本文選題：磁共振成像　切入點(diǎn)：前交叉韌帶　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：引言膝關(guān)節(jié)損傷特別是前交叉韌帶(anterior cruciate ligament,ACL)及半月板損傷是一種常見病和多發(fā)病,可導(dǎo)致關(guān)節(jié)的疼痛、腫脹、功能障礙,甚至運(yùn)動(dòng)功能的減低。準(zhǔn)確診斷ACL損傷、半月板的撕裂及明確撕裂類型有助于臨床治療方法的選擇、手術(shù)方案的制定及預(yù)后的評價(jià)。MRI具有優(yōu)良的軟組織分辨率和空間分辨率,已成為評價(jià)膝關(guān)節(jié)損傷的最常用的、無創(chuàng)性檢查方法。常規(guī)2D-MRI已廣泛應(yīng)用于臨床檢查,但較厚的層厚和部分容積效應(yīng)會(huì)掩蓋細(xì)微的病變。3D-MRI所獲取的容積數(shù)據(jù)能夠進(jìn)行多層面重組(multi-plane reformation,MPR),有助于病變的診斷和發(fā)現(xiàn)細(xì)微的病變。研究目的1.評價(jià)3D-MRI PDWI-SPAIR序列在診斷ACL損傷方面的應(yīng)用。2.評價(jià)3D-MRI PDWI-SPAIR序列在診斷半月板撕裂方面的應(yīng)用。研究對象與方法收集并分析2013年12月至2016年5月在我院行MRI檢查,并經(jīng)關(guān)節(jié)鏡證實(shí)的100名患者104個(gè)膝關(guān)節(jié)的臨床、關(guān)節(jié)鏡及MR資料。采用3D-MRI PDWI-SPAIR圖像對ACL行薄層MPR斜冠狀位與橫斷面重建,對半月板行薄層MPR橫斷面、冠狀面重建。與關(guān)節(jié)鏡結(jié)果對照,比較2D-MRI與3D-MRI PDWI-SPAIR序列對ACL損傷診斷的敏感性、特異性和準(zhǔn)確性,評價(jià)3D-MRI PDWI-SPAIR在ACL損傷分級診斷中的應(yīng)用;評價(jià)3D-MRI PDWI-SPAIR序列及其MPR重建對半月板撕裂及不同撕裂類型診斷的應(yīng)用。結(jié)果與關(guān)節(jié)鏡結(jié)果對照,2D-MRI與3D-MRI診斷ACL損傷總的敏感性分別為88與93.4%、總特異性分別為71.4%與92.9%、總準(zhǔn)確性分別為83.6%與93.3%。經(jīng)Kappa檢驗(yàn),2D-MRI與關(guān)節(jié)鏡診斷ACL損傷的結(jié)果有中度一致性,K=0.591;3D-MRI與關(guān)節(jié)鏡診斷ACL損傷的結(jié)果有極好的一致性,K=0.835。1.與關(guān)節(jié)鏡結(jié)果對照,2D-MRI與3D-MRI診斷ACL 3級損傷的敏感性分別為81.8%與94%、特異性分別為94.3%與97.2%、準(zhǔn)確性分別為90.3%與96.2%;診斷ACL 2級損傷的敏感性分別為68%與84%、特異性分別為89.8%與97.5%、準(zhǔn)確性分別為84.6%與94.2%;診斷ACL 1級損傷的敏感性分別為66.7%與88.9%、特異性分別為91.8%與98.9%、準(zhǔn)確性分別為87.5%與97.1%。2.與關(guān)節(jié)鏡結(jié)果對照,2D-MRI、3D-MRI MPR重建對半月板撕裂診斷的敏感性分別為77.2%、91.8%,特異性分別為88%、96%,準(zhǔn)確性分別為79.8%、92.8%。經(jīng)Kappa檢驗(yàn),2D-MRI與關(guān)節(jié)鏡診斷半月板撕裂的結(jié)果有中度一致性,K=0.541;3D-MRI與關(guān)節(jié)鏡診斷半月板撕裂的結(jié)果有極好的一致性,K=0.817。3.與關(guān)節(jié)鏡結(jié)果對照,2D-MRI、3D-MRI對半月板各種撕裂類型診斷的敏感性分別為:復(fù)合裂75.0%、89.6%,水平裂85.0%、95.0%,縱行撕裂83.3%、90.0%,斜行撕裂82.9%、95.1%,桶柄狀撕裂83.3%、l00%,放射狀撕裂85.7%、100%。結(jié)論1.與常規(guī)2D-MRI相比,3D-MRI診斷ACL損傷具有更高的敏感性、特異性和準(zhǔn)確性,有效減少了假陽性及假陰性;但對于慢性韌帶損傷,3D-MRI仍易導(dǎo)致漏診,需密切結(jié)合病史、臨床體格檢查。2.采用4級法(0-3級)作為ACL損傷的分級診斷標(biāo)準(zhǔn),有助于臨床診療方案的有效制訂。在1-3級ACL損傷的分級診斷中,3D-MRI的敏感性、特異性和準(zhǔn)確性均高于 2D-MRI。3.急性ACL損傷組內(nèi)骨挫傷、內(nèi)側(cè)副韌帶損傷、關(guān)節(jié)積液的發(fā)生率明顯高于慢性組。慢性ACL損傷組內(nèi)半月板撕裂、軟骨損傷的發(fā)生率明顯高于急性組。4.與常規(guī)2D-MRI比較,3D-MRI對半月板撕裂具有較高的敏感性、特異性和準(zhǔn)確性,且能更準(zhǔn)確評價(jià)半月板撕裂類型,可為臨床治療方案的選擇和手術(shù)方案的制定提供更多信息。
[Abstract]:The introduction of knee injury especially the anterior cruciate ligament (anterior cruciate, ligament, ACL) and meniscus injury is a common disease that can lead to joint pain, swelling and dysfunction, and even reduce the motor function. The accurate diagnosis of ACL injury, meniscus tear and tear type helps to clear the selection of clinical treatment methods the formulation and operation scheme, prognosis evaluation of.MRI with soft tissue resolution and excellent spatial resolution, has become the most commonly used evaluation of knee joint injury, noninvasive method. The conventional 2D-MRI has been widely used in clinical examination, but the volume data of thick layer thickness and partial volume effect will cover the subtle lesions.3D-MRI get to level (multi-plane reformation, MPR) restructuring, is helpful to the diagnosis of the lesions and detect subtle lesions. The purpose of the study is to evaluate the 3D-MRI sequence in PDWI-SPAIR 1. Application of.2. evaluation of 3D-MRI PDWI-SPAIR sequence in the diagnosis of ACL injury in the diagnosis of meniscus tear. The research objects and methods were collected and analyzed from December 2013 to May 2016 in our hospital MRI examination and confirmed