低场MRI对膝关节隐匿性骨折诊断价值.docVIP

低场MRI对膝关节隐匿性骨折诊断价值【摘要】目的: 探讨膝关节隐匿性骨折的低场MRI表现特点,评价MRI检查的诊断价值。方法: 常规DR及MSCT检查骨质未见明显异常患者126例,膝关节外伤一至三周内行MRI检查,检查序列包括T1WI、T2WI和STIR。结果: 126例中共152处膝部隐匿性骨折。T1WI呈不规则、边缘模糊的片状低信号,T2WI呈略高信号,STIR呈明显高信号,可伴有线样异常信号。常伴有韧带等软组织损伤。结论: 低场MRI是检查膝关节隐匿性骨折的较佳影像学方法,可减少或避免误诊和漏诊,STIR序列最为敏感。 【关键词】隐匿性骨折;膝关节;磁共振成像;诊断 【中图分类号】R445.2 【文献标识码】A 【文章编号】1008-6455(2010)08-0022-02 【Abstract】Objective:To explore the value of low-field MR imaging in the diagnosis of occult fracture of the knee joint.Methods:126 patients,who experienced knee traumas with obvious clinical symptoms and negative DR and MSCT findings,had MRI examinations in a week to tree weeks.Results:A total of 152 occult fractures 0f the knee joint were detected in the 126 patients.The Fracture imaging showed hypo-intensity on TlWI,slightly high intensity on T2WI,and marked hyperintensity on STIR,with ligament and soft tissue injuries and with linear abnormal signal intensity.Conclusion:low-field MRI is the better method in the diagnosis of occult fracture of the knee joint,which can avoid the misdiagnosis and missed diagnosis of occult fractures in the knee joint to a great extent,the STIR sequence is most sensitive. 【Key words】Occult fracture;Knee joint;Magnetic resonance imaging;Diagnosis 膝关节隐匿性骨折是临床较常见的病变,大多有明显的外伤史。主要以膝关节疼痛为主,活动可受限,其他阳性体征可不典型,且常规X线(DR)检查对膝关节隐匿性骨折往往难以做出准确的诊断[1],常导致误诊和漏诊,影响患者治疗及愈后,甚至引发医患纠纷。MRI对骨关节解剖细节显示清晰,凭借其多参数、任意平面成像的优点,能较准确地显示骨骼与周周软组织的形态变化和细微的异常病理变化。本文回顾性分析我院2007年6月-2008年10月诊治的膝关节隐匿性骨折126例的MRI表现,旨在探讨低场MRI对膝关节隐匿性骨折的诊断价值,协助临床提高隐匿性骨折的诊断率、预防和减少本病并发症的发生。 1 材料与方法 1.1 一般资料:本组126例,男72例,女54例;年龄11-79岁,平均约41岁。均有典型的外伤史与关节周围疼痛,外伤前无相应临床症状。所有患者MRI检查前均行常规DR检查,19例先行16排螺旋CT检查。 1.2 方法:所有患者伤后均行DR检查,膝关节正、侧位DR摄片。伤后1d-3W内行MRI检查,使用GE Signa Ovation SYS 0.35T永磁型MRI仪,9-INCHGP 线圈,行矢状位T1WI(SE+POMP)序列,TR=360ms,TE=14,THK=5mm,NSA=4mm;T2WI(FRFSE)序列,TR=2520ms,TE=72ms,THK=5mm,NSA=2mm,冠状位STIR(FRFSE-IR)序列,TR=3200ms,TE=20.5mm,THK=5mm,NSA=2mm,所有检查FOV=180mm,矩阵=512*512。 1.3 隐匿性骨折的判断标准:参考国内外相关作者研究成果[1-2],主要总结为:(1)有明确的急性、慢性外伤史,有局部疼痛、活