Knuesel Patrick R, Pfirrmann Christian W A, Noetzli Hubert P, Dora Claudio, Zanetti Marco, Hodler Juerg, Kuehn Bernd, Schmid Marius R
Department of Radiology, University Hospital Balgrist, Forchstrasse 340, Zurich CH-8008, Switzerland.
AJR Am J Roentgenol. 2004 Dec;183(6):1729-35. doi: 10.2214/ajr.183.6.01831729.
The objective of our study was to compare the diagnostic performance of a dedicated cartilage MR sequence (water-excitation 3D double-echo steady-state) with a standard MR sequence (T1-weighted spin-echo) in detecting articular cartilage lesions of the hip after intraarticular injection of gadopentetate dimeglumine.
In 50 MR arthrograms of the hip joint obtained in 47 consecutive patients, a sagittal 3D double-echo steady-state sequence (TR/TE, 24/6.5; flip angle, 25 degrees ) was compared with a sagittal T1-weighted spin-echo sequence (350/14). Two musculoskeletal radiologists independently evaluated articular cartilage. Sensitivity and specificity for detecting cartilage defects were calculated for those hips that underwent open surgery (n = 21). Lesion conspicuity was retrospectively reviewed and graded between 1 (not visible) and 5 (well defined).
At surgery, a total of 26 lesions of the acetabular (n = 20) and femoral (n = 6) cartilage were found. For the 3D double-echo steady-state and T1-weighted spin-echo sequences, sensitivities and specificities for cartilage lesion detection were 58% and 88% and 81% and 81% for reviewer 1 and 62% and 94% and 62% and 100% for reviewer 2, respectively. Lesion conspicuity was significantly superior (p = 0.036) for the 3D double-echo steady-state sequence (mean grade, 3.4) compared with the T1-weighted spin-echo sequence (mean grade, 3.0). The kappa value was fair for the 3D double-echo steady-state sequence (kappa = 0.40) and moderate for the T1-weighted spin-echo sequence (kappa = 0.55).
The 3D double-echo steady-state sequence optimized for cartilage imaging improves lesion conspicuity but does not improve diagnostic performance.
本研究的目的是比较专用软骨磁共振序列（水激发三维双回波稳态序列）与标准磁共振序列（T1加权自旋回波序列）在关节内注射钆喷酸葡胺后检测髋关节软骨损伤的诊断性能。
在连续47例患者获得的50例髋关节磁共振关节造影中，将矢状面三维双回波稳态序列（TR/TE，24/6.5；翻转角，25度）与矢状面T1加权自旋回波序列（350/14）进行比较。两名肌肉骨骼放射科医生独立评估关节软骨。对接受开放手术的髋关节（n = 21）计算检测软骨缺损的敏感性和特异性。回顾性评估病变的清晰度，并在1（不可见）至5（清晰界定）之间分级。
手术中，共发现26处髋臼（n = 20）和股骨（n = 6）软骨损伤。对于三维双回波稳态序列和T1加权自旋回波序列，观察者1检测软骨损伤的敏感性和特异性分别为58%和88%以及81%和81%，观察者2分别为62%和94%以及62%和100%。与T1加权自旋回波序列（平均分级，3.0）相比，三维双回波稳态序列的病变清晰度明显更高（p = 0.036）（平均分级，3.4）。三维双回波稳态序列的kappa值为中等（kappa = 0.40），T1加权自旋回波序列的kappa值为中等（kappa = 0.55）。
针对软骨成像优化的三维双回波稳态序列可提高病变清晰度，但不能提高诊断性能。
