磁共振肩关节造影评价关节盂唇损伤的价值

The value of MR shoulder arthroplasty in evaluating the joint labrum injury

目的探索MR关节造影(MRA)对评价肩关节盂唇损伤的价值,为临床诊断及治疗肩关节盂唇撕裂伤提供指导。方法回顾分析于2015年1月至2018年2月就治于我院的肩关节盂唇撕裂患者(经关节镜手术证实)58例,共62个部位,其中前盂唇撕裂22例,上盂唇撕裂28例,后盂唇撕裂12例。对比分析患者的磁共振成像(MRI)和MRA征象,评价MRI和MRA对诊断不同部位盂唇撕裂伤及上盂唇前后部(SLAP)损伤分型的敏感度、特异度及准确度。结果前盂唇撕裂:常规MRI诊断敏感度68.2%,准确度88.7%,MRA诊断敏感度100.0%,准确度100.0%;上盂唇撕裂:常规MRI诊断敏感度64.3%,准确度83.9%,MRA诊断敏感度92.3%,准确度96.8%;后盂唇撕裂:常规MRI诊断敏感度66.7%,准确度93.5%,MRA诊断敏感度75.0%,准确度95.2%。MRA诊断上盂唇和前盂唇撕裂的敏感度及准确度显著优于常规MRI(P均<0.05);MRA能诊断出22例SLAP,常规MRI能够诊断出13例SLAP损伤,MRA诊断的敏感度及准确度均显著优于常规MRI(P<0.05),常规MRI对SLAP的分型符合率是40.0%,MRA对SLAP损伤的分型符合率是80.0%,2种检查方法的分型符合率差异有统计学意义(P<0.01)。结论 MRA对前盂唇撕裂、上盂唇撕裂及SLAP分型的诊断效能显著优于常规MRI,MRA对于盂唇撕裂的诊断具有不可替代的作用。

Objective To explore the value of MR joint angiography（MRA） in the evaluation of shoulder lip and labrum injury, and to provide guidance for clinical diagnosis of labrum shoulder laceration. Methods Retrospectively analyze 58 patients with arthroscopic debridement（62 confirmed by arthroscopy） who underwent treatment in our hospital from January 2016 to December 2016 including 62 sites, of which there were 22 cases with anterior labral tear, 28 cases with upper labora tear, 12 cases with latter labrum tear. MRI and MRA signs of each patient were com-pared. The sensitivity, specificity and accuracy of MRI and MRA in diagnosing different types of labrum laceration and the anterior and posterior labrum（SLAP） injury were evaluated. Results Anterior labral tear： the conventional MRI diagnostic sensitivity was 68.2%, accuracy was 88.7%, MRA diagnostic sensitivity was 100.0%, accuracy was 100.0%;upper labrum tear： conventional MRI diagnostic sensitivity of 64.3%, accuracy of 83.9%.MRA diagnostic sensitivity was 92.3%, accuracy was 96.8%; latter labrum tear： conventional MRI diagnostic sensitivity was 66.7%, accuracy was93.5%, MRA diagnostic sensitivity was 75.0%, accuracy was 95.2%. The sensitivity and accuracy of MRA in the diag-nosis of labrum and anterior labral tear were significantly better than those of conventional MRI（all P0.05）. SLAP was diagnosed in 22 cases by MRA, and 13 cases with SLAP were diagnosed by conventional MRI Sensitivity and accuracy were significantly better than those of conventional MRI（P0.05）. The coincidence rate of conventional MRI with SLAP was 40.0%, and that of MRA with SLAP was 80.0%. The coincidence rate for classification of the two methods was sig-nificantly different（P0.01）. Conclusion MRA is superior to conventional MRI in the diagnosis of anterior labrum tear, labrum tear and SLAP classification. MRA plays an irreplaceable role in the diagnosis of a labrum tear.