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肩袖损伤患者MRI和MR肩关节造影的诊断价值比较*

作者:石俊岭1 崔建岭2 孙英彩2 孟凯龙1 张岭岭3 郭俊萍1 王 炜1 徐 静1

所属单位:1.河北省邯郸市第一医院CT室 (河北 邯郸 056200) 2.河北医科大学第三医院CT室 (河北 石家庄 050000) 3.河北省邯郸市第一医院核医学科 (河北 邯郸 056200)

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摘要

目的 比较肩袖损伤患者MRI和MR 肩关节造影的诊断价值。方法 以2013年 7月-2014年12月前来我院就诊106例疑似 肩袖损伤患者进行研究,均行MRI检查, 随后有55例行肩关节MR造影检查,其中20 例高度疑似病例再接受关节镜诊治确诊。 比较MRI和MR的诊断准确性。结果 20例 行关节镜检查患者确诊为12例肩袖部分撕 裂、5例肩袖全层撕裂、3例肩袖变性, 其中6例为肩袖撕裂并发盂唇损伤,MRI 确诊准确性为55(11/20),明显低于MRar 的100.0%(20/20),比较有统计学意义 (χ2=11.613,P=0.000<0.05)。结论 虽 然MRI与MRar均无法较好显示肩袖钙化情 况,但MRar在肩袖损伤临床诊断中的应用 具有更高准确性,可作为首先诊断方法。

Objective To compare the diagnostic value of shoulder joint arthrography with MRI and MR in patients with rotator cuff injury. Methods 106 cases of patients with suspected rotator cuff injury admitted into the hospital during July 2013 to December 2014 were studied and all of them received MRI examination. Then, there were 55 cases receiving arthrography with MR and 20 of whom were highly suspected cases and received arthroscopic diagnosis and treatment to make a definite diagnosis. The diagnostic accuracy of MRI and MR was compared. Results Among 20 cases of patients examined by arthroscopy, there were 12 cases diagnosed as having partial-thickness rotator cuff tears, 5 cases as full-thickness rotator cuff tears and 3 cases as rotator cuff degeneration, including 6 cases as rotator cuff tear concurrent glenoid labrum injury. The accuracy of MRI diagnosis was 55.0% (11/20) which was significantly lower than 100.0% (20/20) of Mrar and the comparison was statistically significant (χ2 =11.613, P=0.000<0.05). Conclusion Although both of MRI and MRar can not well show the status of rotator cuff calcification, the application of MRar in the clinical diagnosis of rotator cuff injury is of higher accuracy, which can be used as the first diagnostic method.

【关键词】肩袖损伤;MRI;MRar;对比剂;关节腔积液

【中图分类号】R323.4+2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.05.040

前言

肩袖损伤为常见肩关节疼痛原因,占肩关节病变17%~41%左 右[1]。该病发病原因较多,包括肌腱改变、急性或反复创伤、肩关节 不稳等[2]。我国MRI及MR造影(MR Arthrography,MRar)于近年在肩袖 损伤临床诊断中得到应用,但相关比较研究较为缺乏[3],本研究以我 院收治患者为例,在肩关节镜为诊断金标准基础上将MRI及MRar诊断价 值进行对比,报道如下。