【摘要】：目的:以膝關節(jié)鏡檢查結(jié)果作為金標準,分析評價并比較磁共振成像(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,對于顯示膝關節(jié)軟骨損傷的特異性、敏感性及準確度;對照膝關節(jié)鏡分級結(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節(jié)軟骨損傷的T2值差異,總結(jié)急性膝關節(jié)軟骨損傷和慢性膝關節(jié)軟骨損傷的MRI影像學表現(xiàn)的差異性。方法:收集即將行關節(jié)鏡檢查的關節(jié)共50個,其中急性損傷20個,骨關節(jié)炎(osteoarthritis,OA)30個。同時選取20個正常膝關節(jié)作為對照組,行MRI特殊序列檢查,將獲得的圖像數(shù)據(jù)結(jié)合后處理圖像對膝關節(jié)軟骨損傷程度及相應的觀察指標進行統(tǒng)計學分析。結(jié)果:3D-FS-SPGR、3D-FIESTA均可以較好的顯示關節(jié)軟骨的損傷并對于關節(jié)軟骨損傷程度作出評價,以3D-FS-SPGR顯示地更為清晰。T2-mapping序列敏感性高,可以顯示關節(jié)鏡檢查未發(fā)現(xiàn)任何形態(tài)異常的關節(jié)軟骨成分的改變,從而判斷關節(jié)軟骨的損傷,但該序列特異性較差,對于關節(jié)軟骨損傷程度難以作出評價。同一膝關節(jié)髕骨被覆軟骨T2值均低于股骨軟骨及脛骨平臺軟骨T2值,而股骨軟骨及脛骨平臺軟骨的平均T2值差異不明顯。外傷與OA所致的關節(jié)軟骨損傷在同一部位T2值并無顯著差異。急性關節(jié)軟骨損傷以II、III級損傷為多,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級損傷多見。結(jié)論:3D-FSPGR、3D-FIESTA、T2-mapping三種序列在顯示膝關節(jié)軟骨損傷方面各有優(yōu)缺點。急、慢性關節(jié)軟骨損傷的影像學表現(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.
【學位授予單位】：山東中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R684;R445.2

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