MRI不同序列对肩袖损伤诊断价值的比较

Comparison of diagnostic effects of rotator cuff tears at MRI different sequences

目的分析肩袖损伤在MRI不同序列上表现的病理基础,比较各种序列对肩袖损伤的检出效果。方法24例患者,采用1.5TMR机,肩关节线圈,常规斜矢状位T1WI,横轴位T2WI,斜冠状位PDFS,SPGR和STIR;层厚4mm,层距0.1mm。判断标准依据肩袖的形态、信号,确定肿胀、断裂、萎缩。根据信号特征区分水肿、出血、纤维化、钙质沉积的病理基础。依据图像质量和显示的解剖细节确定不同序列的检出率,分为优、良、差三级。结果冈上肌腱损伤18例次,水肿4例次;冈下肌腱损伤5例次;肩胛下肌腱损伤4例次;小圆肌腱损伤2例次;肱二头长头肌腱损伤4例次;腱鞘炎1例次;肩关节积液4例次;肩峰下滑囊肿胀3例次;肱骨大结节撕脱骨折3例次;大结节骨折1例次。经卡方检验,各序列之间检出率差别显著(χ2=17.134,P<0.05),PDFS序列对肩袖损伤的显示最佳。结论MRI是诊断肩袖损伤的重要手段,信号的差异可反映不同的病理特征,建议肩袖损伤应首选PDFS序列。

Objective To analyze the pathological basis of MRI features and to compare the display effects of rotator cuff tears among different sequences. Methods Twenty-four patients (10 men and 14 women, age range, 23-84 years; mean, 57 years) underwent T1WI oblique sagittal, T2WI axial, PDFS, STIR and SPGR oblique coronal scanning, with 4 mm slice thickness and 0.1 mm slice space. Results Twenty-four rotator cuff tears were diagnosed, including 18 cases of supraspinatus tendon damages, 4 of swellings, 5 of infraspinatus tendon damages, 4 of subscapularis tendon damages, 2 of teres minor tendon damages, 4 of tendon of long head of biceps damages, 1 of bursitis, 4 of fluid collection in the shoulder joint, 3 of subacromial bursitis, 3 of avulsion fractures of greater tuberosity and 1 of greater tuberosity fracture. Statistics of χ2 showed marked differences among the different sequences (P<0.05). The PDFS was the best technique to detect the rotate cuff tears. Conclusion MRI is the first choice method for diagnosis of rotator cuff tears. The signal of different sequences may reflect different pathology. PDFS sequence should be used as the first choice to diagnose the rotator cuff tears.