不同MRI序列对半月板缝合术后愈合的诊断价值

Diagnostic value of different sequences of magnetic resonance imaging in repaired meniscus

目的评估不同MRI序列在判断半月板缝合术后愈合中的应用价值。方法2002年9月至2008年12月，118例患者（130个半月板）接受关节镜下半月板缝合术。男94例，女24例；年龄15-50岁，平均（25．7±7．5）岁。术前及术后平均（21．9±9．1）个月接受MR检查，记录不同序列上半月板愈合部位的信号等级和3度信号累及层面，并以二次关节镜探查的结果作为金标准计算MRI各序列诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值。结果二次关节镜探查证实半月板愈合率为80．8％（105／130）。MRI各序列诊断的愈合率均低于二次关节镜探查结果。综合T2序列的诊断结果最佳，其敏感性、特异性、准确性、阳性预测值及阴性预测值分别为76．O％、71．4％、72.3％、38．8％及92．6％。按二次关节镜探查结果将所有缝合半月板分为愈合组和未愈合组，愈合组中28．6％（30／105）的半月板呈现3度信号，出现新增3度信号的比例为8．6％（9／105），3度信号累及层面数为0．8±1．0；未愈合组中76．O％（19，25）的半月板呈现3度信号，出现新增3度信号的比例为16．0％（4／25），3度信号累及层面数为3．0±2．0。结论MRI中的综合T2序列判断半月板愈合的敏感性、特异性和准确性均较高；缝合后的半月板出现新增3度信号提示半月板未愈合。

Objective To evaluate the diagnostic value of different sequences of magnetic resonance imaging （MRI） in repaired meniscus. Methods From September 2002 to December 2008, 118 patients （130 menisci） underwent arthroscopic meniscus suture in our hospital, including 94 males and 24 females, aged from 15 to 50 years （average, 25.7±7.5 years）. All pa- tients underwent MRI and second-look arthroscopy postoperatively. Different sequences of MRI were taken to evaluate the grade of meniscal signal at repaired site and the slices involved by grade 3 ignal. The diagnostic sensitivity, specificity, accuracy, pos- itive predict value （PPV） and negative predict value （NPV） were calculated for each sequence by using second-look arthroscopy as the gold standard. Results The total healing rate was 80.8% （105/130） by second-look arthroscopy, which was higher than that by different sequences of MRI. The integrated 3＂2 sequence held the highest diagnostic value, and the sensitivity, specificity, accuracy, PPV and NPV were 76.0%, 71.4%, 72.3%, 38.8% and 92.6%, respectively. According to the second-look arthroscopy result, the menisci were divided into the healed group and unhealed group. In the healed group, 28.6% of cases （30/105） showed grade 3 signal in MRI, which was less than that （76.0%） in the unhealed group. The rate of the new grade 3 signal （8.6%） and the slices involved by grade 3 signal （0.8±1.0） in the healed group were less than those （16.0% and 3.0±2.0） in the unhealed group. Conclusion The diagnostic value of the integrated 3＂2 sequence is encouraging with high sensitivity, specificity and accuracy. The new grade 3 signal in the repaired meniscus usually implies that the meniscus is not healed.