质子密度加权成像对髋臼盂唇撕裂的评估价值

Value of proton density weighted image in evaluating acetabular labrum tears

目的 研究质子密度加权成像(PD-WI)对髋臼盂唇撕裂的评估是否可靠。方法 选取于2019年3月-2020年1月在北京积水潭医院就诊,无明显外伤或轻微外伤后髋关节疼痛的40名患者,男女各20例,年龄为27~65岁,平均年龄为40岁,进行包含PD-WI序列的髋臼盂唇磁共振扫描,排除髋部骨折、肿瘤或感染等因素。在不清楚手术结果的情况下根据PD-WI图像评估髋臼盂唇撕裂的存在,并根据以往组织学的研究通过PD-WI图像将髋臼盂唇撕裂分为盂唇基底部和实质部撕裂2种类型。全部患者在扫描结束后3个月内均接受手术治疗。根据手术结果获取PD-WI评估髋臼盂唇撕裂的敏感度、特异度和准确度,并使用Kappa检验评价髋臼盂唇撕裂和撕裂分型的PD-WI诊断意见与手术结果的一致性。结果 PD-WI评估髋臼前/外上盂唇撕裂的灵敏度分别为96.88%和90.00%,特异度分别为62.50%和93.33%,准确度分别为90.00%和92.50%,髋臼盂唇撕裂和撕裂分型的PD-WI诊断意见与手术结果的一致性较好或很好(前盂唇撕裂Kappa=0.655,外上盂唇撕裂Kappa=0.806,均P<0.001;各型撕裂Kappa值均>0.75,均P<0.001)。结论 PD-WI能够作为可靠的评估髋臼盂唇撕裂的影像学方法,为患者的诊断和治疗方案的选择提供帮助。

Objective To explore the reliability of proton density weighted image(PD-WI) in evaluating acetabular labrum tears. Methods Forty trauma hip pain out-patients(20 males and 20 females, age range: 27-65 years, mean age: 40 years) without obvious or slight trauma in Beijing Jishuitan Hospital from March 2019 to January 2020 were recruited and underwent acetabular labral magnetic resonance imaging scan that included PD-WI sequence to exclude acetabular labrum tears and exclude fracture, tumour, infection and other diseases in hip. The presence of acetabular labrum tear was evaluated according to PD-WI image instead of surgical outcome. Classification consisting of basal and substantial tears from previous histological studies was also determined by PD-WI image. All patients underwent surgery in 3 months after scanning. According to surgical outcome, the sensitivity, specificity and accuracy of PD-WI to evaluate acetabular labrum tears and kappa consistency test to evaluate tears and classification were acquired. Results The sensitivity, specificity and accuracy of PD-WI to evaluate anterior and lateral-superior acetabular labrum tears were 96.88% and 90.00%, 62.50% and 93.33%, 90.00% and 92.50%, respectively. The PD-WI diagnosis of acetabular labial tears and tear classification was in good agreement with the surgical results(anterior labrum tears: Kappa=0.655, P<0.001;lateral-superior labrum tears: Kappa=0.806, P<0.001;all types of tear: Kappa>0.75, P<0.0001). Conclusion PD-WI could be regarded as a reliable imaging method to evaluate acetabular labrum tears and could be helpful for diagnosis and treatment option.