Ⅱ型痛性足副舟骨影像学诊断价值

The value of imaging examination techniques in diagnosing of type Ⅱ painful accessory navicular bone

目的:评价X线、CT、MRI、超声对Ⅰ型痛性足副舟骨(PANB)的诊断价值。方法:回顾性分析42例经手术确诊的45侧Ⅰ型PANB的X线、CT、MRI以及超声影像诊断资料,比较四者诊断PANB的敏感度及测量准确性。结果:X线、CT、MRI、超声诊断Ⅰ型PANB的敏感度分别为68.9%(31/45)、88.9%(40/45)、95.6%(43/45)、91.1%(41/45)。X线的敏感度低于CT、MRI及超声,差异均有统计学意义(均P<0.05)。CT、MRI及超声诊断Ⅰ型PANB敏感度较高,三者间差异均无统计学意义(均P>0.05)。X线、CT、MRI、超声对诊断阳性患者副骨最大径值测量结果分别为(11.5±6.6)mm、(9.5±7.3)mm、(9.3±7.1)mm、(11.8±6.8)mm,四者间差异均无统计学意义(均P>0.05)。结论:X线检查诊断Ⅰ型PANB敏感度相对不足;CT敏感度高但对软组织成像效果欠佳;MRI敏感度最高,且可以显示骨髓水肿和软组织病变,应用价值高但价格昂贵;超声诊断敏感度高,可显示副骨、纤维连接处和软组织病变,可进行动态多角度扫查,且经济方便,可作为首选筛查方法。

Objective: To evaluate the diagnostic value of X-ray, CT, MRI and ultrasonography in type Ⅱ painful accessory navicular bone (PANB). Methods: The X-ray, CT, MRI, and ultrasonic diagnostic data of 45 cases (from 42 patients) of type Ⅱ PANB were retrospectively analyzed. The sensitivity and accuracy of PANB were compared between the four groups. Results: The sensitivity of X-ray, CT, MRI, ultrasonography diagnosis of type Ⅱ PANB was 68.9%(31/45), 88.9%(40/45), 95.6%(43/45), 91.1%(41/45), respectively. The sensitivity of X-ray was lower than that of CT, MRI and ultrasonography, with statistical difference (P<0.05). The sensitivity of CT, MRI and ultrasonography in diagnosing type Ⅱ PANB was high and there was no significant difference between them (P>0.05). The maximum diameter of positive cases measured respectively by X-ray, CT, MRI and ultrasonography was (11.5±6.6)mm,(9.5±7.3)mm,(9.3±7.1)mm,(11.8±6.8)mm, with no statistically significant difference between all groups (P>0.05). Conclusion: X-ray is less sensitive to the diagnosis of type Ⅱ PANB. CT has higher sensitivity, but its imaging capability of soft tissue is poor. MRI has the highest sensitivity and can display the bone marrow edema and soft tissue lesions, but it costs more;Ultrasonography diagnosis, being highly sensitive, able to find the accessory bone, the fibrous junction and soft tissue lesions, can be used for dynamic multi angle scanning. In addition, ultrasonography is more convenient and less expensive. Therefore, it is a recommended screening method.