Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430030, China.
Chin Med J (Engl). 2009 Nov 5;122(21):2624-30.
There is a strong need for quick noninvasive diagnostic technique that can give a valid estimate of the status of the cartilage reliably, discriminating intact cartilage from various grades of impaired cartilage. The goal of this study was to assess the incidence of knee cartilage injuries and compare the accuracy of two-dimension spin echo (2D SE) and fast spin echo (FSE) (conventional MRI), three-dimensional spoiled gradient echo (3D SPGR), three-dimensional fast imaging employing steady state acquisition (3D FIESTA) MR imaging sequences with surgical examination of the articular cartilage.
One hundred and thirty-eight knees with history of knee trauma received conventional MRI, 3D SPGR and 3D FIESTA MRI examination before surgery, and surgical examination of articular cartilage was used as reference standard. A modified version of the Noyes classification system was applied for the evaluation of the lateral femoral condyle (LFC), medial femoral condyle (MFC), lateral tibial plateau (LTP), medial tibial plateau (MTP), trochlea and patella. The incidence and distributions of different injured grades at different articular surfaces of knee were assessed. A series of assessment indeces of 3D SPGR, 3D FIESTA, and the combination of the conventional MRI and 3D SPGR imaging were calculated.
The incidence of cartilage defects (grade 2 to 4) was 22% (183/828), according to surgical examination. Grade 3 and 4 lesions were absent at the medial tibial plateau. The rates of exact match between the grading results of different MRI procedures and surgical examination were 49% of 3D SPGR, 61% of 3D FIESTA, and 82% of the combination of 3D SPGR and conventional MRI. Also, the combination of 3D SPGR and conventional MR imaging provided the highest sensitivity, specificity, accuracy, positive and negative predictive values, at 71%, 97%, 90%, 90% and 90%, respectively.
For all the articular surfaces of the traumatic knees, about one fifth (22%) were cartilage defects. Both 3D SPGR and 3D FIESTA imaging performed similarly in detecting cartilage lesions of the knee. The increased accuracy in chondral assessment can be achieved by combining 3D SPGR and conventional MRI within a reasonable time.
目前急需一种快速、非侵入性的诊断技术，能够可靠地评估软骨状态，将完整的软骨与不同程度受损的软骨区分开来。本研究旨在评估膝关节软骨损伤的发生率，并比较二维自旋回波（2D SE）和快速自旋回波（FSE）（常规 MRI）、三维扰相梯度回波（3D SPGR）、三维稳态采集快速成像（3D FIESTA）磁共振成像序列与关节软骨手术检查的准确性。
138 例膝关节外伤患者术前行常规 MRI、3D SPGR 和 3D FIESTA MRI 检查，以关节软骨手术检查为参考标准。应用改良的 Noyes 分类系统评估外侧股骨髁（LFC）、内侧股骨髁（MFC）、外侧胫骨平台（LTP）、内侧胫骨平台（MTP）、滑车和髌骨的不同损伤等级。评估膝关节不同关节面不同损伤等级的发生率和分布。计算 3D SPGR、3D FIESTA 和常规 MRI 与 3D SPGR 联合成像的一系列评估指标。
根据手术检查，软骨缺损（2 至 4 级）的发生率为 22%（183/828）。内侧胫骨平台未见 3 级和 4 级病变。不同 MRI 检查结果与手术检查结果分级的完全匹配率分别为 3D SPGR 为 49%、3D FIESTA 为 61%、3D SPGR 和常规 MRI 联合应用为 82%。此外，3D SPGR 和常规 MRI 联合应用的灵敏度、特异性、准确性、阳性预测值和阴性预测值最高，分别为 71%、97%、90%、90%和 90%。
对于所有外伤性膝关节的关节面，约五分之一（22%）有软骨缺损。3D SPGR 和 3D FIESTA 成像在检测膝关节软骨病变方面表现相似。通过在合理的时间内结合 3D SPGR 和常规 MRI，可以提高软骨评估的准确性。
