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、脂肪瘤桶柄状撕裂半月板囊肿盘状半月板前交叉韧带完全撕裂后交叉韧带完全撕裂双交叉韧带撕裂内侧副韧带撕裂内侧副韧带撕裂外侧副韧带撕裂内侧支持带撕裂髌韧带撕裂骨挫伤MRI和CT骨软骨骨折半月板修补手术后关节造影半月板修补手术后关节造影肩袖完全撕裂

MR平扫肩袖完全撕裂

MR造影上盂唇撕裂＋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上盂唇撕裂前盂唇撕裂前盂唇撕裂前盂唇撕裂软骨缺损肱骨头软骨缺损肱骨头软骨缺损跟腱撕裂男,12岁,右髋关节痛6月X线vsMR对显示骨质侵蚀的比较正常关节软骨NormalArticularCartilageT2WT1W软骨表面光整，信号均一SPIR/FFEMIP/3D正常关节软骨NormalArticularCartilage层次模糊消失表面毛糙类风关软骨表现RheumatoidarthritisCoarsechondralsurface小囊状缺损Cystiformdefect弥漫性变薄Diffusethinning局部全层丢失Focalloss类风关软骨表现Rheumatoidarthritis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血管翳侵入边缘部骨质Pannusinvolvingbone骨质囊变T1WC+T1WT2WCystofBone

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ArticularDegenerationACL破坏消失ACL滑膜增生包绕SynovialproliferationDestructionofACLNormalACL正常ACL腘窝囊肿形成PoplitealFossaCystT1WT2W皮下结节形成subcutaneousnoduleT1/SPIR/3D/FFET1WC+T1WT2W绒毛结节性滑膜炎膝关节绒毛结节性关节炎PigmentVillonodularSynovitisT2WT1WSTIR踝关节绒毛结节性滑膜炎PigmentVillonodularSynovitisT1WSTIR血友病性关节炎Hemophiliaarthritis腕关节类风湿关节炎Rheumatoidarthritisofwrist其他关节炎MR表现神经性关节炎X线示关节面的不规则缺损Neuroarthritis

Xplainfilmdemonstratesarticularsurfaceirregulardefect脊髓空洞症Neuroarthritissyringomyelia神经性关节炎T2W神经性关节炎—撕脱的软骨片Neuroarthritis结核性关节炎TuberculosisArthritis膝关节痛风PodagraofKnee滑膜软骨瘤病SynovialChondromatosis化脓性关节炎SuppurationarthritisT1WSTIR类风湿性关节炎表现RheumatoidarthritisTarsalSinus:Arthrographic,MRImaging,MRArthrographicSchematicdrawingsofthetarsalsinusligamentoussystem,seeninanoverheadviewandacoronalview,andofthecalcaneusshowthecourseandattachmentsitesofthecervicalligament(1);theinterosseoustalocalcanealligament(3);andthemedial(2),intermediate(4),andlateral(5)rootsoftheinferiorextensorretinaculum.AF=anteriorfacet,MF=medialfacet,PF=posteriorfacet.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.InternalDerangementoftheWrist:IndirectMR

ArthrographyversusUnenhancedMRImaging1

ImagesintwodifferentpatientswithanormalcentraldiskoftheTFCC.(a)Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45°flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthecentraldiskoftheTFCC(arrows).(b)Unenhancedcoronalthree-dimensionalgradient-echoMR