【作者】 张炜；

【导师】 李小明；

【作者基本信息】 华中科技大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 目的:评价1.5T磁共振3D-FSE-Cube序列成像显示膝关节损伤是否优于常规序列成像,以确定膝关节3D-FSE-Cube序列在诊断膝关节病变和临床应用的价值。材料和方法:对2010年2月至2010年11月我院56例伴有不同程度膝关节症状的患者,一共63个膝关节在术前进行了3D-FSE-Cube序列和常规2D-FSE(2D Fast Spine Echo)序列(冠状位FSE-T1WI,冠状位FRFSE-PdWI/T2WI,矢状位FRFSE-PdWI/T2WI)扫描(49例为单膝关节、7例为双膝关节),只有29名患者(均为单膝)在MRI检查后平均一周内(4天至2周)在本院进行了关节镜手术,另外还对1名前交叉韧带重建术后2月的病人进行了上述两种序列成像。将膝关节镜的结果视为“金标准”,比较膝关节3D-FSE-Cube和膝关节常规序列在诊断膝关节半月板损伤,韧带撕裂及软骨损伤的敏感度、特异度和准确度,用Wilson评分法计算敏感性和特异性的95%可信区间,用卡方检验来比较这两种不同MRI序列对膝关节软骨损伤、半月板及交叉韧带撕裂诊断的显著性差异(当n<40或实际频数<5时,采用Fisher精确概率检验法)。结果:以关节镜结果作为诊断的“金标准”,3D-FSE-Cube和常规序列诊断软骨损伤的敏感度分别为70.9%和50.6%,特异度分别为72.6%和58.9%,准确度分别为71.8%和55.2%,3D-FSE-Cube诊断软骨损伤的敏感度、特异度和准确度高于常规序列(P≤0.05);3D-FSE-Cube和常规序列诊断韧带撕裂的敏感度分别为76.9%和53.8%,特异度分别为87.5%和75%,准确度分别为82.8%和65.5%,3D-FSE-Cube诊断韧带撕裂的敏感度、特异度及准确度均高于常规序列,但无统计学差异(可能与前交叉韧带撕裂阳性样本率低有关);3D-FSE-Cube和常规序列诊断半月板撕裂的敏感性分别为82.9%和77.1%,特异性分别为95.0%和91.4%,准确性分别为92.5%和88.5%,虽然3D-FSE-Cube的敏感性、特异性和准确性均稍高于常规序列,但两者在统计学上没有明显差异。结论:在本实验中3D-FSE-Cube序列成像在评价膝关节软骨损伤优于常规序列成像,而在评价半月板撕裂和交叉韧带撕裂方面的敏感度、特异度和准确度虽高于膝关节MRI常规序列成像,但无明显统计学差异。更多还原

【Abstract】 Purpose: To evaluate if 1.5T magnetic resonance 3D-FSE-Cube sequence imaging is superior to conventional sequence imaging in showing the injury of knee joint, and determine the clinical value of 3D-FSE-Cube in the diagnosis of knee joint injury. Materials and Methods: 63 knee joints of 56 patients ( single knee joint of 49 patients and double knee joints of 7 patients ) with varying degree knee joint injury in our hospital during February 2010 and November 2010, were collected in our study which all received 3D-FSE-Cube sequence image and conventional sequence image ( Coronal FSE-T1WI, Coronal FRFSE-PdWI/T2WI,Sagittal FRFSE-PdWI/T2WI ) before arthroscopies, only 29 patients ( all single knee ) have received arthroscopic surgery within a week on average ( ranging from 4 days two weeks ) after the MRI exam, and one more patient with anterior cruciate ligament reconstruction have also received this MRI exam. The results of arthroscopic surgery were used as reference standard, comparing the sensibility, specificity and veracity of 3D-FSE-Cube sequence and conventional sequence in the diagnosis of knee joint meniscus injuries, torn ligament and articular cartilage lesions. The Wilson scoring method was used to determine the 95% confidence intervals for sensibility and specificity. The chi-square statistics was used as the test of significance comparing the grading results of the two different magnetic resonance image in the diagnosis of knee joint meniscus injuries, torn ligament and articular cartilage lesions(when n<40 or actual frequency <5,use the Fisher exact probability test).Results: The results of arthroscopic surgery were used as reference standard. In diagnosis of articular cartilage lesions, the sensibility of 3D-FSE-Cube sequence and conventional 71.8% and 55.2% respectively, 3D-FSE-Cube sequence has significantly higher sensibility, specificity and veracity than conventional sequence (P≤0.05); In diagnosis of torn ligament, the sensibility of 3D-FSE-Cube sequence and conventional sequence are 76.9% and 53.8% respectively, the specificity 87.5% and 75%, the veracity 82.8% and 65.5% respectively, the sensibility, specificity and veracity of 3D-FSE-Cube sequence in diagnosis of torn ligament are higher than that of conventional sequence, but all have no significant difference in statistics (P≤0.05); In diagnosis of knee joint meniscus injuries, the sensibility of 3D-FSE-Cube sequence and conventional sequence are 82.9% and 77.1% respectively, the specificity 95.0% and 91.4%, the veracity 92.5% and 88.5% respectively, though conventional sequence has higher sensibility, specificity and veracity than 3D-FSE-Cube sequence , they had no significant difference in statistics.Conclusion: In this research, 3D-FSE-Cube sequence is superior to conventional sequence in evaluation of articular cartilage lesions, although 3D-FSE-Cube sequence is superior to conventional sequence in evaluation of knee joint meniscus injuries and torn ligament but they have no significant difference in statistics (P≤0.05).更多还原