腕关节MRI影像诊断.ppt

腕关节MRI影像诊断,复旦大学华山医院放射科,陈爽,.,ArtoscanEMRI,ESAOTE,.,手腕关节EMRI线圈,standard,Phasedarray,.,手腕关节的参考序列,矢状面:SET1W冠状面:SET1W,TMET2W,GE-STIR横断面:TMET2W,.,ScanThicknessSlicesTETRFAFOVMatrixExcitationTimeSE3.51224540-14192x16023.13TME3.512902800-14192x16013.13GE3.512175407514192x16023.04GE3D0.8-151050-14192X16024.58,.,补充序列,冠状面:GE冠状面:3D-GE(层厚0.8mm),.,SET1,GE,3DGET1,.,Highresolution,SET1,460/26,352X256,360/26,256X192,3“58,2“21,.,腕关节的解剖,.,腕管的解剖,.,腕管的解剖,.,伸肌腱,拇伸短,拇长展,桡腕伸,拇长伸,.,伸肌腱,尺腕伸,指伸,.,腕骨间韧带,.,远端尺桡关节,.,腕关节内造影检查(intra-articularcontrast),病人和医生的观念适应症发展方向,.,腕关节内造影检查技术及问题,造影剂成分：GD-DTPA+0.9%NaCl造影剂量：5-7ml造影剂浓度：0.3%穿刺部位:拇长伸肌腱和指总伸肌腱之间检查序列：SET1W+GE,.,造影有关解剖,.,纤维三角软骨,造影有关解剖,.,纤维三角软骨复合体Triangularfibrocartilagecomplex(TFCC),桡腕关节与尺桡关节分开周边血供:尺侧副韧带和掌背侧韧带血管,中心无组成:远端桡尺骨韧带,三角纤维软骨,尺侧韧带,掌尺韧带.功能:稳定远端桡尺关节,固定尺掌区域的稳定性及力量的传导.,.,腕关节内造影检查的临床应用,纤维三角软骨损伤(TFCC),SE,GE,CASE1,.,intra-articularcontrast,.,.,SE,GE,intra-articularcontrast,CASE2,.,CASE3,.,纤维三角软骨损伤,.,纤维三角软骨损伤,PalmerTFCC:创伤和退变创伤:A中心穿孔;B尺侧撕脱;C远端撕脱;D桡侧撕脱;E整体损伤退变:ATFCC撕脱;BTFCC伴月或尺侧软骨软化(有或无尺骨远端骨折);CTFCC伴月或尺侧软骨软化(有或无桡骨乙状切迹骨折);DTFCC伴月或尺侧软骨软化,月三角韧带穿孔;ETFCC伴月或尺侧软骨软化,月三角韧带穿孔,尺桡关节炎.,.,手腕关节的疾病,炎症外伤肿瘤,.,炎症,病因:全身:类风关局部:反复的微创伤,明确范围,.,腱滑膜炎和腱鞘炎,肿胀积液腱鞘低信号,Fungusinfection,.,Acute-Chronicinfection,.,感染,Boneinvolvedornot,.,手腕类风湿关节炎,MRI检查的重要性时间窗概念临床意义,.,手腕类风湿关节炎检查序列选择,静脉增强前后T1W:观察滑膜情况平扫T2W,GE,STIR:软组织肿胀,关节积液及骨侵蚀,.,手腕类风湿关节炎MRI表现,炎性充血关节积液滑膜增厚伴发肌腱炎囊性骨侵蚀,.,类风关,治疗前,SET1,GE-STIR,.,治疗后一周,.,类风关,-C,+C,.,类风关,-C,+C,STIR,.,类风关,-C,+C,.,滑膜囊肿,-C,+C,.,肌肉撕裂,Conservativeorsurgicaltreatment?,.,韧带损伤,Ulnarcollaterallig,.,韧带损伤,Surgeryisneedtorepairforstability,.,骨关节损伤,hemorrhage,.,occultfracture,.,dislocation,.,腕骨无菌性坏死,舟,月骨常见临床表现:局部压痛,僵硬,乏力临床分期,.,月骨无菌性坏死临床分期,期X线正常,有时可见细小骨折线期骨密度增高,无腕不稳定A加舟骨可复性半脱位B加舟骨不可复性半脱位期加弥漫性,退行性关节炎,.,无菌性坏死,LimitsofT1W:viable,necrosis,fibrosis,edema,hypermia,.,Viable(edema,granulation)notfibrosisornecrosis,.,Viable:edemaorgranuloma,.,LunateAVNLesstraumathanscaphoidDominanthandShortulna,.,+C,Viableandbetterprognosis,.,腕管综合征(CTS),定义:任何导致腕管体积缩小或病变使正中神经受压,导致其水肿及脱髓鞘,造成分布范围内的感觉,运动麻痹.,.,腕管综合征MRI检查的意义,临床与肌电图不符确定范围肿瘤可能术后症状继续存在术中未发现病因,.,腕管综合征MRI表现,掌側环状韧带膨出正中神经受压水肿,体积大,T2高信号伴发表现:腱鞘炎,滑膜囊肿等,.,腕管综合征(CTS),Narrowestlevelathamate,.,腕管综合征,Inflammation:thicken,.,腕管综合征,MassGanglioncystOthers:lipoma