关节软骨病损的磁共振成像与关节镜检查的比较

Study of MR imaging sequence in detecting articular cartilage erosion:comparison with arthroscopy

[目的]对照膝关节软骨病损的MRI和关节镜表现,评价MRI对早期软骨病变诊断的临床价值。[方法]对临床上拟行膝关节镜检查的膝关节疼痛患者共26人27例膝关节,术前常规行T1加权快速自旋回波(FSET1WI)和质子密度加权快速自旋回波(FSE PDWI)2种MRI序列扫描,其中10例加做三维脂肪抑制扰相梯度回波(3D FS-FSPGR)序列。MRI分级结果并与关节镜下分级诊断结果比较。[结果]以关节镜诊断为标准,3D FS-FSPGR序列敏感度最高,可达96.5%,准确率达95.0%。在敏感度和准确度上3D FS-FSPGR>FSE FDWI>FSET1WI,与关节镜诊断的一致性上,3D FS-FSPGR的Kappa值达到0.776,一致性极佳,均明显优于FSE PDWI和FSET1WI(P值均<0.01)。[结论]3D FS-FSPGR序列能够准确反映软骨病变,并且对于早期的软骨病变亦能较真实体现,与关节镜诊断结果具有良好的一致性,而且通过三维重建对软骨病变进行立体定位诊断,应用前景广阔。

[ Objective] To compare the value of the MR imaging and arthroscopy for detecting articular cartilage erosion, and to evaluate the clinical effect of MR imaging on the correct diagnosis in the early stage of articular cartilage lesion. [ Method] Twenty-six patients （27 knees） with persistent knee pain who were scheduled for arthroscopy underwent MR scanning, including 3D FS-FSPGR, FSE PDWI and FSE T1WI sequences. The results of each sequence were then compared with the arthroscopic findings. [ Result] Using arthroscopic results as the standard of reference, the 3D FS-FSPGR images had the higher sensitivity （96. 5% ） and accuracy （95.0%） than the standard MR imaging, the 3D FS-FSPGR sequence was well consistent with the result of arthroscopic, Kappa value was higher （0. 776） than the other sequences （P 〈 0. 01 ）. [ Conclusion ] 3D FS-FSPGR imaging is a favorable scanning sequence. It can show the pathological changes of articular cartilage including the early stage and has good veracity to the early pathological changes of articular cartilage erosion. The three-dimensional reconstruction is helpful to make sure the location of the erosion. So it has a wide application prospects.