关节软骨病损的影像学诊断

Imaging diagnosis of the articular cartilage disorders

目的 探讨慢性骨关节炎、类风湿性关节炎等几种慢性关节软骨损伤平片和MRI的诊断与鉴别诊断。方法 89例患者 (骨关节炎 6 1例 ,类风湿性关节炎 9例 ,其他慢性损伤 19例 )共115个关节均行平片检查及MRT1WI、T2 WI+质子密度加权像 (PDWI)、短时反转恢复抑脂序列 (STIR)、三维抑脂扰相梯度回波序列 (3DFSSPGR)扫描 ,32例 4 4个关节进行了增强扫描。其中 90个膝关节的MRI分髌骨、股骨内髁、股骨外髁、胫骨 4个关节面 ,按软骨病变Outerbridge分级法进行分析观察 ,6 1例 75个关节进行了平片与MRI征象的对照观察。结果 MRI表现 :关节软骨病变 115个 (10 0 % ) ,同时伴有关节软骨变薄 5 8个 (5 0 4 % )、软骨下骨质、骨髓改变 2 2个 (19 7% ,)、滑膜增生 5 2个(45 2 % ,) ;类风湿性关节炎与骨关节炎组和其他慢性损伤组比较 ,类风湿性关节炎的软骨下骨质、骨髓改变的发生率与骨关节炎组及其他慢性损伤组差异有显著性意义 (P值均 =0 0 0 0 )。把受累几率最大的髌软骨 (81/90 ,90 % )按MRI软骨病损Ⅰ～Ⅱ级为 1组 ,Ⅲ～Ⅳ级为另 1组 ,与平片的征象进行相关对照分析 ,两组间分别在平片的关节间隙狭窄 (χ2 =9 349,P =0 0 0 2 )、关节面下小囊变 (χ2 =9 885 ,P =0 0 0 2 )差异有非常显著性意义。结论 I～?

Objective To evaluate the diagnosis and differential diagnosis among the chronic osteoarthritis, rheumatoid arthritis and other chronic cartilage lesions on the plain films and MR images. Methods Eighty-nine cases, including 115 joints, underwent plain film and MRI examination, and enhanced MRI scan was performed on 32 of them, including 44 joints. MRI scan sequences consisted of T 1WI, T 2WI+PDWI, STIR, and 3D FS SPGR. There were 90 knee joints in this group and each of the articular cartilage was divided into four parts: patella, femoral medial condyle, femoral lateral condyle, and tibia facet on MR images. The cartilage disorders were classified according to the outerbridge method. In addition, 61 cases including 75 joints were observed as a control group on the plain films and MR images. Results 115 cartilage lesions were found on MR images, in which thinness of the cartilage (58 cases, 50 4%), bone changes under the cartilage (22 cases, 19.7%), medullar edema (22 cases, 19.7%), and synovial hyperplasia (52 cases, 45.2%) were seen. The patella cartilage was the most likely affected part (81/90, 90%). So the patellar cartilage lesions were divided as group 1 (grade Ⅰ-Ⅱ) and group 2 (grade Ⅲ-Ⅳ) on MR images, which were compared with the plain film signs. The narrowing of the joint space and saccules under the articular surface were statistically significant with each other, and χ 2 values were 9.349 and 9.885, respectively (P=0.002). Conclusion No constant signs could be seen on the plain films with grade Ⅰ-Ⅱ cartilage disorders. While the narrowing joint space and saccules under the joint surface could be seen on them with grade Ⅲ-Ⅳ cartilage disorders, which were mainly correlated with the cartilage disorders and bone changes under the articular cartilages. A combination of the plain films and MR images is the best imaging method for examining the joints and joint cartilages. Enhanced MRI scan is very helpful on the diagnosis and differential diagnosis of the synovial lesions.