膝关节透明软骨缺损的脂肪抑制三维扰相梯度回波磁共振成像：与标准磁共振成像及关节镜检查的比较

Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy.

作者信息

Disler D G, McCauley T R, Kelman C G, Fuchs M D, Ratner L M, Wirth C R, Hospodar P P

机构信息

Department of Radiology, Albany Medical College, NY 12208, USA.

出版信息

AJR Am J Roentgenol. 1996 Jul;167(1):127-32. doi: 10.2214/ajr.167.1.8659356.

DOI:10.2214/ajr.167.1.8659356

PMID:8659356

Abstract

OBJECTIVE

The sensitivity of fat-suppressed three-dimensional spoiled gradient-echo (SPGR) images was compared with that of standard MR images for detecting hyaline cartilage defects of the knee, using arthroscopy as the standard of reference.

SUBJECTS AND METHODS

We assessed 114 consecutive patients for hyaline cartilage defects of the knee with both standard MR imaging sequences and a sagittal fat-suppressed three-dimensional SPGR sequence. Of these patients, 48 with meniscal or ligament injury, or persistent symptoms, underwent subsequent arthroscopy. The standard MR images and SPGR images of these 48 patients were then retrospectively analyzed for articular defects in a blinded fashion by two independent observers. Sensitivity, specificity, and intraobserver and interobserver agreement were determined for the different imaging techniques.

RESULTS

One fourth of the patients who went on to arthroscopy were shown to have isolated hyaline cartilage lesions that were clinically confused with meniscal tears and that were missed on the standard MR images. When looking at all surfaces combined for each reader, the SPGR imaging sequence had a significantly higher sensitivity than the standard MR imaging sequences for detecting hyaline cartilage defects (75-85% versus 29-38%, p < .001 for each comparison). When looking at individual surfaces for each reader, significant differences in sensitivity were shown for each surface except the trochlear and lateral tibial surfaces. We found no difference in specificity (97% versus 97%, p > .99). We also found that combined evaluation of standard MR and SPGR images gave no added diagnostic advantage (sensitivity, 86%; specificity, 97%; p > .42). Except for the lateral tibial surface, the study achieved excellent reproducibility among readings and between readers.

CONCLUSION

Fat-suppressed three-dimensional SPGR imaging is more sensitive than standard MR imaging for the detection of hyaline cartilage defects of the knee.

摘要

目的

以关节镜检查作为参考标准，比较脂肪抑制三维扰相梯度回波（SPGR）图像与标准磁共振（MR）图像检测膝关节透明软骨缺损的敏感性。

对象与方法

我们采用标准MR成像序列和矢状位脂肪抑制三维SPGR序列，对114例连续患者的膝关节透明软骨缺损情况进行评估。其中48例伴有半月板或韧带损伤或持续症状的患者随后接受了关节镜检查。然后由两名独立观察者以盲法对这48例患者的标准MR图像和SPGR图像进行回顾性分析，以确定关节缺损情况。针对不同成像技术测定敏感性、特异性以及观察者内和观察者间的一致性。

结果

接受关节镜检查的患者中有四分之一被发现存在孤立的透明软骨损伤，这些损伤在临床上易与半月板撕裂混淆，且在标准MR图像上被漏诊。对于每位阅片者，当综合观察所有表面时，SPGR成像序列在检测透明软骨缺损方面的敏感性显著高于标准MR成像序列（75% - 85% 对 29% - 38%，每次比较p <.001）。对于每位阅片者，当单独观察各个表面时，除滑车和胫骨外侧表面外，每个表面的敏感性均显示出显著差异。我们发现特异性无差异（97% 对 97%，p >.99）。我们还发现，标准MR图像和SPGR图像的联合评估未带来额外的诊断优势（敏感性86%；特异性97%；p >.42）。除胫骨外侧表面外，该研究在阅片之间以及阅片者之间均具有出色的可重复性。