3T磁共振3D-FS-SPGR序列对膝关节软骨损伤的诊断价值

摘要

目的:以关节镜检查结果为标准,分析评价3.0T磁共振3D-FS-SPGR序列对膝关节软骨损伤的诊断价值.方法:对将要进行关节镜检查的50个膝关节进行磁共振多序列、多方位成像,包括矢状位FSE-T2WI、FSE-T1WI、FS-FSE-T2WI、3D-FS-SPGR序列及冠状位、轴位FS-FSE-T2WI序列.利用矢状位3D-FS-SPGR序列图像重建出冠状位及轴位图像.将磁共振检查结果与随后进行的关节镜检查结果进行对照.在MRI上对股骨内外侧髁、胫骨内外侧平台、股骨滑车及髌骨六个关节面关节软骨(共300处)进行评价.另外选取10名志愿者20个膝关节作为对照组进行MR成像.成像序列同患者组.结果:①在FS-FSE-T2wI序列上正常膝关节软骨为光滑的曲线状高信号带,在股骨内、外髁及胫骨平台表面关节软骨呈由表及里的高、低、高3层结构;FSE-T2WI及FSE-T1WI上关节软骨分层现象不明显呈中低信号;在3D-FS-SPGR序列上关节软骨呈明显带状高信号并呈由表及里的高、低、高3层结构;②软骨I级损伤在FS-FSE-T2WI上表现为低或高信号,在3D-FS-SPGR序列上表现为低信号,软骨分层现象消失;软骨缺损(Ⅱ～Ⅳ级损伤)在FSE-T1WI上呈等信号,在FSE-T2WI及FS-FSE-T2WI上表现为高信号,在3D-FS-SPGR上表现为低信号;③3D-FS-SPGR序列对软骨损伤显示的敏感度为91.4%.特异度为95.9%,Kappa值为0.808(＞0.75);FS-FSE-T2WI序列的敏感度为88.9%,特异度为96.8%,Kappa值为0.774(＞0.75);FSE-T2WI序列的敏感度为75.3%,特异度为98.2%,Kappa值为0.548;FSE-T1WI序列的敏感度为64.2%,特异度为99.1%,Kappa值为0.444.结论:①FSE-T2WI、FSE-T,WI、FSFSE-T2WI、3D-FS-SPGR序列均可以很好的显示膝关节软骨,以3D-FS-SPGR序列显示的最清晰;②3D-FS-SPGR序列显示膝关节软骨损伤优于FSE-T2WI、FSE-T1WI、FS-FSE-T2WI序列,为诊断膝关节软骨损伤的最佳序列.%Objective: To investigate the diagnostic value of different MRI sequences (FSE-T2 W, FSE-T1WI. FSE-FST2 WI and 3D-FS-SPGR ) in detection of the articular cartilage injury of knee joints compared with the arthroscopic findings. Methods: Sagittal-FSE-T2 WI, sagittal-FSE-T1 WI. sagittal-FS-FSE-T2 WI. sagittal-3D-FS-SPGR. coronal-FS-FSET2 WI, axi-FS-FSE-T2 WI, and arthroscopy were performed in 50 patients with articular cartilage injury in knee joints.Sagittal-3D-FS-SPGR images were reconstructed with MPR. In addition. 20 normal knee joints of healthy volunteers underwent MRI. All the MR images of cartilage injury of the medial and lateral femoral condyles. medial and lateral tibial plateaus. femoral trochlea and patella were compared with results of arthroscopic examination. Results: ① On FS-FSET2 WI. the articular cartilages of the normal knees presented as smooth curve-like hyperintensity. The signal of articular carrtilages of medial and lateral femoral condyles. medial and lateral tibial plateaus consisted of clear three-layered structure showing high-low-high intensity from superficial to deep layer. Meanwhile. the articular cartilages of knees showed as unclear two-layered moderately intensity on FSE-T2 WI and FSE-T1 WI. Evident band-like hyperintensity with three-layered structure of high-low-high intensity from superficial to deep layer were showed on 3D-FS-SPGR; ②The articular cartilages of Grade I injury presented as low or high intensity on FS-FSE-T2 WI. low intensity on 3D-FS-SPGR without laminating. The articular cartilage of Grade Ⅱ～ Ⅳ injury presented as moderately intensity on FSE-T1 WI. high intensity on FSE-T2 WI and FS-FSE-T2 WI. low intensity on 3 D-FS-SPGR; ③ Compared with arthroscopic result. the sensitivity, specificity and Kappa were 91. 4％, 95. 9％ and 0. 808(＞0. 75) respectively with 3D-FS-SPGR sequence; 88. 9％, 96. 8％and 0. 774(＞0. 75) with FS-FSE-T2 WI sequence; 75. 3％, 98. 2％ and 0. 548 with FSE-T2WI sequence, 64. 2％ , 99. 1 ％, 0. 444 with FSE-T1 WI sequence. Conclusion;① The articular cartilages of knees are satisfactorily demonstrated on FSE-T1 WI. FSE-T1 WI. FSE-FS-T2 WI 3D-FS-SPGR sequence. and 3D-FS-SPGR sequence is the best; ②Based on the arthroscopic result, the diagnostic accuracy of 3D-FS-SPGR sequence for cartilage injury is better than that of FSE-FS-T2 WI. FSE-T2 WI. FSE-T1 WI. and 3 D-FS-SPGR is the best sequence in detecting cartilage injury.