膝关节半月板撕裂的MRI与关节镜诊断对照研究

The comparative study of MRI and arthroscope diagnosis of knee joint meniscus tear

目的:比较分析半月板撕裂的MRI征象与关节镜下表现,提高半月板撕裂的MRI诊断准确率。方法:选取本院76个半月板病例,对其进行MRI征象分析并诊断,所有病例2周内行关节镜检查,将其结果与MRI诊断结果进行对比。结果:本组病例,MRI诊断30个半月板为Ⅲ级损伤;关节镜诊断28个半月板为撕裂即Ⅲ级损伤。MRI与关节镜诊断一致的撕裂半月板个数为22个,MRI诊断为可疑撕裂但关节镜诊断为阴性的半月板个数为8个,MRI诊断为阴性但关节镜诊断为撕裂的半月板为6个。本组病例半月板撕裂的MRI诊断的灵敏性为79%,特异性为93%。结论:从半月板撕裂的MRI征象中,分析假阳性及假阴性病例,找出提高MRI对半月板撕裂诊断准确率的对策为:MRI诊断应结合患者的临床症状,对于半月板内高信号的性质判断应准确,防止周围韧带被误认为半月板撕裂信号,对于线状高信号的层数判断应准确,对于半月板变形与弥漫性高信号的分析应结合伴随征象,对于桶柄状撕裂的征象应观察清楚。

Objective To improve the accuracy of MRI diagnosis by comparative analysis of the MRI symptom and arthroscope view of meniscal tear. Methods 76 cases of meniscus in our hospital were selected to analyze their MRI symptoms. All cases were examined by arthroscopy in 2 weeks. The arthroscopic findings were then compared with the MRI diagnoses. Results This study showed that 30 cases are Grade 11I injuries by MRI; 28 cases were Grade m （i.e. tear） by arthroscopy. The diagnoses of 22 cases by MRI were consistent with those by arthroseopy. 8 cases, being suspicious tears by MRI diagnosis, were negative by arthroscopy. 6 cases being negative by MRI diagnosis, were tear by arthroscopie analysis. Our results showed that the sensitivity and specificity of MRI diagnosis of meniscal tears were 79% and 93%, respectively. Conclusions An effective strategy to improve the diagnostic accuracy of MRI of meniseal tears through MRI diagnosis： MRI diagnosis should be combined with the clinical symptoms, diagnosis of the of the high signal intensity within the meniscus should be accurate to prevent the surrounding ligaments be mistaken for a torn meniscus signal. Linear high signal layers should be accurately identified. The analysis of meniscus deformation and diffuse high-signal analysis should be combined with the concurring signs. Bucket-handle tear of the signs should be clearly observed.