by clinical arthroscopy in 100 patients with 104 knee joints, joint mirror and MR data using 3D-MRI PDWI-SPAIR image on ACL. Thin layer MPR oblique coronal and axial reconstruction, the meniscus were thin MPR sections, coronal reconstruction. Compared with the results of arthroscopy, comparison of 2D-MRI and 3D-MRI PDWI-SPAIR sequence on ACL damage diagnostic sensitivity, specificity and accuracy of 3D-MRI PDWI-SPAIR application, evaluation grading in the diagnosis of ACL injury; evaluation of 3D-MRI PDWI-SPAIR sequence and MPR reconstruction application of different types of meniscal tear and tear. The diagnosis and arthroscopic findings, 2D-MRI and 3D-MRI in the diagnosis of ACL damage sensitivity of the total Were 88 and 93.4%, the overall specificity were 71.4% and 92.9%, the total accuracy is 83.6% and 93.3%. respectively by Kappa test, the results of 2D-MRI and arthroscopy in the diagnosis of ACL injury with moderate consistency, K=0.591; the results of 3D-MRI and arthroscopy in the diagnosis of ACL injury has excellent consistency, K= 0.835.1. and arthroscopic findings, the sensitivity of 2D-MRI ACL and 3D-MRI diagnosis of grade 3 injuries were 81.8% and 94%, the specificity was 94.3% and 97.2%, accuracy were 90.3% and 96.2%; the sensitivity of diagnosis of ACL grade 2 injury were 68% and 84%, the specificity was 89.8% and 97.5%, accuracy were 84.6% and 94.2%; the sensitivity of diagnosis of ACL grade 1 injury were 66.7% and 88.9%, the specificity was 91.8% and 98.9% respectively, the accuracy control, and the results of 87.5% 97.1%.2. and arthroscopic MPR reconstruction of 2D-MRI, the sensitivity of 3D-MRI diagnosis of meniscus were 77.2%, 91.8%,. Specific were 88%, 96%, the accuracy was 79.8%, 92.8%. by Kappa test, 2D-MRI and arthroscopy in the diagnosis of meniscal tear results with moderate consistency, K=0.541 consistency; 3D-MRI and arthroscopy in the diagnosis of meniscal tear results are excellent, the control results of K=0.817.3. and arthroscopy, sensitivity of 3D-MRI to 2D-MRI, various types of diagnosis of meniscus tear. Is that a composite split 75% 89.6%, 85%, 95%, horizontal fissure, longitudinal tear in 83.3%, 90%, 95.1%, 82.9% oblique tear, bucket handle tear 83.3%, l00%, 85.7% 100%. radial tear, the conclusion of 1. compared with the conventional 2D-MRI, 3D-MRI diagnosis of ACL injury has higher sensitivity, specificity and accuracy of effective to reduce the false positive and false negative; but for chronic ligament injury, 3D-MRI still easily lead to misdiagnosis, should be closely combined with clinical history, physical examination by.2. 4 grades (grade 0-3) as the classification criteria for the diagnosis of ACL injury To formulate effective, contribute to the clinical diagnosis and treatment. In the classification level 1-3 ACL damage, 3D-MRI sensitivity, specificity and accuracy were higher than that of bone contusion in acute ACL injury group 2D-MRI.3., medial collateral ligament injury, joint effusion was significantly higher than that in chronic group. Chronic ACL injury group, meniscus tear, cartilage the incidence of injury was significantly higher than that of the acute group.4. and conventional 2D-MRI, 3D-MRI has a higher sensitivity of meniscal tear, specificity and accuracy, and can more accurately evaluate the meniscal tear type, can provide more information for the choice of clinical treatment and surgical plan formulation.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R686.5

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