CT、MRI与MRI不同序列对膝关节外伤后前后交叉韧带损伤的诊断价值

Diagnostic value of CT, MRI and different sequences of MRI for anterior and posterior cruciate ligament injury after knee trauma

目的分析计算机断层扫描(CT)、磁共振成像(MRI)与MRI不同序列对膝关节外伤后前后交叉韧带损伤的诊断价值。方法回顾性分析2020年1月至12月本院收治的60例疑似膝关节外伤后前后交叉韧带损伤患者的一般资料。比较CT、MRI、解剖测量的前交叉韧带(ACL)、后交叉韧带(PCL)的长度、厚度及角度测量值;将关节镜检查作为金标准,比较CT、MRI对膝关节外伤后前后交叉韧带损伤的诊断效能,并比较不同MRI序列对膝关节前后交叉韧带损伤分级的诊断符合情况。结果CT的ACL长度、角度测量值小于解剖测量值,ACL厚度测量值大于解剖测量值,PCL长度、厚度及角度测量值大于解剖测量值(P<0.05);MRI的ACL、PCL长度、厚度及角度测量值与解剖测量值比较,差异无统计学意义(P>0.05)。关节镜检查结果显示,膝关节外伤后前后交叉韧带损伤阳性28例,阴性32例;CT显示阳性22例,阴性38例;MRI显示阳性27例,阴性33例。MRI对膝关节外伤后前后交叉韧带损伤诊断的准确度、灵敏度高于CT(P<0.05);MRI对膝关节外伤后前后交叉韧带损伤诊断的特异度略高于CT,但差异无统计学意义(P>0.05)。MRI三维序列对膝关节前后交叉韧带损伤分级的诊断符合率高于MRI二维序列(P=0.001)。结论MRI检查的测量值可反映出前后交叉韧带的真实解剖结构,同时准确度、灵敏度均优于CT,属于膝关节韧带损伤首选的无创检查方式。MRI三维序列较MRI二维序列在膝关节前后交叉韧带损伤分级评估上有一定优势。

Objective To analyze the diagnostic value of computed tomography(CT), magnetic resonance imaging(MRI)and different sequences of MRI in anterior and posterior cruciate ligament injury after knee trauma. Methods The general data of 60 patients with suspected anterior and posterior cruciate ligament injury after knee trauma admitted in our hospital from January to December 2020 were retrospectively analyzed. The length, thickness and angle of anterior cruciate ligament(ACL) and posterior cruciate ligament(PCL) measured by CT, MRI and auatomy were compared. Arthroscopic examination was used as the gold standard, the diagnostic efficacy of CT and MRI in anterior and posterior cruciate ligament injury after knee trauma were compared, and the coincidence of different sequences of MRI in the diagnosis of anterior and posterior cruciate ligament injury classification of knee joint were compared. Results The length and angle of ACL measured by CT were smaller than those measured by anatomy, the thickness of ACL was larger than that measured by anatomy, the length,thickness and angle of PCL were larger than those measured by anatomy(P<0.05);there were no significant differences in the length, thickness and angle of ACL and PCL between MRI and anatomical measurement(P>0.05). The results of arthroscopic examination showed 28 cases of positive anterior and posterior cruciate ligament injury and 32 negative cases;CT showed 22positive cases and 38 negative cases;MRI showed 27 positive cases and 33 negative cases. The accuracy and sensitivity of MRI in the diagnosis of anterior and posterior cruciate ligament injury after knee trauma were higher than those of CT(P<0.05);the specificity of MRI in the diagnosis of anterior and posterior cruciate ligament injury after knee trauma was slightly higher than that of CT, but the difference was not statistically significant(P>0.05). The diagnostic coincidence rate of MRI threedimensional sequence for anterior and posterior cruciate ligament injury classification of knee joint was higher than that of MRI two-dimensional sequence(P=0.001). Conclusion The measured values of MRI examination can reflect the real anatomical structure of anterior and posterior cruciate ligaments, the accuracy and sensitivity are better than CT, which is the preferred non-invasive examination method for knee ligament injury. MRI three-dimensional sequence has certain advantages over MRI two-dimensional sequence in evaluating the degree of anterior and posterior cruciate ligament injury of knee joint.