MRI联合X线诊断腕关节不稳定的临床价值

摘要

目的 探讨MRI联合X线诊断腕关节不稳定的临床价值.方法 选择我院2013年8月至2014年6月腕关节不稳定患者100例,根据入院先后顺序分为观察组和对照组,每组50例,观察组进行MRI联合X线诊断检查,对照组仅进行X线检查,分析各组的影像学特征并比较两组的特异性、灵敏性、阳性预测值等临床指标.结果 对照组的阳性检出率为56.0%(28/50),明显低于观察组的88.0%(44/50),差异具有统计学意义(P<0.05);观察组的阳性预测值为86.0%(43/50)、特异性为88.0%(44/50)、灵敏性为80%(40/50),对照组的阳性预测值为46.0%(23/50)、特异性为56.0%(28/50)、灵敏性为42.0%(21/50),观察组的阳性预测值、特异性、灵敏性等指标显著优于对照组,差异具有统计学意义(P<0.05);腕骨病变MRI检查结果中,T1WI轴位像:掌指关节周围滑膜显著增厚,信号减低,呈长或稍长T1信号改变;T1WI冠状位:近端指间关节、掌指关节及双侧腕关节周围滑膜增厚,呈等或稍长T1信号;STIR冠状位像:病灶呈高或稍高信号,病灶部位、形态、范围较T2WI、T1WI像显示更清晰,指骨近端及腕关节、双侧掌骨远端构成骨信号增高,提示骨髓水肿.结论 腕关节不稳定进行MRI与X线联合诊断可提高其检测的特异性、灵敏性,提高其阳性诊断率.%Objective To discuss the clinical value of magnetic resonance imaging (MRI) combined with X-ray in diagnosis of wrist joint instability. Methods One hundred patients with wrist joint instability from August 2013 to June 2014 were selected in our hospital, which were divided into the study group and the control group, accord-ing to the order of admission. The study group (n=50) underwent MRI combined with X-ray examination, while the con-trol group was only performed X-ray examination. The imaging characteristics of each group were analyzed, and the specificity, sensitivity and positive predictive value of the two groups were compared. Results The positive detection rate of the control group was 56.0%(28/50), which was significantly lower than 88.0%(44/50) in the study group (P<0.05). The positive predictive value, specificity, sensitivity were 86.0% (43/50), 88.0% (44/50), 80.0% (40/50), and 46.0%(23/50), 56.0%(28/50), 42.0%(21/50) in the control group, with statistically significant difference between the two groups (P<0.05). Carpal lesions were examined by MRI. Axial T1WI images showed markedly thickened peripheral synovial membrane in metacarpophalangeal joint, reduced signal, and long or slightly long T1 signal change. Coronal T1WI images showed thickened peripheral synovial membrane in proximal interphalangeal joint, metacarpophalangeal joint and bilateral wrist joint, as well as similar or slightly long T1 signal. STIR coronal images showed high or slightly high signal, clearer lesion location, shape and range than T2WI, T1WI images, increased signal in proximal phalanges, wrist joints and bilateral distal metacarpus, suggesting bone marrow edema. Conclusion The combination of MRI and X-ray in diagnosis of wrist joint instability can improve the specificity and sensitivity, as well as the positive diagnosis rate.