髋关节MRI的关节外偶然发现

Incidental extra-hip findings at hip joint MRI

目的探讨髋关节MRI检查中髋关节外偶然发现(IEHFs)的发现率及漏诊率,评估其临床意义。方法回顾性分析2014年9月至2018年9月保定市第一中心医院1734例接受髋关节MRI检查的患者资料,采用结构化读片的方法,并参考修订后的CT结肠成像报告数据系统(C-RADS)将IEHFs分为4类:E1为解剖变异;E2无临床意义;E3临床意义不大;E4有重要临床意义。分析IEHFs的类型和分布,并将结构化读片的结果与初始的MRI报告结果对比,计算漏诊率。结果1734例患者中,1064例患者共发现1651处IEHFs,其中E2类1080处(65.4%,1080/1651),以宫颈腺囊肿最多,占26.0%(281/1080);E3类354处(21.4%,354/1651),以前列腺增生最多(47.2%,167/354);E4类217处(13.1%,217/1651),以腹股沟区肿大淋巴结最多(30.9%,67/217)。男性患者中E2类、E3类IEHFs所占比例较大,而女性患者E2类所占比例最大,男女患者间IEHFs构成差异有统计学意义(χ²=294.080,P<0.001)。年龄60岁以下患者IEHFs以E2为主,而60岁以上患者则以E3为主,不同年龄组间IEHFs构成差异有统计学意义(χ²=206.702,P<0.001)。IEHFs总的漏诊率为85.2%(1406/1651),其中E2类漏诊率最高(91.1%,984/1080),E4类的漏诊率最低(63.1%,137/217)。结论在接受髋关节MRI的患者中,IEHFs普遍存在。使用结构化读片方法可以提高IEHFs的发现率,建议采用修订后的C-RADS对IEHFs进行分级报告,以降低漏诊率。

Objective To explore the detection rate,missed diagnosis rate,and clinical significance of incidental extra-hip findings(IEHFs)in hip joint MRI.Methods The data of 1734 cases who underwent MRI examination of hip joint from September 2014 to September 2018 at the First Central Hospital of Baoding City were retrospectively analyzed.According to the revised CT colonography reporting and data system(C-RADS),the IEHFs were divided into 4 types using structural imaging reading method.E1 type was anatomical variation;E2 type was sign without clinical significance;E3 type was sign with little clinical significance;E4 type was sign with important clinical significance.The types and distributions of IEHFs were analyzed,and the results of structural imaging reading were compared with those of the initial MRI reports.The missed diagnosis rate was calculated in this group.Results Among the 1734 patients,1651 of IEHFs were found in 1064 patients.There were 1080 E2 type IEHFs(65.4%,1080/1651),with cervical cysts(26.0%,281/1080)accounting for the largest number.There were 354 IEHFs of E3 type(21.4%,354/1651),with most cases were prostatic hyperplasia(47.2%,167/354).There were 217 IEHFs of E4 type(13.1%,217/1651),most of which were the enlarged lymph nodes in the inguinal region(30.9%,67/217).E2 and E3 IEHFs accounted for a great proportion in male patients.The proportion of E2 IEHFs was the largest in female patients.There was significant difference in IEHFs composition between male and female patients(χ²=294.080,P<0.001).The IEHFs of patients under 60 years old were mainly E2 type,while those of over 60 years old patients were mainly E3 type.There was significant difference in IEHFs composition among different age groups(χ²=206.702,P<0.001).The overall missed diagnosis rate of IEHFs was 85.2%(1406/1651).The missed diagnosis rate of E2 was the highest(91.1%,984/1080),and that of E4 was the lowest(63.1%,137/217).Conclusion The incidence of IEHFs in patients undergoing hip joint MRI are prevalent.The structural imaging reading method can increase the detection of IEHFs.Therefore,it is suggested that revised C-RADS be used to grade IEHFs to reduce the rate of missed diagnosis.