3T高清MRI对三角纤维软骨复合体损伤的诊断价值

Diagnostic value of high-resolution 3T MRI for triangular fibrocartilage complex injuries

目的探讨3T高清MRI对腕关节三角纤维软骨复合体(TFCC)损伤的诊断价值。方法采用回顾性病例系列研究分析2013年1月—2018年4月北京积水潭医院收治的133例腕尺侧疼痛患者临床资料,其中男68例,女65例;年龄14~69岁,平均32.6岁。统一参数下行腕关节MRI检查,并在随后接受腕关节镜下探查或治疗。将TFCC损伤分为两类,第一类为中心型损伤,即三角纤维软骨盘损伤;第二类为边缘型损伤,包括TFCC桡侧附着部、尺侧附着部、远尺桡韧带、尺腕韧带损伤。以腕关节镜下探查结果为“金标准”,通过对比分别得出MRI诊断TFCC中心型损伤和边缘型损伤的敏感度、特异度、阳性/阴性预测值和阳性/阴性似然比。结果关节镜检查确诊TFCC损伤者122例,其中中心型损伤72例,边缘型损伤102例;MRI检查结果为阳性124例,其中诊断为中心型损伤75例,边缘型损伤111例。通过对比,得出3T高清MRI诊断TFCC中心型损伤的敏感度/特异度、阳性/阴性预测值及阳性/阴性似然比分别为0.972/0.918,0.933/0.966,11.85/0.03;诊断边缘型损伤的敏感度/特异度、阳性/阴性预测值及阳性/阴性似然比分别为0.882/0.323,0.811/0.455,1.30/0.37。结论对于TFCC中心型损伤,无论是创伤性撕裂还是退行性损伤,3T高清MRI均可准确诊断。MRI在TFCC边缘型损伤的诊断中具备一定的参考价值,但较低的特异度提示临床中对MRI的阳性结果应持谨慎态度,需着重结合病史与体检结果进行诊断。

Objective To investigate the value of high resolution 3T MRI in the detection of〖JP3〗triangular fibrocartilage complex(TFCC)injuries through a diagnostic test.Methods A retrospective case series analysis was performed in 133 patients with ulnar wrist pain admitted in Beijing Jishuitan Hospital from January 2013 to April 2018.There were 68 males and 65 females,aged 14 69 years(mean 32.6 years).The patients was examined with the wrist MRI with consistent parameters and then received wrist arthroscopic detection or treatment.The TFCC injuries were classified as central injury,namely triangular fibrocartilage disc injury and peripheral injury,namely the tear of ulnar attachment,radial attachment,distal radioulnar ligaments and ulnocarpal ligaments.Take the results of wrist arthroscopy as the gold standard,the MRI and arthroscopic findings were compared and the sensitivity,specificity,positive/negative predictive value and positive/negative likelihood ratio were determined.Results Wrist arthroscopy confirmed TFCC injuries in 122 patients,among which 72 patients were with central injury and 102 with peripheral injury.Meanwhile,TFCC injuries were diagnosed with MRI in 124 patients,among which 75 patients were central injury and 111 cases were peripheral injury.As for central injury,the sensitivity/specificity,positive/negative predictive value and positive/negative likelihood ratio of MRI were 0 972/0.918,0.933/0.966 and 11.85/0.03,respectively;when the target pathology was peripheral injury,the sensitivity/specificity,positive/negative predictive value and positive/negative likelihood ratio of MRI were 0.882/0.323,0 811/0.45 and 1.30/0.37,respectively.Conclusions High-resolution 3T MRI is accurate in detection of central injury of TFCC,no matter the injury is traumatic or degenerated.In the diagnosis of peripheral injury of the TFCC,MRI can provide some help for its high sensitivity.However,the positive findings of MRI on peripheral structures should be cautious because of the poor specificity,and hence the results of history,physical examination and MRI should be considered together to attain an accurate diagnosis.