四肢关节专用MRI对膝关节半月板桶柄样撕裂的诊断价值

Bucket-Handle Tears of Knee Menisci:Evaluation with Dedicated MRI

目的探讨膝关节半月板桶柄样撕裂的MRI征象及其诊断价值。方法回顾分析膝关节半月板桶柄样撕裂23例,所有病例均经过四肢关节专用MRI检查并经关节镜证实。由2名有经验的放射科医师进行盲法阅片,记录并评价各征象的诊断价值。结果23例共见半月板桶柄样撕裂23个,其中发生于内侧半月板者16例(69.6%),外侧半月板者7例(30.4%)。出现领结消失征15例(65.2%),双前角征9例(39.1%),半月板翻转征3例(13.0%),髁间碎片征19例(82.6%),双后交叉韧带征7例(30.4%),后角比例失调征8例(34.8%)。序列试验显示各征象联合诊断时特异性明显提高,其中髁间碎片征和双后交叉韧带征联合的特异度达100%。结论MRI是半月板桶柄样撕裂理想的无创检查方法,有利于该疾病的术前诊断和手术计划制定。

Objective To analyze the MRI signs of the bucket - handle tears of menisci of the knee and evaluate their value in the diagnosis of the lesion. Methods The MRI signs of 23 patients with bucket - handle tears of menisci, which were proved with arthroscopy, were analyzed retrospectively. The MRI imaging of all patients were evaluated by two experienced radiologists independently with unknown of the results of arthroscope. The MRI signs of bucket - handle tears were recorded and their diagnostic value was estimated. Resuits Of 23 patients, sixteen （69.6 % ） with medial and seven （30.4 % ） with lateral bucket - handle tears of menisci were found. The percentage of absent bow tie sign, double anterior horn sign, flipped meniscus sign, fragment sign within the intercondylar notch, double posterior cruciate ligament sign and disproportional posterior horn sign were 65.2%, 39.1%, 13.0%, 82.6%, 30.4% and 34.8%, respectively. This study demonstrated that the specificity of diagnosis increased remarkably when these different signs occurred together. Combining the fragment sign within the intercondylar notch with the double posterior eruciate ligament sign, the specificity could get to 100%. Conclusion MRI is an excellent and noninvasive modality to diagnose the bucket - handle tears of menisci of the knee, which is of benefit to establish surgery plan accurately.