不同角度屈位MRI检查对膝关节前交叉韧带断裂的诊断价值

The Diagnostic Value of MRI Examination at Different Angles of Flexion Position for Anterior Cruciate Ligament Rupture of the Knee Joint

目的探究不同角度屈位MRI检查对膝关节前交叉韧带(ACL)断裂的诊断价值。方法选取2022年3月至2023年12月医院收治的81例拟行膝关节镜检查的膝关节外伤患者作为研究对象。患者入院时均接受17°屈位、30°屈位MRI检查,并择期进行膝关节镜检查。以膝关节镜检查结果为金标准,分析不同角度屈位MRI检查对膝关节ACL断裂的诊断价值,并比较不同角度屈位MRI检查对ACL结构(全长、残端、内外侧束)的显示评分。结果膝关节镜检查结果显示,81例患者中52例为膝关节ACL断裂。以膝关节镜检查结果为金标准,17°屈位MRI检查对膝关节ACL断裂诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为84.62%、89.66%、86.42%、93.62%、76.47%,30°屈位MRI检查对膝关节ACL断裂诊断的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为96.15%、93.10%、95.06%、96.15%、93.10%。30°屈位MRI检查的诊断灵敏度高于17°屈位,差异有统计学意义(P<0.05);不同角度屈位MRI检查的特异度、准确度、阳性预测值、阴性预测值比较,差异无统计学意义(P>0.05)。不同角度屈位MRI检查对膝关节ACL断裂的诊断结果与膝关节镜检查结果的一致性均极好(Kappa>0.75)。30°屈位MRI检查对膝关节ACL全长、残端、内外侧束的显示评分均高于17°屈位MRI检查,差异有统计学意义(P<0.05)。结论不同角度屈位MRI检查对膝关节ACL断裂诊断的特异度、准确度均较高,但30°屈位检查的诊断灵敏度更高,且在膝关节ACL结构显示方面具有一定优势。

Objective To explore the diagnostic value of MRI examination at different angles of flexion position for anterior cruciate ligament(ACL)rupture in the knee joint.Methods With the selection of 81 patients with knee joint injuries scheduled for knee arthroscopy examination who were admitted to the hospital from March 2022 to December 2023 as the research subjects,all patients underwent 17°flexion and 30°flexion MRI examination at admission,and knee arthroscopy was performed at the appropriate time.With knee arthroscopy examination results as the gold standard,the diagnostic value of MRI examination at different angles of flexion for knee ACL rupture was analyzed.Meanwhile,the visualization scores of ACL structures(total length,stump and lateral and internal tract)on MRI examinations at different angles of flexion position were compared.Results The results of knee arthroscopy showed that 52 out of 81 patients had ACL rupture in the knee joint.Based on the results of knee arthroscopy as the gold standard,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 17°flexion MRI examination for the diagnosis of ACL rupture in the knee joint were 84.62%,89.66%,86.42%,93.62%,and 76.47%,respectively,and the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of 30°flexion MRI examination for the diagnosis of knee ACL rupture were 96.15%,93.10%,95.06%,96.15%,and 93.10%,respectively.The diagnostic sensitivity of MRI examination in 30°flexion position was higher than that in 17°flexion position,and the difference was statistically significant(P<0.05);There were no statistically significant differences in the specificity,accuracy,positive predictive value,and negative predictive value of MRI examinations at different angles of flexion position(P>0.05).The consistency between the diagnostic results of knee ACL rupture by MRI examination at different angles of flexion position and the results of knee arthroscopy examination was excellent(Kappa>0.75).The visualization scores of the total length,stump and lateral and internal tract of the knee ACL in 30°flexion MRI examination were higher than those in 17°flexion MRI examination,and the differences were statistically significant(P<0.05).Conclusion The diagnostic specificity and accuracy of different angles of flexion MRI examination for knee ACL rupture were high,but the sensitivity of 30°flexion examination was higher,and it had certain advantages in displaying the structure of knee ACL.