行业特制 MR在关节疾患中的应用价值

MR在关节疾患中的应用价值,瑞金临床医学院影像医学教研室,1,资料借鉴1,无X线辐射可作任意切面的成像成像参数多，所含信息量大软组织分辨率高可同时显示关节内的各种结构,MR在骨关节检查中的优点,2,资料借鉴1,MR诊断价值,MR表现具有特征性,可以确立诊断:外伤、退行性变、滑膜病变、肿瘤MR表现有一定特征性,可以帮助确立诊断:需结合其他检查滑膜病变、肿瘤MR表现缺乏特征性，需依靠其他其他检查滑膜病变、肿瘤,3,资料借鉴1,MR表现具有特征性,关节损伤：半月板撕裂、韧带撕裂、肌腱损伤、软骨缺损（如果采用关节造影，其准确率更高）、骨挫伤退行性变：滑膜病变：绒毛结节滑膜炎、滑膜皱襞肿瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、脂肪瘤,4,资料借鉴1,桶柄状撕裂,5,资料借鉴1,半月板囊肿,6,资料借鉴1,盘状半月板,7,资料借鉴1,前交叉韧带完全撕裂,8,资料借鉴1,后交叉韧带完全撕裂,9,资料借鉴1,双交叉韧带撕裂,10,资料借鉴1,内侧副韧带撕裂,11,资料借鉴1,内侧副韧带撕裂,12,资料借鉴1,外侧副韧带撕裂,13,资料借鉴1,内侧支持带撕裂,14,资料借鉴1,髌韧带撕裂,15,资料借鉴1,骨挫伤MRI和CT,16,资料借鉴1,骨软骨骨折,17,资料借鉴1,半月板修补手术后,关节造影,18,资料借鉴1,半月板修补手术后,关节造影,19,资料借鉴1,肩袖完全撕裂,MR平扫,20,资料借鉴1,肩袖完全撕裂MR造影,21,资料借鉴1,上盂唇撕裂肩袖（冈上肌肌腱）部分撕裂,上盂唇撕裂,上盂唇撕裂,22,资料借鉴1,前盂唇撕裂,前盂唇撕裂,23,资料借鉴1,软骨缺损,肱骨头软骨缺损,肱骨头软骨缺损,24,资料借鉴1,跟腱撕裂,25,资料借鉴1,26,资料借鉴1,男,12岁,右髋关节痛6月,27,资料借鉴1,28,资料借鉴1,29,资料借鉴1,X线vsMR对显示骨质侵蚀的比较,30,资料借鉴1,正常关节软骨NormalArticularCartilage,T2W,T1W,软骨表面光整，信号均一,31,资料借鉴1,SPIR/FFE,MIP/3D,正常关节软骨NormalArticularCartilage,32,资料借鉴1,层次模糊消失表面毛糙,类风关软骨表现Rheumatoidarthritis,Coarsechondralsurface,小囊状缺损,Cystiformdefect,33,资料借鉴1,弥漫性变薄Diffusethinning,局部全层丢失Focalloss,类风关软骨表现Rheumatoidarthritis,34,资料借鉴1,髌骨关节软骨局部全层缺失,关节软骨三维重建图像直观显示缺失区域,T1/SPIR/3D/FFE,35,资料借鉴1,血管翳侵入边缘部骨质,Pannusinvolvingbone,36,资料借鉴1,骨质囊变,T1WC+,T1W,T2W,CystofBone,37,资料借鉴1,T1W、T2W和GE-T1W显示髌骨和股骨髁的软骨厚度变薄，软骨下骨增生硬化，髌上囊积液,关节退变,ArticularDegeneration,38,资料借鉴1,ACL破坏消失,ACL滑膜增生包绕,Synovialproliferation,DestructionofACL,NormalACL,正常ACL,39,资料借鉴1,腘窝囊肿形成PoplitealFossaCyst,T1W,T2W,40,资料借鉴1,皮下结节形成subcutaneousnodule,T1/SPIR/3D/FFE,T1WC+,T1W,T2W,41,资料借鉴1,绒毛结节性滑膜炎,42,资料借鉴1,膝关节绒毛结节性关节炎,PigmentVillonodularSynovitis,T2W,T1W,STIR,43,资料借鉴1,踝关节绒毛结节性滑膜炎,PigmentVillonodularSynovitis,T1W,STIR,44,资料借鉴1,血友病性关节炎,Hemophiliaarthritis,45,资料借鉴1,腕关节类风湿关节炎,Rheumatoidarthritisofwrist,46,资料借鉴1,47,资料借鉴1,其他关节炎MR表现,48,资料借鉴1,神经性关节炎,X线示关节面的不规则缺损,Neuroarthritis,Xplainfilmdemonstratesarticularsurfaceirregulardefect,49,资料借鉴1,脊髓空洞症,Neuroarthritis,syringomyelia,神经性关节炎,T2W,神经性关节炎撕脱的软骨片,Neuroarthritis,50,资料借鉴1,结核性关节炎,TuberculosisArthritis,51,资料借鉴1,膝关节痛风,PodagraofKnee,52,资料借鉴1,53,资料借鉴1,54,资料借鉴1,55,资料借鉴1,滑膜软骨瘤病,SynovialChondromatosis,56,资料借鉴1,化脓性关节炎,Suppurationarthritis,T1W,STIR,57,资料借鉴1,类风湿性关节炎表现Rheumatoidarthritis,58,资料借鉴1,TarsalSinus:Arthrographic,MRImaging,MRArthrographic,Schematicdrawingsofthetarsalsinusligamentoussystem,seeninanoverheadviewandacoronalview,andofthecalcaneusshowthecourseandattachmentsitesofthecervicalligament(1);theinterosseoustalocalcanealligament(3);andthemedial(2),intermediate(4),andlateral(5)rootsoftheinferiorextensorretinaculum.AF=anteriorfacet,MF=medialfacet,PF=posteriorfacet.,59,资料借鉴1,Coronal(a)T1-weighted(600/11)and(b)T2-weighted(2,000/80)MRarthrogramsofaspecimenfromamalecadaver(ageatdeath,87years)showirregularthickeningofthecervicalligament(arrow).