骨与关节的MRI诊断 PPT课件.ppt

.,1,脊柱、关节影像（Spine&joint),.,2,膝关节的MRI诊断,3,.,膝关节解剖,韧带,4,.,膝关节解剖,半月板及韧带,5,.,膝关节解剖,前面观,6,.,膝关节解剖,后面观,7,.,膝关节,解剖,半月板,8,.,半月板,内侧半月板呈C形矢状位可见后角高于前角1/3。,9,.,半月板,内侧半月板,外侧半月板,膝横韧带,10,.,十字交叉韧带,ACL,PCL,11,.,内侧副韧带,三层结构,表层：髌骨网状结缔组织，缝匠肌周围及覆盖腓肠肌表面的深筋膜（红箭）。中层：胫骨的侧副韧带。深层：滑膜囊壁（黄箭）。,12,.,外侧副韧带,构成及支持结构,髂胫肌附着部股二头肌腱（红）外侧副韧带纤维（黄）Popliteal肌腱滑膜囊壁,13,.,14,.,15,.,膝关节矢状位MRI,16,.,膝关节冠状位MRI,ACL,ACL,ACL,ACL,PCL,PCL,前附着点,骼胫肌腱,17,.,半月板分级与撕裂,一级（退变）,18,.,半月板分级与撕裂,二级信号（退变）,19,.,半月板分级与撕裂,三级信号（撕裂）,20,.,半月板囊肿,21,.,半月板囊肿,22,.,盘状半月板,23,.,盘状半月板撕裂,24,.,假性撕裂（误区）,25,.,假性退变信号（误区）,半月板附着点脂肪垫,26,.,假性撕裂（误区）,27,.,半月板退变性撕裂（误区）,28,.,盘内撕裂（误区）,盘状半月板及盘内撕裂,29,.,伪迹（误区）,30,.,十字交叉韧带,前交叉,31,.,前交叉韧带撕裂,边缘不清肿块韧带信号异常断端回缩增厚变形韧带不连续走行角度改变,32,.,前交叉韧带撕裂,33,.,前交叉韧带撕裂,34,.,前交叉韧带撕裂并骨损伤,35,.,前交叉韧带撕裂,36,.,前交叉韧带撕裂（误区）,关节腔积液,37,.,前交叉韧带撕裂（误区）,38,.,前交叉韧带撕裂的诊断,39,.,后交叉韧带与半月板股韧带,40,.,后交叉韧带部分撕裂,41,.,后交叉韧带撕裂,42,.,MCL撕裂及分级,一度：轻微损伤，韧带稳定。二度：局部松驰，部分纤维连续。三度：完全断裂,43,.,MCL撕裂,三度,44,.,MCL撕裂并骨损伤,45,.,MCL撕裂,46,.,髌韧带与髌韧带断裂,47,.,髌韧带损伤,OSGOOD-SCHLATER病,48,.,髌韧带部分撕裂与退变,髌骨网状韧带损伤,49,.,股四头肌腱断裂,50,.,关节骨损伤,51,.,膝关节高分辨成像,Knee:T2WwithFsat3:50,0.35x0.3mm*/3.5mmx4ModerateTE,highresolution,wellfatsuppressed,52,.,关节骨损伤,53,.,关节骨及ACL损伤,54,.,关节的骨损伤,一型：骨骺及干骺端的弥漫T1低信号。,55,.,关节骨损伤,56,.,剥脱性骨软骨炎,57,.,剥脱性骨软骨炎,58,.,慢性压缩性骨折,StressFracture,59,.,骨坏死,SystemicLupusErythematosis,60,.,骨坏死,自发性骨坏死,61,.,关节腔脂性积液,62,.,关节表面软骨的结构,表层为一坚实的胶原纤维。中层为含有蛋白糖原的波状胶原纤维网架,并含有大量的限制水。深层为钙化的胶原纤维，与骨皮面紧密粘接。,63,.,关节表面软骨的成像序列,SE,FSE,64,.,关节表面软骨的成像序列,GE-fs,MT,65,.,表面软骨的退行性变,早期软骨损伤的病理改变是胶原纤维的破坏和蛋白糖原的丢失，限制水被破坏，组织水化作用增强，大量自由水增加，局部肿胀，T2值延长。,正常,早期退变,66,.,关节镜软骨损伤分级,0级,一级,二级,三级,四级,67,.,表面软骨一级损伤,关节镜检查为一级软骨损伤，MRI见髌骨内侧关节面表面软骨明显肿胀，在短TE和长TE成像中均表现为信号。,68,.,关节表面软骨损伤,一级,三级,69,.,关节表面软骨损伤四级,四级损伤：MRI表现为高信号病变深达软骨下骨组织。病变的尺寸：大于1cm者需手术磨除，小于者跟踪随访。,70,.,关节表面软骨损伤,多数慢性关节软骨病变表现为软骨逐渐变薄，直达深部软骨下骨，引起相邻骨组织在T1加权像上信号减低，T2加权表现为骨的硬化改变。,71,.,关节表面软骨外伤,外伤可致表面软骨的撕脱，必须手术切除撕脱的软骨碎片，磨平修复创面。,72,.,关节表面软骨损伤,73,.,膝关节术后表现,完全切除部分切除局部修补,%25,%50,74,.,膝关节术后表现,完全半月板切除后病人临床症状不能缓解，重力的作用下关节失去半月板生物垫的缓冲，造成关节软骨及骨的损伤。,75,.,膝关节术后表现,矢状位示术后半月板修复良好，但冠状位见关节腔内有残存的半月板碎片。