MR在关节疾患中应用价值

1、MR在关节疾患中应用价值l无无X线辐射线辐射l可作任意切面的成像可作任意切面的成像l成像参数多，所含信息量大成像参数多，所含信息量大l软组织分辨率高软组织分辨率高l可同时显示关节内的各种结构可同时显示关节内的各种结构MR表现具有特征性表现具有特征性,可以确立诊断可以确立诊断: 外伤、退行性变、滑膜病外伤、退行性变、滑膜病变、肿瘤变、肿瘤MR表现有一定特征性表现有一定特征性,可以帮助确立诊断可以帮助确立诊断:需需结合其他检查结合其他检查 滑膜病变、肿瘤滑膜病变、肿瘤MR表现缺乏特征性，需依靠其他其他检查表现缺乏特征性，需依靠其他其他检查 滑膜病变、肿瘤滑膜病变、肿瘤关节损伤：半月板撕裂、韧带撕裂

2、、肌腱损伤、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，其软骨缺损（如果采用关节造影，其 准确率更高）准确率更高） 、骨挫伤、骨挫伤退行性变：退行性变：滑膜病变：绒毛结节滑膜炎、滑膜皱襞滑膜病变：绒毛结节滑膜炎、滑膜皱襞肿肿 瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、 脂肪瘤脂肪瘤半月板修补手术后半月板修补手术后上盂唇撕裂肩袖（冈上肌肌腱）部分撕裂上盂唇撕裂肩袖部分撕裂上盂唇撕裂男,12岁,右髋关节痛6月X线线 vs MR 对显示骨质侵蚀的比较对显示骨质侵蚀的比较正常关节软骨正常关节软骨Normal Articular CartilageT

3、2WT1W软骨表面光整，软骨表面光整，信号均一信号均一SPIR/FFEMIP/3D正常关节软骨正常关节软骨Normal Articular Cartilage层次模糊消失表面毛糙层次模糊消失表面毛糙类风关软骨表现类风关软骨表现Rheumatoid arthritisCoarse chondral surface小囊状缺损小囊状缺损Cystiform defect弥漫性变薄弥漫性变薄Diffuse thinning局部全层丢失局部全层丢失Focal loss类风关软骨表现类风关软骨表现 Rheumatoid arthritis髌骨关节软骨髌骨关节软骨局部全层缺失局部全层缺失关节软骨三维重建图关节

4、软骨三维重建图像直观显示缺失区域像直观显示缺失区域T1/SPIR/3D/FFE血管翳侵入边缘部骨质血管翳侵入边缘部骨质Pannus involving bone骨质囊变骨质囊变T1WC+T1WT2WCyst of Bone T1W、T2W和和GE-T1W显示髌骨和股骨髁显示髌骨和股骨髁的软骨厚度变薄，软骨下骨增生硬化，髌的软骨厚度变薄，软骨下骨增生硬化，髌上囊积液上囊积液关节退关节退 变变Articular DegenerationACL破坏消失破坏消失ACL滑膜增生包绕滑膜增生包绕Synovial proliferationDestruction of ACLNormal ACL正常正常AC

5、L腘窝囊肿形成腘窝囊肿形成Popliteal Fossa CystT1WT2W皮下结节形成皮下结节形成subcutaneous noduleT1/SPIR/3D/FFET1WC+T1WT2W膝关节绒毛结节性关节炎膝关节绒毛结节性关节炎Pigment Villonodular SynovitisT2WT1WSTIR踝关节绒毛结节性滑膜炎踝关节绒毛结节性滑膜炎Pigment Villonodular SynovitisT1WSTIR血友病性关节炎血友病性关节炎Hemophilia arthritis腕关节类风湿关节炎腕关节类风湿关节炎Rheumatoid arthritis of wrist神经性