(c)SagittalT1-weightedMRarthrogram(600/11)and(d)reconstructedMRarthrogramperpendiculartothecourseofthecervicalligamentshowapartialtear(arrow).(e)Thepartialtear(arrow)wasconfirmedontheanatomicsection.,60,资料借鉴1,InternalDerangementoftheWrist:IndirectMRArthrographyversusUnenhancedMRImaging1,ImagesintwodifferentpatientswithanormalcentraldiskoftheTFCC.(a)Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthecentraldiskoftheTFCC(arrows).(b)Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina21-year-oldwomandemonstratesanormallow-signal-intensitycentraldiskoftheTFCC(arrows).,triangularfibrocartilagecomplex(TFCC),61,资料借鉴1,ImagesintwodifferentpatientswithanormalcentraldiskoftheTFCC.(a)Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthecentraldiskoftheTFCC(arrows).(b)Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina21-year-oldwomandemonstratesanormallow-signal-intensitycentraldiskoftheTFCC(arrows).,62,资料借鉴1,ImagesintwodifferentpatientswithtearsofthecentraldiskoftheTFCC.(a)Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina42-year-oldmanillustratesabsenceofthecentraldiskoftheTFCC(blackarrows),whichisconsistentwithalargecentraltear.Thereisalsoabnormalmarrowsignalintensity(whitearrows)intheulnarsideofthelunate,whichisconsistentwithulnarimpactionsyndrome.(b)Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina23-year-oldwomandemonstratesabnormalhighsignalintensityextendingthroughthecentraldiskoftheTFCC(arrows).,63,资料借鉴1,Imagesintwodifferentpatientswithnormalscapholunateligaments.(a)Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthescapholunateligament(arrows).(b)Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina37-year-oldmandemonstratesanormallow-signal-intensityscapholunateligament(arrows).,64,资料借鉴1,5a.Imagesintwodifferentpatientswithtornscapholunateligaments.(a)CoronalT1-weightedfat-suppressedindirectMRarthrogram(500/14)ina53-year-oldwomandemonstratesfluidsignalintensity(arrows)betweenthescaphoidandthelunate.(b)Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina46-year-oldmandemonstratesabnormalhighsignalintensitytrackingthroughthescapholunateligament(arrows).,65,资料借鉴1,Abnormalulnarcollateralligament.E=medialepicondyle,F=commonflexortendon,U=ulna.(a)LongitudinalUSimageoftheulnarcollateralligamentshowsfocalhypoechoicdisruption(arrow)ofligamentfiberswithrelativelynormalligamentseendistally(arrowheads).