MRI髋关节单侧斜冠状扫描对髋关节撞击综合征的诊断价值

Diagnostic value of MRI hip joint unilateral oblique coronary scanning for femoroacetabular impingement

目的探讨MRI髋关节单侧斜冠状扫描对髋关节撞击综合征(femoroacetabular impingement,FAI)的临床诊断价值。方法 2014年2月—10月选取75例因髋关节疼痛,经过X线或CT检查后,高度怀疑为FAI的患者为研究对象。使用Siemens 1.5 T MRI扫描仪,体表相控阵柔性线圈,采用T2加权脂肪抑制成像序列、T1加权成像序列和质子密度加权成像序列,对同一患者分别采用A、B两种扫描方式。A扫描方式:在髋关节矢状面图像上,定位线平行于患者(单侧)股骨颈长轴方向的斜冠状面扫描。B扫描方式:在髋关节横断面图像上,定位线平行于左右股骨头的常规髋关节冠状面扫描。对两种不同扫描方式所得到的髋关节图像进行解剖结构和病变特征对比分析,采用配对χ2检验进行统计分析。结果 A扫描方式的FAI检出率为62.6%(47/75),B扫描方式检出率为30.6%(23/75),A扫描方式的FAI检出率高于B扫描方式,差异有统计学意义(P<0.001)。结论采用平行于股骨颈长轴的斜冠状获得的图像,可以更全面地展示髋臼唇及股骨头颈连接部位解剖结构的病理改变和股骨头颈交界处的损伤情况,可以为临床诊断FAI提供更可靠的影像学依据。

Objective To investigate the diagnostic value of MRI hip joint unilateral oblique coronary scanning in the diagnosis of femoroacetabular impingement（FAI）. Methods From February to October 2014, 75 patients with hip joint pain who were highly suspected of FAI after X-ray or CT examination were selected as subjects. Using Siemens 1.5 T MR, fat-suppressed T2-weighted imaging sequences, T1-weighted imaging sequences, and proton density-weighted imaging sequences were used. For each patient two scan methods were used. Method A： on the sagittal image of the hip joint, the line of sight was parallel to the oblique coronal plane scan of the（one-sided） long axis of the femoral neck.Method B： on the cross-sectional image of the hip joint, the positioning line was parallel to the conventional hip joint coronal scan of the left and right femoral heads. Mc Nemar test was used to compare the detection rates of FAI of the two methods. Result The detection rate of FAI of A-scanning [62.6%（47/75）] was higher than that of B-scanning [30.6%（23/75）], and the difference was statistically significant（P〈0.001）. Conclusion An image obtained from a diagonal coronal scan parallel to the long axis of the femoral neck can more fully display the pathological changes of the acetabular labrum and the anatomy of the femoral head and neck joints, and the damage of the femoral head and neck junction,which provides a more reliable imaging basis for the clinician to diagnose FAI.