膝关节髌内侧滑膜皱襞正常及病理性滑膜皱襞综合征MRI表现

MRI Features of Normal and Pathological Plica Syndrome in Knee Medial Patellar Plica

目的探讨膝关节髌内侧滑膜皱襞的正常和病理性滑膜皱襞综合征的MRI表现。方法回顾性分析737例膝关节MRI检查及其中经关节镜证实的13例髌内侧滑膜皱襞综合征的MRI表现，观察髌内侧滑膜皱襞的发生率和各亚型的正常及病理性滑膜皱襞综合征的MRI表现。结果737例膝关节MRI检查共发现髌内侧滑膜皱襞157例（21．4％）。根据Sakakibara法将髌内侧滑膜皱襞分为4个亚型：A型78例（49．7％），B型46例（29．3％），C型28例（17．8％），D型5例（3．2％）。正常髌内侧滑膜皱襞表现为横轴位和矢状位上髌股关节内侧壁线样或带状低信号影（多为A型和B型），当关节囊有积液时在T2WI高信号背景下尤易观察，厚度1～2mm，边缘清晰，一般不超过同层股骨内髁。当发现髌内侧滑膜皱襞明显增厚、增宽，完全覆盖股骨内侧髁面关节软骨（C型或D型），同时伴有皱襞形态扭曲，边缘毛糙，信号增高，邻近股骨内髁或髌骨内侧面骨软骨损伤，周围滑膜炎、关节积液及软组织肿胀等征象时，在排除其他关节结构病变后应考虑内侧滑膜皱襞综合征。结论熟悉膝关节髌内侧滑膜皱襞的正常MRI表现，有利于提高对其病理表现引起滑膜皱襞综合征的诊断。

Objective To analyze the incidence, normal and pathological MRI manifestations of medial patellar plica of the knee. Methods 737 patients performed MRI examination from 2012.1 to 2012.6, and 13 cases were found medial synovial plicae symptom confirmed by arthroscopy. The MRI features were retrospectively analyzed. Results The knee medial patellar plica was found in 157 cases （21.4%） , moreover, the incidence of four types according to Sakakibara＇ s method were： type A（78 cases, 49.7% ） 〉 type B（46 cases, 29.3% ） 〉 type C（28 cases, 17.8% ） 〉 type D（5 ca- ses, 3.2% ）. Normal synovial plicae appeared as bands of low signal intensity within the high-signal-intensity joint fluid on axial and coronal MRI, with well-defined margin and 1 - 2 mm of thickness. A diffusely thickened synovial plica （ type C or D）, completely covered femoral medial condyle cartilage, perhaps associated with synovitis and injury of the articular carti- lage of the patella or femoral medial condyle, such manifestations should suggest the diagnosis of plicae syndrome. Con- clusion Familiar with the normal MRI appearance of knee medial patellar plica will helpful to potentially diagnose patho- logical medial synovial plicae symptom.