(b)CoronalT1-weightedspin-echoMRimage(700/14)and(c)coronalanatomicsliceobtainedafterintraarticularadministrationofcontrastmaterialshowabnormalcontrastmaterialextension(arrow)intotheproximalaspectoftheulnarcollateralligament(arrowhead).,66,资料借鉴1,ChronicAdultHipPain,Evaluationofthepatientwithchronicmechanicalhippainhasremainedadiagnosticdilemmaforphysicians.Thedifferentialdiagnosisisdiverseincludingcommonentitiessuchasosteoarthritis,fracture,andavascularnecrosis,aswellaslesscommonentitiesincludingpigmentedvillonodularsynovitis,synovialosteochondromatosis,snappinghipsyndrome,andhemorrhageintotheligamentumteres(1,2).Similartofindingsinthekneeandshoulder,radiographsappearnormalinthevastmajorityofpatientswithinternalderangementasacauseforhipsymptoms(2).Inonestudy,labrallesionswereidentifiedatarthroscopyin55%ofpatientswithintractablehippain(2).Owingtothepreviouslackofareliableimagingexamination,diagnosiswasoftendelayed.Inanotherstudy,patientsaveraged25monthsofsymptomsbeforethecausewasestablished(3).,67,资料借鉴1,Normalanatomyina43-year-oldmanwithchronichippainisdepictedonT1-weighted(repetitiontimemsec/echotimemsec=600/17)MRimagesobtainedwithintraarticularcontrastmaterial.(a)AxialMRimagedemonstratesthenormaltriangularcrosssectionoftheanteriorandposteriorlabrum(arrowheads),smallperilabralsulci(shortarrows),andcrosssectionofligamentumteres(longarrow).(b)SagittalMRimagealongthemedialjointincludesthetransverseligament(arrowheads).(c)MidlinecoronalMRimageshowsthelongaxisoftheligamentumteres(shortarrow)anditsinsertionontothetransverseligament(longarrow).Anormalsuperiorlabrum(curvedarrow)andthelargersuperiorperilabralrecess(arrowhead)areseen.(d)OnamoreposteriorcoronalMRimage,thecircularfibersofthezonaorbicularis(arrowheads)areevident,asarethelongitudinalfibersoftheiliofemoralligament(shortarrow).Acleftisseenwherethetransverseligamentandlabrumstarttomerge(longarrow).,68,资料借鉴1,Normalanatomyina43-year-oldmanwithchronichippainisdepictedonT1-weighted(repetitiontimemsec/echotimemsec=600/17)MRimagesobtainedwithintraarticularcontrastmaterial.(a)AxialMRimagedemonstratesthenormaltriangularcrosssectionoftheanteriorandposteriorlabrum(arrowheads),smallperilabralsulci(shortarrows),andcrosssectionofligamentumteres(longarrow).(b)SagittalMRimagealongthemedialjointincludesthetransverseligament(arrowheads).(c)MidlinecoronalMRimageshowsthelongaxisoftheligamentumteres(shortarrow)anditsinsertionontothetransverseligament(longarrow).Anormalsuperiorlabrum(curvedarrow)andthelargersuperiorperilabralrecess(arrowhead)areseen.(d)OnamoreposteriorcoronalMRimage,thecircularfibersofthezonaorbicularis(arrowheads)areevident,asarethelongitudinalfibersoftheiliofemoralligament(shortarrow).Acleftisseenwherethetransverseligamentandlabrumstarttomerge(longarrow).,69,资料借鉴1,Extensivelabraltearina38-year-oldwomanwhoisanavidrunner.T1-weighted(600/17)axialMRimagedepictscontrastmaterialthroughoutthelabralsubstance.Thelabrumisenlargedandmaintainsitstriangularshape(arrowheads).Anextensivelinearintralabralcollectionofcontrastmaterialispresent(shortarrow).Communicationbetweenthejointandtheiliopsoasbursaisevident(longarrow).,70,资料借鉴1,Buckethandlelabraldetachmentina17-year-oldgirlwithdevelopmentaldysplasiawhosepainwasoutofproportiontoradiographicchanges.