6、关节炎神经性关节炎X线示关节面的不规则缺损线示关节面的不规则缺损Neuroarthritis X plain film demonstrates articular surface irregular defect脊髓空洞症脊髓空洞症Neuroarthritissyringomyelia神经性关节炎神经性关节炎T2W神经性关节炎神经性关节炎撕脱的软骨片撕脱的软骨片Neuroarthritis结核性关节炎结核性关节炎Tuberculosis Arthritis膝关节痛风膝关节痛风Podagra of Knee滑膜软骨瘤病滑膜软骨瘤病Synovial Chondromatosis化脓性关节炎化脓性

7、关节炎Suppuration arthritisT1WSTIR类风湿性关节炎表现类风湿性关节炎表现Rheumatoid arthritisTarsal Sinus: Arthrographic, MR Imaging, MR ArthrographicSchematic drawings of the tarsal sinus ligamentous system, seen in an overhead view and a coronal view, and of the calcaneus show the course and attachment sites of the cervi

8、cal ligament (1); the interosseous talocalcaneal ligament (3); and the medial (2), intermediate (4), and lateral (5) roots of the inferior extensor retinaculum. AF = anterior facet, MF = medial facet, PF = posterior facet. Coronal (a) T1-weighted (600/11) and (b) T2-weighted (2,000/80) MR arthrogram

9、s of a specimen from a male cadaver (age at death, 87 years) show irregular thickening of the cervical ligament (arrow). (c) Sagittal T1-weighted MR arthrogram (600/11) and (d) reconstructed MR arthrogram perpendicular to the course of the cervical ligament show a partial tear (arrow). (e) The parti

10、al tear (arrow) was confirmed on the anatomic section. Internal Derangement of the Wrist: Indirect MR Arthrography versus Unenhanced MR Imaging1 Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45 flip

11、 angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10 flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the T

12、FCC (arrows). triangular fibrocartilage complex (TFCC)Images in two different patients with a normal central disk of the TFCC. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45 flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the

13、central disk of the TFCC (arrows). (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10 flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows). Images in two different patients with tears of the central disk of the TFCC.

14、(a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45 flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the ulnar

15、 side of the lunate, which is consistent with ulnar impaction syndrome. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10 flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows). Images in two dif

16、ferent patients with normal scapholunate ligaments. (a) Coronal three-dimensional gradient-echo indirect MR arthrogram (46/15, 45 flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the scapholunate ligament (arrows). (b) Unenhanced coronal three-dimensional gr

17、adient-echo MR image (58/12, 10 flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows). 5a. Images in two different patients with torn scapholunate ligaments. (a) Coronal T1-weighted fat-suppressed indirect MR arthrogram (500/14) in a 53-year-old w

18、oman demonstrates fluid signal intensity (arrows) between the scaphoid and the lunate. (b) Unenhanced coronal three-dimensional gradient-echo MR image (58/12, 10 flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the scapholunate ligament (arrows). Abnormal

19、 ulnar collateral ligament. E = medial epicondyle, F = common flexor tendon, U = ulna. (a) Longitudinal US image of the ulnar collateral ligament shows focal hypoechoic disruption (arrow) of ligament fibers with relatively normal ligament seen distally (arrowheads). (b) Coronal T1-weighted spin-echo

20、 MR image (700/14) and (c) coronal anatomic slice obtained after intraarticular administration of contrast material show abnormal contrast material extension (arrow) into the proximal aspect of the ulnar collateral ligament (arrowhead). Chronic Adult Hip PainEvaluation of the patient with chronic me

21、chanical hip pain has remained a diagnostic dilemma for physicians. The differential diagnosis is diverse including common entities such as osteoarthritis, fracture, and avascular necrosis, as well as less common entities including pigmented villonodular synovitis, synovial osteochondromatosis, snap

22、ping hip syndrome, and hemorrhage into the ligamentum teres (1,2). Similar to findings in the knee and shoulder, radiographs appear normal in the vast majority of patients with internal derangement as a cause for hip symptoms (2). In one study, labral lesions were identified at arthroscopy in 55% of

23、 patients with intractable hip pain (2). Owing to the previous lack of a reliable imaging examination, diagnosis was often delayed. In another study, patients averaged 25 months of symptoms before the cause was established (3).Normal anatomy in a 43-year-old man with chronic hip pain is depicted on

