磁共振弥散成像对膝关节骨挫伤的评价

Diagnosis value of diffusion-weighted imaging in knee bone contusion

目的探讨磁共振弥散成像对膝关节骨挫伤的临床诊断价值。方法临床纳入本院2017年1月—2017年12月期间收治92例膝关节骨挫伤患者作为研究对象,随机将全部入选者分为研究组、对照组,均为46例。对照组患者进行64排螺旋CT诊断,研究组应用磁共振弥散成像(DWI)技术进行诊断,分析对比两组诊断准确率、误诊率及漏诊率。另选取同期于本院门诊进行健康体检的46名正常人,将其骨髓平均值与研究组患者生理反应性骨髓水肿及外伤性骨髓水肿表现ADC值进行对比,对膝关节骨挫伤患者愈合过程中DWI动态变化情况进行观察。结果研究组患者临床诊断准确率为97.83%,与对照组的86.96%相比明显更高(χ2=8.408、P=0.004);研究组未出现漏诊情况,误诊率2.17%;对照组出现1例漏诊,漏诊率为2.17%,4例误诊,误诊率为8.70%(χ2=2.194、P=0.139,χ2=4.148、P=0.042);经DWI动态变化显示,研究组生理反应性骨髓水肿、外伤性骨髓水肿患者ADC值均明显高于正常人ADC值(t=22.127、t=33.591),P<0.05。结论 DWI对膝关节骨挫伤患者具有较高临床诊断价值,且ADC值对膝关节外伤患者具有重要鉴别诊断意义。

Objective： To discuss the diagnosis value of diffusion-weighted imaging（ DWI） in knee bone contusion. Methods： 92 patients with knee bone contusion treated from January 2017 to December 2017 in our hospital were selected. The subjects were randomly assigned to study group and control group,46 cases each group. Patients received the64-slice spiral CT examination or DWI,respectively. The diagnosis accuracy,misdiagnosis rate and missed diagnosis rate was analyzed; 46 healthy check-ups were selected. The mean value and ADC（ apparent diffusion coefficients） in patients with physiological and traumatic bone marrow edema were compared. During the healing process,the dynamic changes of DWI were observed. Results： The diagnosis accuracy in the study group（ 97. 83%） was significantly higher than control group（ 86. 96%）（ χ^2= 8. 408,P = 0. 004）; the missed diagnosis rate and misdiagnosis rate in the study group（ 0%,2. 17%） was better than control group（ 2. 17%/1,8. 70%/4）（ χ^2= 2. 194,P = 0. 139; χ^2= 4. 148,P = 0. 042）; according to the DWI dynamic changes,the ADC in patients with physiological and traumatic bone marrow edema were significantly higher than those in the healthy check-ups（ t = 22. 127,t = 33. 591,P〈0. 05）. Conclusion： The DWI is of great importance in the diagnosis of knee bone contusion. The ADC is accessible to make a differential diagnosis of knee joint injury.