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半月板撕裂和并发软骨下骨髓损伤的快速术前磁共振成像。对自然发生颅交叉韧带断裂犬的研究。

Fast presurgical magnetic resonance imaging of meniscal tears and concurrent subchondral bone marrow lesions. Study of dogs with naturally occurring cranial cruciate ligament rupture.

作者信息

Olive J, d'Anjou M-A, Cabassu J, Chailleux N, Blond L

机构信息

Dr. Julien Olive, Département des Sciences Cliniques, Faculty of Veterinary Medicine, University of Montreal, 3200 Rue Sicotte, PO Box 5000, Saint-Hyacinthe, QC, Canada, E-mail:

出版信息

Vet Comp Orthop Traumatol. 2014;27(1):1-7. doi: 10.3415/VCOT-13-04-0054. Epub 2013 Nov 13.

DOI:10.3415/VCOT-13-04-0054
PMID:24226972
Abstract

Meniscal tears and subchondral bone marrow lesions have both been described in dogs with cranial cruciate ligament rupture, but their possible concurrence has not been evaluated. In a population of 14 dogs exhibiting signs of stifle pain with surgically confirmed cranial cruciate ligament rupture, a short presurgical 1.5T magnetic resonance (MR) imaging protocol including dorsal proton density, dorsal T1-weighted gradient recalled echo, and sagittal fat-saturated dual echo sequences was tested to further investigate these features and illustrate meniscal tears. Interobserver agreement for detection of medial meniscal tears (k=0.83) and bone marrow lesions (k=0.87) was excellent. Consensus MR reading allowed detection of nine out of 12 surgically confirmed medial meniscal tears and there was no false positive. All dogs had cruciate ligament enthesis-related bone marrow lesions in the tibia, femur or both bones. Additionally, among the 12 dogs with confirmed medial meniscal tears, subchondral bone marrow lesions were present in the caudomedial (9 dogs) and caudoaxial (11 dogs) regions of the tibial plateau, resulting in odds ratios (13.6, p=0.12, and 38.3, p=0.04, respectively) that had large confidence intervals due to the small group size of this study. The other two dogs had neither tibial bone marrow lesions in these locations nor medial meniscal tears. These encouraging preliminary results warrant further investigation using this clinically realistic preoperative MR protocol. As direct diagnosis of meniscal tears remained challenging in dogs even with high-field MR, identification of associated signs such as subchondral bone marrow lesions might indirectly allow suspicion of an otherwise unrecognized meniscal tear.

摘要

在患有前交叉韧带断裂的犬类中,已发现半月板撕裂和软骨下骨髓损伤,但尚未评估它们同时出现的可能性。在14只表现出膝关节疼痛且经手术证实存在前交叉韧带断裂的犬类群体中,测试了一种简短的术前1.5T磁共振(MR)成像方案,该方案包括背侧质子密度、背侧T1加权梯度回波和矢状位脂肪饱和双回波序列,以进一步研究这些特征并显示半月板撕裂。观察者间对内侧半月板撕裂(k = 0.83)和骨髓损伤(k = 0.87)检测的一致性极佳。通过MR的一致性读数,在12例经手术证实的内侧半月板撕裂中检测出9例,且无假阳性。所有犬在胫骨、股骨或两者均有与交叉韧带附着点相关的骨髓损伤。此外,在12例经证实存在内侧半月板撕裂的犬中,软骨下骨髓损伤出现在胫骨平台的后内侧(9只犬)和后外侧(11只犬)区域,由于本研究样本量小,导致优势比(分别为13.6,p = 0.12,和38.3,p = 0.04)的置信区间较大。另外两只犬在这些位置既没有胫骨骨髓损伤,也没有内侧半月板撕裂。这些令人鼓舞的初步结果表明,使用这种临床实际的术前MR方案值得进一步研究。即使使用高场MR,犬类半月板撕裂的直接诊断仍然具有挑战性,识别诸如软骨下骨髓损伤等相关体征可能间接提示存在原本未被识别的半月板撕裂。

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