膝关节损伤MRI表现与关节镜检查对照研究

Comparative study of MRI verus arthroscopy in evaluating the injuries of knee joint

目的分析研究膝关节半月板及韧带损伤的MRI表现,并与关节镜诊断结果相对照,评价MRI的临床应用价值。方法48例膝关节外伤患者均经MRI和关节镜检查。半月板损伤的分级标准采用Kaplan的三级分类方法。韧带损伤参照Ruiz进行分级。膝关节MRI检查采用常规序列:T1WI/SE,T2WI/TSE,STIR和GRE。关节镜检查由一名主任医师和一名主治医师共同完成。MRI检查后患者均于1～2周内行关节镜检查或手术。结果与关节镜检查结果比较,MRI诊断半月板损伤的准确率为85.4%,敏感性为92.1%,特异性为81.0%,阳性预测值为76.1%,阴性预测值为94.0%。MRI诊断韧带损伤的准确率为93.1%。然而,MRI对滑膜皱襞综合征、剥脱性骨软骨炎及创伤性滑膜炎诊断价值较低。结论MRI对膝关节半月板及韧带损伤诊断具有明显的临床应用价值,同时可作为关节镜术前的筛选工具,指导关节镜在临床中的合理运用。

Objective To study the MRI findings of traumatic knee menisci and ligameats and to compare with arthroscopic findings so as to assess the clinical usefulness of MRI. Methods Forty - eight patients with traumatic knee menisci and ligaments underwent the both examinations of MRI and arthroscopy. The injuries of knee menisci were divided into three grades by Kaplan＇s classification, while the injuries of knee ligaments were graded by Ruiz＇ s criterion. MRI examinations of knee joints were performed by using conventional sequences which comprised T1WI/SE, T2WI/TSE, STIR and GRE, while arthroscopic procedures were completed together by a chief physician and a middling physician. All arthroscopies or surgeries were performed within one - two weeks after MRI scanning. Results Compared with arthroscopy which was taken as a gold criterion, the accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI in identifying the injuries of knee menisci were 85.4%, 92. 1%, 81.0%, 76. 1% and 94.0%. respectively. The accuracy of MRI in identifying the injuries of knee ligaments was 93. 1%. However, the value of MRI in the diagnosis of synovial plica syndrome, desquamative osteochondritis and traumatic synovitis was lower. Conclusion MRI has important value in evaluating the injuries of knee menisci and ligaments, simultaneously, it can bws taken as a screening tool before arthroscopy and therefore it can guide clinically reasonable applications of arthroscopy.