股骨头缺血性坏死不同时期的MRI影像特征及与髋关节结核的鉴别诊断

MRI imaging features of ischemic necrosis of femoral head in different stages and differential diagnosis with hip tuberculosis

目的探讨股骨头缺血性坏死不同时期的磁共振成像(MRI)影像特征及与髋关节结核的鉴别诊断价值。方法回顾性分析2017年2月至2019年12月本院收治的股骨头缺血性坏死患者80例(共80髋)的临床资料,另收集同期本院收治75例髋关节结核患者的临床资料,所有患者均接受MRI与电子计算机层扫描(CT)检查。分析股骨头缺血性坏死患者的MRI影像学特征,并对比两种检查方法在鉴别诊断股骨头缺血性坏死与髋关节结核中的临床价值。结果80例患者经MRI检查后:3个股骨头表现正常,21个股骨头上缘呈斑片状异常信号影,29个骨髓腔内部表现出异常的线性信号影,与低信号相比,主要呈现在T_(1)WI,与高信号相比,主要呈现在T_(2)WI;22个可见长T_(1)与长T_(2)信号,5个髋关节内存在髋积液;MRI检查股骨头缺血性坏死符合率为93.75%,明显高于CT检查的81.25%,差异有统计学意义(P<0.05),且经Kappa一致性检验显示,MRI与临床综合检查一致性较好,Kappa值为0.897,CT与临床综合检查一致性一般,Kappa值为0.717。结论MRI检查对临床上鉴别诊断股骨头缺血性坏死与髋关节结核具有重要价值,可有效提高临床诊断准确度。

Objective To explore the characteristics of magnetic resonance imaging(MRI)at different stages of avascular necrosis of the femoral head and the value of differential diagnosis with tuberculosis of the hip.Methods The clinical data of 80 patients(a total of 80 hips)with avascular necrosis of femoral head admitted to our hospital from February 2017 to December 2019 were retrospectively analyzed,and clinical data of 75 patients with tuberculosis of hip joint treated in our hospital during the same period were collected.All patients undergo MRI and electronic computed tomography(CT)examination.Analyze the MRI imaging characteristics of patients with avascular necrosis of the femoral head,and compare the clinical value of the two examination methods in the differential diagnosis of avascular necrosis of the femoral head and tuberculosis of the hip.Results After MRI examination of 80 patients,3 femoral heads showed normal,21 upper femoral head showed patchy abnormal signal shadow,and 29 bone marrow cavity showed abnormal linear signal shadow.Compared with low signal,the main Presented on T_(1)WI,compared with high signal,mainly presented on T_(2)WI;22 visible long T_(1) and long T_(2) signals,5 hips had hip effusion;The coincidence rate of MRI examination of avascular necrosis of the femoral head was 93.75%,which was significantly higher than that of CT examination of 81.25%,and the difference was statistically significant(P<0.05),and the Kappa consistency test shows that the consistency of MRI and clinical comprehensive examination is good,and the Kappa value is 0.897,CT and clinical comprehensive examination are generally consistent,Kappa value is 0.717.Conclusion MRI examination is of great value in the differential diagnosis of avascular necrosis of the femoral head and tuberculosis of the hip,and can effectively improve the accuracy of clinical diagnosis.