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MRI三维扰相梯度回波序列在膝关节软骨损伤中的诊断价值*

作者:李 兰 罗文军 殷富春 郭 伟

所属单位:重庆市梁平县人民医院(重庆 405200)

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摘要

目的探讨三维扰相梯度回波(3D GRE)序列在膝关节软骨损伤中的价值,通 过观察分析软骨的信号强度、厚度及形态 的变化等,为早期发现关节软骨损伤提供 诊断依据。方法 收集200例18-60岁患者 膝关节MRI成像资料,按年龄分为18-40 岁、41-60岁两组。常规行T1WI、T2WI、 水脂分离技术(WFS)及三维扰相梯度回波 成像(3D GRE)序列进行膝关节软骨MRI成 像,且在MRI 3D GRE序列矢状位上测量膝 关节内外侧关节面上下及髌软骨最厚处共 5点关节软骨厚度,应用SPSS 19.0统计学 软件对结果进行统计分析,均以P<0.05 为差异有统计学意义。结果 在膝关节软 骨病变检查中,三维扰相梯度回波(3D GRE)序列图像显示软骨的信号强度、厚度 及形态变化最清晰,且图像的组织分辨率 最高。结论 三维扰相梯度回波(3D GRE) 序列技术是目前MRI检查膝关节软骨病变 中最好的技术,软骨损伤越严重,软骨厚 度越薄,并且可以减少漏诊、误诊。

Objective To discuss the value about three-dimensional spoiled gradient echo (3D GRE) sequence in the diagnosis of knee joint cartilage injury by observing and analyzing the signal strength of cartilage and the change of the thickness and shape, etc., to provide diagnostic basis for early detection of articular cartilage injury. Methods 200 patients' cases of knee MRI data were collected between18 to 60, they were divided into two groups which was 18 to 40 and 41 to 60 years old respectively and they were both checked by conventional T1WI, T2WI, water fat separation technology (WFS) and threedimensional spoiled gradient echo imaging (3D GRE) sequence of MRI, 5 places of articular cartilage thickness were measured on knee joints and patellar cartilage by sagittal MRI 3D GRE sequence, applying SPSS 19.0 statistical software for statistical analysis with P<0.05 for the difference statistically significant. Results In the inspection of knee joint cartilage lesions, the three-dimensional spoiled gradient echo(3D GRE) sequence image display the cartilage's signal strength, thickness and the clearest shape change with the highest image resolution. Conclusion MRI three-dimensional spoiled gradient echo(3D GRE) sequence is currently the best diagnostic technique in knee joint cartilage lesions. The more serious cartilage damage is, The thinner thickness of cartilage is, and can reduce missed diagnosis and misdiagnosis.

【关键词】三维扰相梯度回波序列;膝关节;软骨损伤;厚度

【中图分类号】R445.2;R684

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.11.035

前言

膝关节软骨是指覆盖于膝关节表面的透明软骨,是组成活动关节 面的有弹性的负重组织,是关节行使正常活动功能所必须的,关节软 骨的形态、完整性关系到膝关节的正常运动。但是各种创伤、劳损及 关节内部的疾病,均可损伤关节软骨。由于关节软骨的修复再生能力 有限,关节软骨损伤预后的情况直接关系到患者的生活质量,是否能 早期诊断、早期治疗是影响预后的关键[1]。晚期病变,则治疗效果不 佳。所以准确评价膝关节软骨损伤的范围及程度对临床制定治疗方案 非常重要。但常规磁共振扫描序列检测膝关节软骨损伤却不敏感, 磁共振(magnetic resonance imaging, MRI)三维扰相梯度回波序列 (three-dimensional spoiled gradient echo sequence,3D GRE)应用 于实验动物研究和临床应用研究鲜有报道[2]。本组200例膝关节软骨扫 描均采用T1WI、T2WI、水脂分离技术(WFS)及3D GRE序列对软骨损伤进 行评估,分析3D GRE序列的临床应用价值。