膝关节半月板损伤患者行MR检查技术及对诊断符合率影响分析

Analysis of the Effect of MR Examination on the Diagnosis Coincidence Rate in Patients with KneeMeniscus Injury

目的:分析膝关节半月板损伤患者行MR检查技术及对诊断符合率的影响。方法:回顾性分析2021年1月~2022年12月收集的170例可疑膝关节半月板损伤患者的MR影片及临床资料作为分析对象,最终有158例确诊为膝关节半月板损伤患者拟作金标准,并观察金标准与MR检查比较半月板不同部位撕裂的准确率及其影响因素。结果:与金标准相比,MRI检出率为94.30%(149/158),一致性高(Kappa=0.95);其中MRI检查诊断半月板内侧前角、内侧后角、内侧体部、内侧后根、外侧前角、外侧后角、外侧体部、外侧后根、Ramp损伤准确率分别为82.60%、93.33%、94.73%、94.11%、84.00%、85.71%、88.88%、95.00%、84.21%;其中前角撕裂的诊断率相比后角和体部撕裂要高,差异有统计学意义(P<0.05),进一步多因素分析(χ^(2)检验)显示,MR对内侧半月板损伤撕裂诊断的误诊及漏诊影响因素多受年龄、损伤的部位与类型、长度相关,差异有统计学意义(P<0.05);MR对外侧半月板损伤撕裂诊断的误诊及漏诊影响因素多受损伤的部位与类型、长度相关,差异有统计学意义(P<0.05)。结论:MR检查技术可以作为膝关节半月板损伤的诊断方法之一,但其所受影响因素较多,则需斟酌患者多方面实际情况进一步提升半月板损伤的检出率。

Objective:To analyze the effect of MR examination on the diagnosis coincidence rate of patients with knee meniscus injury.Methods:The MR films and clinical data of 170 patients with suspected knee meniscus injury collected from January 2021 to December 2022 were retrospectively analyzed as analysis objects.Finally,158 patients diagnosed with knee meniscus injury were proposed as the gold standard,and the accuracy rate and influencing factors of the gold standard compared with MR examination for meniscus tear in different parts were observed.Results:Compared with the gold standard,the detection rate of MRI was(149/158,94.30%),with high consistency(Kappa=0.95).The accuracy of MRI in diagnosing the medial anterior angle of meniscus,medial posterior angle,medial body,medial posterior root,lateral anterior angle,lateral posterior angle,lateral body,lateral posterior root and Ramp injury was 82.60%,93.33%,94.73%,94.11%,84.00%,85.71%,88.88%,95.00%,and 84.21%,respectively);Among them,the diagnostic miss of anterior angle tear was higher than that of posterior angle tear and body tear,and the difference was statistically significant(P<0.05).Further multi-factor analysis(χ^(2) test)showed that the influence factors of MR’s misdiagnosis and missed diagnosis of medial meniscus injury tear were mostly related to age,injury site,type and length,and the difference was statistically significant(P<0.05).The factors influencing the misdiagnosis and missed diagnosis of lateral meniscus injury and tear in MR were mostly related to the injured site,type and length,and the difference was statistically significant(P<0.05).Conclusion:MR technique can be used as one of the diagnostic methods for knee meniscus injury,but it is affected by many factors,so it is necessary to further improve the detection rate of meniscus injury by considering various actual conditions of patients.