The imaging findings of acute and chronic articular cartilage injury are different.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684;R445.2

【参考文献】