(a)T1-weighted(450/17)coronalMRimageobtainedwithintraarticularcontrastmaterialdemonstratescontrastmaterialinterposedalongtheentiresuperioracetabular-labralinterface(arrowheads).(b)Fat-suppressedT1-weighted(980/14)sagittalMRimageobtainedwithintraarticularcontrastmaterialshowsthatthedetachmentinvolvestheanteriorandanterosuperiorlabrum(arrowheads).,71,资料借鉴1,MRImagingoftheMetacarpophalangealJointsoftheFingers,Althoughuncommon,injuriesofthemetacarpophalangeal(MCP)jointsofthefingersnecessitateaccuratediagnosis,becausethelossoffunctionofevenoneMCPjointcanseriouslyimpairoverallhandfunction(1).Toensureappropriatetreatment,theidentificationofthedamagedstructuresatthetimeofinjuryisessential.Advancesinmagneticresonance(MR)imagingtechnologythatimprovespatialresolutionenablethevisualizationofimportantintra-andperiarticularstructures,eveninsmalljointssuchastheMCPjoints,withstandardclinicalequipment.DetailedknowledgeofthenormalanatomyremainsessentialtotheanalysisofMRimagesofthisarea.,72,资料借鉴1,DrawingillustratestransverseviewofthemainstructuresoftheMCPjointafterremovalofthemetacarpalhead.,73,资料借鉴1,Drawingoftheextensorhood.Thesagittalbandsarelocatedabovethejointline,andthetransversefibersofthelumbricalandinterosseoustendonsaremoredistal,overtheproximalphalanx.,74,资料借鉴1,SagittalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a)T1-weightedspin-echoMRarthrogram(500/12)and(b)correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(arrowheads).Abarearea(openarrow)canbeseenbetweenthecartilage(longstraightarrows)andthedorsalinsertionofthecapsule.(c)T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothesurfaceofthebone.,75,资料借鉴1,SagittalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a)T1-weightedspin-echoMRarthrogram(500/12)and(b)correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(arrowheads).Abarearea(openarrow)canbeseenbetweenthecartilage(longstraightarrows)andthedorsalinsertionofthecapsule.(c)T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothesurfaceofthebone.,76,资料借鉴1,SagittalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a)T1-weightedspin-echoMRarthrogram(500/12)and(b)correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(arrowheads).Abarearea(openarrow)canbeseenbetweenthecartilage(longstraightarrows)andthedorsalinsertionofthecapsule.(c)T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothesurfaceofthebone.,77,资料借鉴1,CoronalviewsoftheMCPjointsofthesecondandthirdfingersinextension,withanatomiccorrelation.T1-weightedspin-echo(a)conventionalMRimage(500/12)and(b)MRarthrogram(500/12)and(c)thecorrespondinganatomicspecimenshowtheproximal(blackarrowheadsinaandb)anddistal(straightarrows)attachmentsofthemaincollateralligament.Notetheheterogeneoussign