多层螺旋CT与磁共振成像对膝关节隐匿性骨折的诊断价值分析

Analysis of the value of multi-slice spiral CT and magnetic resonance imaging in the diagnosis of occult fracture of knee joint

目的探讨多层螺旋CT(multi-slice spiral CT,MSCT)与磁共振成像(magnetic resonance imaging,MRI)对膝关节隐匿性骨折的诊断价值。方法回顾性分析本院2018年7月至2019年6月就诊的疑似膝关节隐匿性骨折的108例患者的临床资料。所有患者先后于本院完成MSCT和MRI检查,观察MSCT和MRI图像特征,以手术或关节镜检查结果为金标准,评估两种影像学检查方法对膝关节隐匿性骨折的诊断效能(灵敏度、特异度、准确率、阳性预测值、阴性预测值)。比较MSCT和MRI对关节腔积液、韧带损伤、半月板损伤、关节面软骨损伤/水肿、骨髓水肿等膝关节病变的检出率。结果MRI诊断膝关节隐匿性骨折的灵敏度、特异度、准确率、阳性预测值、阴性预测值均显著高于MSCT(均P<0.05),且对关节腔积液、韧带损伤、半月板损伤、关节面软骨损伤/水肿、骨髓水肿的检出率均显著高于MSCT(均P<0.05)。结论MRI诊断膝关节隐匿性骨折较MSCT具有更高的诊断效能,且对膝关节软组织损伤具有较高的检出率。临床上对于高度疑为膝关节隐匿性骨折的患者应进行MRI检查,以帮助确诊。

Objective To explore the diagnostic value of multi-slice spiral CT(MSCT)and magnetic resonance imaging(MRI)in the diagnosis of occult fracture of knee joint.Method The clinical data of 108 patients with suspected occult fracture of knee joint from July 2018 to June 2019 were analyzed retrospectively.All patients underwent MSCT and MRI in our hospital,and the characteristics of MSCT and MRI images were observed.The results of surgery or arthroscopy were used as the gold standards to evaluate the diagnostic efficacy(sensitivity,specificity,accuracy,positive predictive value,negative predictive value)of the two imaging methods on occult fractures of knee joint.The detection rates of MSCT and MRI on joint cavity effusion,ligament injury,meniscus injury,articular cartilage injury,edema,bone marrow edema and other knee joint lesions were compared.Result The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MRI were significantly higher than those of MSCT in the diagnosis of occult fractures of knee joint(all P<0.05).The detection rates of MRI on joint cavity effusion,ligament injury,meniscus injury,articular cartilage injury,edema and bone marrow edema were significantly higher than those of MSCT(all P<0.05).Conclusion MRI has higher diagnostic efficacy than MSCT in the diagnosis of occult fractures of knee joint,and has a higher detection rate of soft tissue injury of knee joint.It is necessary to perform MRI examination for patients with highly suspected occult fractures of knee joint so as to help make a definite diagnosis.