24、T1-weighted (repetition time msec/echo time msec = 600/17) MR images obtained with intraarticular contrast material. (a) Axial MR image demonstrates the normal triangular cross section of the anterior and posterior labrum (arrowheads), small perilabral sulci (short arrows), and cross section of liga

25、mentum teres (long arrow). (b) Sagittal MR image along the medial joint includes the transverse ligament (arrowheads). (c) Midline coronal MR image shows the long axis of the ligamentum teres (short arrow) and its insertion onto the transverse ligament (long arrow). A normal superior labrum (curved

26、arrow) and the larger superior perilabral recess (arrowhead) are seen. (d) On a more posterior coronal MR image, the circular fibers of the zona orbicularis (arrowheads) are evident, as are the longitudinal fibers of the iliofemoral ligament (short arrow). A cleft is seen where the transverse ligame

27、nt and labrum start to merge (long arrow). Normal anatomy in a 43-year-old man with chronic hip pain is depicted on T1-weighted (repetition time msec/echo time msec = 600/17) MR images obtained with intraarticular contrast material. (a) Axial MR image demonstrates the normal triangular cross section

28、 of the anterior and posterior labrum (arrowheads), small perilabral sulci (short arrows), and cross section of ligamentum teres (long arrow). (b) Sagittal MR image along the medial joint includes the transverse ligament (arrowheads). (c) Midline coronal MR image shows the long axis of the ligamentu

29、m teres (short arrow) and its insertion onto the transverse ligament (long arrow). A normal superior labrum (curved arrow) and the larger superior perilabral recess (arrowhead) are seen. (d) On a more posterior coronal MR image, the circular fibers of the zona orbicularis (arrowheads) are evident, a

30、s are the longitudinal fibers of the iliofemoral ligament (short arrow). A cleft is seen where the transverse ligament and labrum start to merge (long arrow). Extensive labral tear in a 38-year-old woman who is an avid runner. T1-weighted (600/17) axial MR image depicts contrast material throughout

31、the labral substance. The labrum is enlarged and maintains its triangular shape (arrowheads). An extensive linear intralabral collection of contrast material is present (short arrow). Communication between the joint and the iliopsoas bursa is evident (long arrow). Bucket handle labral detachment in

32、a 17-year-old girl with developmental dysplasia whose pain was out of proportion to radiographic changes. (a) T1-weighted (450/17) coronal MR image obtained with intraarticular contrast material demonstrates contrast material interposed along the entire superior acetabular-labral interface (arrowhea

33、ds). (b) Fat-suppressed T1-weighted (980/14) sagittal MR image obtained with intraarticular contrast material shows that the detachment involves the anterior and anterosuperior labrum (arrowheads). MR Imaging of the Metacarpophalangeal Joints of the Fingers Although uncommon, injuries of the metacar

34、pophalangeal (MCP) joints of the fingers necessitate accurate diagnosis, because the loss of function of even one MCP joint can seriously impair overall hand function (1). To ensure appropriate treatment, the identification of the damaged structures at the time of injury is essential. Advances in ma

35、gnetic resonance (MR) imaging technology that improve spatial resolution enable the visualization of important intra- and periarticular structures, even in small joints such as the MCP joints, with standard clinical equipment. Detailed knowledge of the normal anatomy remains essential to the analysi

36、s of MR images of this area.Drawing illustrates transverse view of the main structures of the MCP joint after removal of the metacarpal head. Drawing of the extensor hood. The sagittal bands are located above the joint line, and the transverse fibers of the lumbrical and interosseous tendons are mor

37、e distal, over the proximal phalanx. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-echo MR arthrogram (500/12) and (b) corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow),

38、and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess

39、 (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-echo MR arthrogram (500/12) and (b) corresponding anatomic section sho

40、w the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the

41、third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone. Sagittal MR arthrograms of the MCP joint of the third finger in extension, with anatomic correlation. (a) T1-weighted spin-

42、echo MR arthrogram (500/12) and (b) corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule. (c) T1-weighted spin-echo MR arthrogram (500/12) of the MCP of the third finger in flexion sh