【摘要】：目的:以膝關(guān)節(jié)鏡檢查結(jié)果作為金標(biāo)準(zhǔn),分析評(píng)價(jià)并比較磁共振成像(Magnetic resonance imaging,MRI)的三維擾相梯度回波脂肪抑制序列(three-dimensional fat suppress spoiled gradient recalled echo,3D-FS-SPGR)及三維穩(wěn)態(tài)采集快速成像序列(three-dimensional fast imaging employing steady state acquisition,3D-FIESTA)兩種特殊序列,對(duì)于顯示膝關(guān)節(jié)軟骨損傷的特異性、敏感性及準(zhǔn)確度;對(duì)照膝關(guān)節(jié)鏡分級(jí)結(jié)果,利用T2-mapping序列比較受損軟骨與正常軟骨T2值變化以及急慢性關(guān)節(jié)軟骨損傷的T2值差異,總結(jié)急性膝關(guān)節(jié)軟骨損傷和慢性膝關(guān)節(jié)軟骨損傷的MRI影像學(xué)表現(xiàn)的差異性。方法:收集即將行關(guān)節(jié)鏡檢查的關(guān)節(jié)共50個(gè),其中急性損傷20個(gè),骨關(guān)節(jié)炎(osteoarthritis,OA)30個(gè)。同時(shí)選取20個(gè)正常膝關(guān)節(jié)作為對(duì)照組,行MRI特殊序列檢查,將獲得的圖像數(shù)據(jù)結(jié)合后處理圖像對(duì)膝關(guān)節(jié)軟骨損傷程度及相應(yīng)的觀察指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:3D-FS-SPGR、3D-FIESTA均可以較好的顯示關(guān)節(jié)軟骨的損傷并對(duì)于關(guān)節(jié)軟骨損傷程度作出評(píng)價(jià),以3D-FS-SPGR顯示地更為清晰。T2-mapping序列敏感性高,可以顯示關(guān)節(jié)鏡檢查未發(fā)現(xiàn)任何形態(tài)異常的關(guān)節(jié)軟骨成分的改變,從而判斷關(guān)節(jié)軟骨的損傷,但該序列特異性較差,對(duì)于關(guān)節(jié)軟骨損傷程度難以作出評(píng)價(jià)。同一膝關(guān)節(jié)髕骨被覆軟骨T2值均低于股骨軟骨及脛骨平臺(tái)軟骨T2值,而股骨軟骨及脛骨平臺(tái)軟骨的平均T2值差異不明顯。外傷與OA所致的關(guān)節(jié)軟骨損傷在同一部位T2值并無(wú)顯著差異。急性關(guān)節(jié)軟骨損傷以II、III級(jí)損傷為多,以股骨內(nèi)側(cè)髁、脛骨內(nèi)側(cè)髁好發(fā),慢性關(guān)節(jié)軟骨損傷亦多發(fā)生在股骨內(nèi)側(cè)髁及脛骨內(nèi)側(cè)髁,以III、IV級(jí)損傷多見(jiàn)。結(jié)論:3D-FSPGR、3D-FIESTA、T2-mapping三種序列在顯示膝關(guān)節(jié)軟骨損傷方面各有優(yōu)缺點(diǎn)。急、慢性關(guān)節(jié)軟骨損傷的影像學(xué)表現(xiàn)具有差異性。
[Abstract]:Objective: to take the results of knee arthroscopy as gold standard. Three dimensional scrambling gradient echo fat suppression sequence (three-dimensional fat suppress spoiled gradient recalled echo,3D-FS-SPGR) and three dimensional steady-state acquisition fast imaging sequence (three-dimensional fast imaging employing steady state acquisition,3D-FIESTA) were analyzed and compared. In order to show the specificity, sensitivity and accuracy of articular cartilage injury, the difference of T2 value between damaged cartilage and normal cartilage and acute and chronic articular cartilage injury was compared by T2-mapping sequence compared with the results of knee arthroscopic grading. To summarize the difference of MRI imaging findings between acute and chronic knee cartilage injury. Methods: 50 joints were collected for arthroscopy, including 20 acute injuries and 30 osteoarthritis (osteoarthritis,OA). At the same time, 20 normal knee joints were selected as the control group, and the special MRI sequence was performed. The degree of cartilage injury and the corresponding observation indexes were analyzed statistically by combining the obtained image data with post-processing images. Results: 3D-FS-SPGRGR3D-FIESTA could show the injury of articular cartilage and evaluate the degree of articular cartilage injury. The 3D-FS-SPGR was more clear and the sensitivity of T2-mapping sequence was higher than that of 3D-FS-SPGRGR3D-FIESTA. Arthroscopic examination can show that there is no change of articular cartilage component which is abnormal in shape, so as to judge the damage of articular cartilage, but the specificity of the sequence is poor, so it is difficult to evaluate the degree of articular cartilage injury. The T2 value of patellar coated cartilage of the same knee joint was lower than that of femur cartilage and tibial plateau cartilage, but the mean T2 value of femoral cartilage and tibial plateau cartilage had no significant difference. There was no significant difference in T 2 value between trauma and OA induced articular cartilage injury. Most of acute articular cartilage injuries were II,III grade injuries. Medial femoral condyle and medial tibial condyle were the most common injuries. Chronic articular cartilage injuries also occurred in medial femoral condyle and medial tibial condyle. III,IV grade injuries were more common. Conclusion: 3 D-FSPGRG 3 D-FIESTAN T 2-mapping has advantages and disadvantages in displaying cartilage injury of knee joint. The imaging findings of acute and chronic articular cartilage injury are different.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R684;R445.2

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