Lee S H, Jacobson J, Trudell D, Resnick D
Department of Radiology, St. Joseph Hospital and Medical Center, Orange, CA, USA.
J Comput Assist Tomogr. 1998 Sep-Oct;22(5):807-13. doi: 10.1097/00004728-199809000-00027.
Our purpose was to define the normal MR arthrographic anatomy of ankle ligaments.
Prior to injection of intraarticular gadolinium in cadaveric ankle joints, proton density and T2-weighted images were obtained to assess the integrity of the ligaments and tendons as well as the amount of preexisting joint effusion. Following injection of 10 ml of contrast agent (gadopentetate dimeglumine 1:250, Omnipaqe 300, Knox gelatin 50%, and methylene blue), T1-weighted images with fat saturation in axial, oblique axial, coronal, and sagittal planes were obtained in neutral, dorsiflexion, and plantar flexion positions. Specimens were sectioned, allowing anatomic and MR correlation.
Contrast agent outlining anterior and posterior aspects of the anterior talofibular ligament and posterior talofibular ligament (PTAF) was a normal finding, related to anterior and posterior recesses of the ankle joint that extend out beyond these ligaments in an anteroposterior direction above the level of the ligaments. Intraarticular contrast material allowed resolution of superficial and deep components of the posterior tibiofibular ligament. Both were seen separately from PTAF with dorsiflexion. Posterior intermalleolar ligament was not present in our specimens. Visualization of calcaneofibular ligament was much improved by contrast material outlining the articular aspect of the ligament. Visualization of the syndesmotic ligamentous complex also was improved by contrast material outlining the articular side of the ligaments and separating them from adjacent bone. Superiorly, the distribution of contrast agent was limited by the interosseous ligament. Visualization of the medial collateral ligaments was not improved by the presence of the intraarticular contrast material.
MR arthrography of the ankle allows improved visualization and evaluation of the lateral and syndesmotic ligamentous complex.
我们的目的是明确踝关节韧带的正常磁共振关节造影解剖结构。
在尸体踝关节内注射关节内钆之前，获取质子密度和T2加权图像，以评估韧带和肌腱的完整性以及关节内预先存在的积液量。注射10毫升造影剂（钆喷酸葡胺1:250、欧乃影300、诺克斯明胶50%和亚甲蓝）后，在中立位、背屈位和跖屈位获取轴位、斜轴位、冠状位和矢状位的脂肪抑制T1加权图像。对标本进行切片，以便进行解剖学与磁共振成像的对照。
造影剂勾勒出距腓前韧带和后距腓韧带（PTAF）的前后方面是正常表现，这与踝关节的前后隐窝有关，这些隐窝在韧带水平上方沿前后方向延伸至韧带之外。关节内造影剂使胫腓后韧带的浅层和深层得以分辨。在背屈位时，两者均与PTAF分开显示。我们的标本中未发现后踝间韧带。造影剂勾勒出韧带的关节面，大大改善了跟腓韧带的显示。造影剂勾勒出韧带的关节侧并将其与相邻骨分开，也改善了下胫腓韧带复合体的显示。在上方，造影剂的分布受骨间韧带限制。关节内造影剂的存在并未改善内侧副韧带的显示。
踝关节磁共振关节造影可改善外侧和下胫腓韧带复合体的显示及评估。
