关节镜和3.0TMRI对膝关节关节软骨损伤诊断的对比研究

3.0T MR Diagnosis of Articular Cartilage Lesion:Compared with Arthroscopy

目的：通过采用关节镜检查探讨3．0TMRI在膝关节股骨远端外伤性骨挫伤致关节软骨损伤诊断中的作用。方法：采用关节镜对2010年10月～2013年3月共收治经3．0TMRI影像检查．MRI图像后期三维重建处理，显示股骨远端外伤性骨挫伤致膝关节软骨损伤22例，其中合并胫骨近端骨挫伤3例，合并外、内侧膝半月板损伤7例，12例确诊膝前交叉韧带断裂，4例膝前交叉韧带并膝内侧副韧带损伤．在手术中与MRI对比观察关节软骨损伤情况。结果：膝关节股骨远端骨挫伤患者关节镜下见到膝关节软骨损伤与3．0TMRI所显示基本一致，脂肪抑制三维稳态进动快速成像序列（fat—saturatedthree—dimensionalfastimagingwithsteady—stateprocession，FS-3D—FISP）敏感度为91．3％，特异度为96．8％，Kappa值为0．812，SE—T1WI敏感度为71．7％，特异度为97．9％，Kappa值为0．514。结论：FS-3D—FISP序列对膝关节股骨远端骨挫伤致关节软骨损伤诊断的准确性明显优于SE—T1WI，3．0TMRI与关节镜对软骨损伤病变诊断的结果之间具有良好的一致性，3．0TMRI扫描时间更短，成像更清晰，但〈1．0cm0的软骨损伤区MRI表现与关节镜问的诊断有差别，软骨损伤面积与MRI信号改变的范围呈正相关，关节镜下I度膝软骨损伤无阳性发现，由于MRI机身容积效应影响，在某些情况下关节软骨致伤的严重程度不能真实反映，主是通过软骨下骨及骨髓内的异常信号等间接征象表现关节软骨的损伤。

Objective： By arthroscopy discuss MRI in the distal femoral bone bruise in articular cartilage damage diagnosis to the role. Methods：Using arthroscopy on October 2010 - March 2012 were treated by MRI imaging, MRI image 3 d reconstruction processing, display distal femoral bone bruise in the articular cartilage injury 22 cases, which combined the tibia near end a bone bruise in 3 cases, accompanied by the lateral meniscus injury in 7 cases, 12cases were diagnosed have anterior cruciate ligament rupture, 4cases of anterior cruciate liga- ment and medial collateral ligament tear damage, in surgical treatment and observation articular cartilage injury. Results：The distal femoral bone contusion patients see arthroscopic knee joint cartilage damage and MRI shows basic anastomosis, 3 D fat suppression steady - state precession fast image sequence （fat - saturatedthree - di- mensional fast imaging with steady - state procession, FS - 3 D - FISP） were 91.3 % and 96.8 %, respec- tively） for, Kappa value is 0.812, SE - T1WI were 71.7% end 97.9%, respectively）for, Kappa value is 0.514.Conclusion：FS - 3 D - FISP sequence for knee distal femoral bone bruise in the articular cartilage damage diagnosis accuracy is obviously superior to the SE - T1WI, MRI and articular cartilage damage to mir- ror the diagnosis of disease has a good consistency between the results, but〈 1.0 cm2 cartilage damage area MRI sometimes can＇ t real performance, cartilage damage area and MRI signal change range of I positively ratio, degree of cartilage damage arthroscopic no positive found that, because MRI fuselage volume effect difference, in some cases articular cartilage injury severity cannot really reflect, the subchondral bone and bone marrow in ab- normal signal is articular cartilage damage important indirect signs.