Willemsen U F, Wiedemann E, Brunner U, Scheck R, Pfluger T, Kueffer G, Hahn K
Department of Diagnostic Radiology, Klinikum Innenstadt, University of Munich, Germany.
AJR Am J Roentgenol. 1998 Jan;170(1):79-84. doi: 10.2214/ajr.170.1.9423604.
The purpose of this study was to evaluate the accuracy of high-volume saline-enhanced MR arthrography in assessing the labrum, the ligaments, and the bony components of the glenohumeral joint.
Forty-four patients with recurrent anterior dislocations of the shoulder underwent MR arthrography after intraarticular injection of 15-40 ml of saline solution. Two-dimensional fast low-angle shot and T1-weighted spin-echo sequences were prospectively evaluated by two observers. Anterior (Bankart) lesions, superior labral lesions extending from anterior to posterior, and Hill-Sachs lesions were diagnosed. Glenohumeral ligaments (GHLs) were identified and classified using a standard system. MR imaging results were compared with those of arthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard.
Bankart lesions and superior labral lesions extending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respectively. Diagnostic accuracy was 89% for both types of lesions. All six patients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging results and arthroscopy correlated in 25 of the 31 patients. In three patients all three GHLs were visible on MR imaging, but only two GHLs were detected with arthroscopy. In three patients two GHLs were detected on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%.
High-volume saline-enhanced MR arthrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint Saline solution is inert and inexpensive, two advantages over gadopentetate dimeglumine.
本研究旨在评估大容量生理盐水增强磁共振关节造影在评估盂肱关节的盂唇、韧带和骨成分方面的准确性。
44例复发性肩关节前脱位患者在关节腔内注射15 - 40 ml生理盐水后接受磁共振关节造影。两位观察者对二维快速低角度激发序列和T1加权自旋回波序列进行前瞻性评估。诊断前（Bankart）损伤、从前向后延伸的上盂唇损伤和希尔-萨克斯损伤。使用标准系统识别并分类盂肱韧带（GHLs）。将磁共振成像结果与关节镜检查（n = 32）或开放手术（n = 12）的结果进行比较，二者均作为金标准。
Bankart损伤和从前向后延伸的上盂唇损伤的检出灵敏度分别为93%和89%，特异度分别为80%和89%。两种损伤的诊断准确率均为89%。6例骨Bankart损伤患者在T1加权磁共振图像上碎片内均有高骨髓信号强度。对于GHLs，31例患者中有25例磁共振成像结果与关节镜检查结果相关。3例患者的所有三条GHLs在磁共振成像上均可见，但关节镜检查仅检测到两条GHLs。3例患者在磁共振成像上检测到两条GHLs，但关节镜检查三条均可见。希尔-萨克斯损伤的检出灵敏度为95%，特异度为50%，准确率为81%。
大容量生理盐水增强磁共振关节造影在显示盂肱关节的盂唇、韧带和骨成分方面是准确的。生理盐水是惰性的且价格低廉，这是相对于钆喷酸葡胺的两个优点。
