CT与MRI在成人早期股骨头坏死诊断中的价值探讨

Investigation of the diagnostic value of CT and MRI in early femoral head necrosis in adults

目的探讨CT与磁共振成像(MRI)在成人早期股骨头坏死诊断中的价值。方法71例(82髋)成人早期股骨头坏死患者为研究对象,入院后均行CT及MRI检查。比较两种检查方式的检出率、漏诊率、误诊率及典型征象检出率。结果最终确诊Ⅰ期股骨头坏死39髋、Ⅱ期股骨头坏死43髋。MRI对于Ⅰ、Ⅱ期股骨头坏死的检出率95.1%高于CT的74.4%,漏诊率4.9%低于CT的24.4%,差异具有统计学意义(P<0.05);两种检查方式的误诊率比较,差异无统计学意义(P>0.05)。MRI对早期股骨头坏死的线样征、骨髓水肿、骨小梁模糊、坏死周围囊变征象检出率分别为76.8%、46.3%、51.2%、54.9%,均高于CT的17.1%、14.6%、14.6%、37.8%,差异具有统计学意义(P<0.05)。结论成人早期股骨头坏死患者MRI检出率明显高于CT,MRI对于缺血位置周围软组织坏死情况显示更加清晰,值得推广应用。

Objective To discuss the value of CT and magnetic resonance imaging(MRI)in the diagnosis of early femoral head necrosis in adults.Methods 71 adult patients(82 hips)with early femoral head necrosis were studied,and CT and MRI examinations were performed after admission.The detection rate,missed diagnosis rate,misdiagnosis rate and typical signs detection rate of the two methods were compared.Results Finally,39 hips with stageⅠfemoral head necrosis and 43 hips with stage Ⅱ femoral head necrosis were confirmed.The detection rate of MRI for stage Ⅰ and Ⅱ femoral head necrosis was 95.1%,which were higher than 74.4% of CT,and the missed diagnosis rate 4.9%was lower than 24.4% of CT.All the differences were statistically significant(P<0.05).There was no statistically significant difference in the misdiagnosis rate between the two methods(P>0.05).The detection rates of MRI for the line-like signs,bone marrow edema,trabecular obscuration,and perinecrotic cystic degeneration of early femoral head necrosis were 76.8%,46.3%,51.2%,and 54.9%,which were all higher than 17.1%,14.6%,14.6%,and 37.8% of CT,and the difference was statistically significant(P<0.05).Conclusion The detection rate of MRI in adult patients with early femoral head necrosis is significantly higher than that of CT,and MRI shows a clearer picture of soft-tissue necrosis around the ischemic location.It is worthy of promotion and application.