儿童早期化脓性髋关节炎:3.0T MR影像特征分析

3.0T MR imaging characteristics of early septic arthritis in hip with children

目的探讨儿童早期化脓性髋关节炎3.0T MR影像特征。方法收集我院2004年1月—2008年4月间发病时间在两周之内确诊为早期化脓性髋关节炎21例,所有病例均经临床血细菌培养、关节液细菌培养和组织学病理检查证实,所有患者均行3.0T MR双侧髋关节轴位及冠状位平扫,分析3.0T MR早期化脓性髋关节骨髓、骨骺、软骨、周围软组织影像特征性改变。结果MR表现:①患髋骨髓、骨骺及软骨信号改变:化脓性髋关节炎中13例患者股骨头骨骺及干骺端内部信号不均,骨骺形态失常,呈斑片状长T1长T2信号,为骨质破坏的表现,累及骺板者表现为穿越骺板的T2WI条形高信号影,累及骨骺软骨者表现为骺软骨薄厚不均,信号异常,还可以累及相邻的髂骨、耻骨。②患髋关节周围软组织信号改变:19例化脓性髋关节炎患者髋周软组织T2W-SPAIR上高信号(水肿表现),多累及髂肌、臀肌、耻骨肌及股内外侧肌,其中1例化脓性关节炎患者仅表现为肌间隙条片状高信号。③髋关节积液:21例均出现患侧髋关节积液,其中2例同时出现健侧髋关节积液。结论3.0T MR检查有助于儿童早期化脓性髋关节炎诊断与鉴别诊断,儿童早期化脓性髋关节炎3.0TMRI影像特征为骨髓、骨骺及软骨信号的异常升高和患髋关节周围软组织水肿。

Objective To study the 3.0T MRI features of early septic arthritis in hip with pediatric patients. Methods The MRI and clinical findings in 21 pediatric patients with early septic arthritis in hip, with nontraumatic acute hip pain and limp during the period between Jan 2004 and Apr 2008, were reviewed retrospectively. MRI was performed on 3.0T system and comprised coronal T1WI-TSE, T2WI TSE and T2W-SPAIR sequences. The MRI findings were analyzed with em phasis on alterations in signal intensity in bone marrow, epiphysis, cartilage and the soft tissues, and the presence of joint effusion. Results ①Signal intensity alterations in soft tissue： high signal intensity on T2W-SPAIR （i. e. edema） were seen in iliacus, gluteus, pectineal, vastus medialis/lateralis of 19 septic arthritis patients. However, only one patient shows high signal intensity on TEWI SPAIR in spatium intermusculare.②Signal intensity alterations in bone marrow, epiphysis, cartilage： low signal intensity on TlWI and high signal intensity on T2WI （i. e. destruction of sclerotin） in epiphysis of femoral head and metaphysic. If epiphyseal plate involvement, high signal intensity across the epiphyseal plate were seen on T2WI; If cartilage involvement, signal intensity alterations and thickness alterations were seen also on T2WI, maybe the ilium and pubis could he involvement, ③Joint effusion： joint effusion in effected hip joint were seen in all patients; joint effusion in contralateral hip joint were seen in 2 of 21 patients with septic arthritis. Conclusion MR is helpful in diagnosis of early septic arthritis of hip in children. The significant MR finding are the signal intensity abnormalities in bone marrow, epiphysis, cartilage, soft tissue and joint effusion.