常规MRI与MR关节造影诊断肩关节前脱位所致盂肱下韧带及前下盂唇撕裂

Conventional MRI and MR arthrography in diagnosing inferior glenohumeral ligament and anterior inferior labrum tears caused by anterior dislocation of shoulder joint

目的 对比观察常规MRI与MR关节造影(MRA)对肩关节前脱位所致盂肱下韧带及前下盂唇撕裂的诊断价值。方法 对56例肩关节前脱位患者(56侧患肩)行肩关节常规MR检查及MRA,以手术结果为金标准,对比观察其对盂肱下韧带撕裂及前下盂唇撕裂的诊断价值。结果 56侧患肩中,38侧(38/56, 67.86%)盂肱下韧带撕裂,44侧(44/56, 78.57%)前下盂唇撕裂。常规MRI诊断盂肱下韧带撕裂的敏感度为26.32%(10/38)、特异度为83.33%(15/18)、准确率为44.64%(25/56),诊断前下盂唇撕裂分别为88.64%(39/44)、 75.00%(9/12)及85.71%(48/56);MRA诊断盂肱下韧带撕裂的敏感度为89.47%(34/38),特异度为100%(18/18),准确率为92.86%(52/56);诊断前下盂唇撕裂分别为93.18%(41/44)、83.33%(10/12)及91.07%(51/56)。MRA诊断盂肱下韧带撕裂的敏感度及准确率高于常规MRI(χ^(2)=27.69、25.47,P均<0.05),特异度与常规MRI差异无统计学意义(χ^(2)=4.15,P>0.05);诊断前下盂唇撕裂的敏感度、特异度及准确率与常规MRI差异无统计学意义(χ^(2)=4.56、2.73、4.42,P均>0.05)。结论 MRA对盂肱下韧带撕裂的诊断效能优于常规MRI;对前下盂唇撕裂的诊断效能与常规MRI相当。

Objective To compare the values of conventional MRI and MR arthrography(MRA)for diagnosing inferior glenohumeral ligament and anterior inferior labrum tears caused by anterior dislocation of shoulder joint.Methods Conventional MR examinations and MRA were performed in 56 patients with anterior dislocation of unilateral shoulder.Taken surgical results as the gold standards,the diagnostic values of conventional MRI and MRA for inferior glenohumeral ligament tear and anterior inferior labrum tear were observed and compared.Results Inferior glenohumeral ligament tear and anterior inferior labial ligament tear were detected in 38(38/56,67.86%)and 44(44/56,78.57%)shoulders,respectively.The sensitivity,specificity and accuracy of conventional MRI in diagnosis of inferior glenohumeral ligament tear was 26.32%(10/38),83.33%(15/18)and 44.64%(25/56),in diagnosis of anterior inferior labial ligament tear was 88.64%(39/44),75.00%(9/12)and 85.71%(48/56),respectively.The sensitivity,specificity and accuracy of MRA in diagnosis of anterior inferior labial ligament tear was 89.47%(34/38),100%(18/18),and 92.86%(52/56),of anterior inferior labial ligament tear was 93.18%(41/44),83.33%(10/12)and 91.07%(51/56),respectively.The sensitivity and accuracy of MRA for diagnosing inferior glenohumeral ligament tears were all higher than those of conventional MRI(χ^(2)=27.69,32.47,both P<0.05),but there was no significant difference of the specificity between MRA and conventional MRI(χ^(2)=4.15,P>0.05).There was no significant difference of the sensitivity,specificity and accuracy of MRA and conventional MRI for diagnosing anterior inferior labrum tears(χ^(2)=4.56,2.73,4.42,all P>0.05).Conclusion For inferior glenohumeral ligament tear,MRA had better diagnostic efficacy than conventional MRI,while for anterior inferior labrum tear,the diagnostic efficacy of MRA was comparable to that of conventional MRI.