,76,.,ACL重建修复,关节内关节外关节内外,77,.,ACL重建修复,78,.,关节动态成像,.,79,肩关节,山东省医学影像学研究所赵斌,80,.,肩关节的MRI解剖,Subscapularis(red)Supraspinatus(yellow)Infraspinatus(green)Teresminor(blue),四块主要肌肉,81,.,肩关节的MRI解剖,Teresminormuscles,infraspinatus,coracoid,supraspinatustenden,humeralhead,subscapularis,subscapularis,coracoid,supraspinatus,82,.,肩关节的MRI解剖,Glenohumeralligament,acromion,supraspinatus,acromion,labrum,Musculotendinousjoint,83,.,肩关节的MRI解剖,supraspinatus,Coracoid,subscapularis,labrum,subscapularis,Coracoid,84,.,肩关节的MRI解剖,Bicepstenden,Lessertuberosity,Glenoidlabrum,Greatertuberosity,85,.,TE长短的应用,微小胶元纤维断裂-修复-退变-运动功能障碍,86,.,肩凝症（RotatorCuff）,Impingementsyndrome分期,病因,老人、损伤、疲劳、炎症、挤压,充血水肿,纤维化,袖撕裂,87,.,1、肩峰的形态2、峰肩关节病3、喙肩韧带增粗,88,.,肩峰的类型,Type1,Type2,Type3,89,.,肩凝症的病因病机,spurs,下倾,90,.,肩凝症的MRI表现,下倾,骨质增生,肩峰下滑膜囊积液,91,.,肩凝症的MRI表现,92,.,肩凝症的MRI表现,93,.,肩凝症的MRI表现,94,.,肩凝症的MRI表现,95,.,肩凝症的MRI表现,96,.,肩凝症的MRI表现,97,.,肩凝症的MRI表现,Subscapularismuscls,98,.,肱二头肌腱损伤,99,.,肱二头肌腱损伤,100,.,肱二头肌腱损伤,101,.,肱二头肌腱损伤,102,.,肱二头肌腱损伤,103,.,104,.,关节盂及关节囊损伤,105,.,关节盂及关节囊损伤,106,.,关节盂及关节囊损伤,107,.,关节盂及关节囊损伤,108,.,关节盂及关节囊损伤,109,.,关节盂及关节囊损伤,110,.,踝关节高分辨成像,Ankle:T2WwithFsat,5:36,0.6x0.6mm/3mmx34,111,.,关节,NEW:T13DFLASH水激发,3mm,4:57min,24片,T1SE,4:34min,sl3mm,256矩阵,15slices,GRE,TR600,TE17,3mm,11x12cm,6min,3DCISS,1.5mm,20片,只需2:52分,112,.,:T2TSERestorecor,4:24min,5mm,256矩阵,15片,关节,T2Medic,2mm,18FoV,4.24min,T13DFLASH水激发,4:45min,3mm,113,.,脊柱spine,114,.,115,.,116,.,CT,117,.,正常颈椎,T2WI,T1WI,3,118,.,T2WI,T1WI,T1WI,T1WI,胸椎,4,119,.,50岁T1WI,30岁T1WI,30岁T2WI,30岁T1WI,腰椎,6,120,.,正常腰椎MR,T2,T1,T2,121,.,T2,T2,T1,颈椎退行性变并椎管狭窄,122,.,胸腰椎退行变、黄韧带肥厚,T2,T2,T1,123,.,124,.,125,.,C4/5间盘突出并脊髓受压水肿,126,.,F22L2/3结核,127,.,L4/5结核,128,.,M34胸椎结核,129,.,脊柱及椎间盘炎症（TB）,130,.,M34T8/9脊柱结核并冷脓肿,131,.,F36脊髓炎,T2,T1,GD,GD,T1,132,.,M40脊膜、脊髓炎,133,.,3D,134,.,环枕关节脱位,MPR,MIP,135,.,椎体不全脱位,136,.,骨质增生,137,.,棘球蚴脊柱炎,男，61，echinococcal,138,.,椎体骨折,139,.,M27C5椎体压缩性骨折压迫脊髓,140,.,胸椎压缩性骨折滑脱脊髓横断,141,.,损伤,142,.,滑膜囊积液,143,.,滑膜囊肿(synovialcyst),144,.,F1皮毛窦、脊髓栓系,145,.,M1脊柱裂、腰胝椎管脂肪瘤并脊髓栓系,146,.,F33脊柱裂、脊髓栓系、脊髓脊膜膨出,147,.,F40脂性终丝,148,.,椎管内肿瘤,椎管内肿瘤分为：髓内及髓外肿瘤。髓外肿瘤又分为髓外硬膜下肿瘤及硬膜外肿瘤。髓内常见的肿瘤有室管膜瘤、星形细胞瘤、血管母细胞瘤、脂肪瘤、皮样囊肿、胆脂瘤等和转移性肿瘤；髓外硬膜下肿瘤常见的有：神经鞘瘤、神经纤维瘤、脊膜瘤以及畸胎类肿瘤；硬膜外肿瘤常见的以转移性肿瘤为多，其次有淋巴肉瘤、恶性纤维组织细胞瘤、神经母细胞瘤等。,149,.,M39椎管内、外神经纤维瘤术后复发,GD,GD,GD,GD,150,.,M45神经纤维瘤囊变,151,.,M28右侧神经纤维瘤,152,.,F58枕大孔神经纤维瘤,153,.,M37C椎管内外神经鞘瘤,GD,154,.,F14神经鞘瘤,155,.,F64脊膜瘤,156,.,F51脊膜瘤,157,.,M35脊膜瘤,158,.,F48多发脊膜瘤,159,.,F54脊膜瘤,160,.,女60椎管肿瘤术后转移,161,.,女60椎管肿瘤术后转移,162,.,