MR在关节疾患中的应用价值

单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,MR,在关节疾患中的应用价值,瑞金临床医学院,影像医学教研室,无,X,线辐射,可作任意切面的成像,成像参数多，所含信息量大,软组织分辨率高,可同时显示关节内的各种结构,MR,在骨关节检查中的优点,MR,诊断价值,MR,表现具有特征性,可以确立诊断:,外伤、退行性变、滑膜病变、肿瘤,MR,表现有一定特征性,可以帮助确立诊断:需结合其他检查,滑膜病变、肿瘤,MR,表现缺乏特征性，需依靠其他其他检查,滑膜病变、肿瘤,MR,表现具有特征性,关节损伤：半月板撕裂、韧带撕裂、肌腱损伤、,软骨缺损,（如果采用关节造影，其,准确率更高）,、骨挫伤,退行性变：,滑膜病变：绒毛结节滑膜炎、滑膜皱襞,肿 瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、,脂肪瘤,桶柄状撕裂,半月板囊肿,盘状半月板,前交叉韧带完全撕裂,后交叉韧带完全撕裂,双交叉韧带撕裂,内侧副韧带撕裂,内侧副韧带撕裂,外侧副韧带撕裂,内侧支持带撕裂,髌韧带撕裂,骨挫伤,MRI,和,CT,骨软骨骨折,半月板修补手术后,关节造影,半月板修补手术后,关节造影,肩袖完全撕裂,MR,平扫,肩袖完全撕裂,MR,造影,上盂唇撕裂肩袖（冈上肌肌腱）部分撕裂,上盂唇撕裂,肩袖部分撕裂,上盂唇撕裂,上盂唇撕裂,前盂唇撕裂,前盂唇撕裂,前盂唇撕裂,软骨缺损,肱骨头软骨缺损,肱骨头软骨缺损,跟腱撕裂,男,12岁,右髋关节痛6月,X,线,vs,MR,对显示骨质侵蚀的比较,正常关节软骨,Normal,Articular,Cartilage,T,2,W,T,1,W,软骨表面光整，,信号均一,SPIR/FFE,MIP/3D,正常关节软骨,Normal,Articular,Cartilage,层次模糊消失表面毛糙,类风关软骨表现,Rheumatoid arthritis,Coarse,chondral,surface,小囊状缺损,Cystiform,defect,弥漫性变薄,Diffuse thinning,局部全层丢失,Focal loss,类风关软骨表现,Rheumatoid arthritis,髌,骨关节软骨,局部全层缺失,关节软骨三维重建图像直观显示缺失区域,T,1,/SPIR/3D/FFE,血管翳侵入边缘部骨质,Pannus,involving bone,骨质囊变,T,1,WC+,T,1,W,T,2,W,Cyst of Bone,T,1,W、T,2,W,和,GE-T,1,W,显示髌骨和股骨髁的软骨厚度变薄，软骨下骨增生硬化，髌上囊积液,关节退 变,Articular,Degeneration,ACL,破坏消失,ACL,滑膜增生包绕,Synovial proliferation,Destruction of ACL,Normal ACL,正常,ACL,腘窝囊肿形成,Popliteal,Fossa,Cyst,T,1,W,T,2,W,皮下结节形成,subcutaneous nodule,T,1,/SPIR/3D/FFE,T,1,WC+,T,1,W,T,2,W,绒毛结节性滑膜炎,膝关节绒毛结节性关节炎,Pigment,Villonodular,Synovitis,T,2,W,T,1,W,STIR,踝关节绒毛结节性滑膜炎,Pigment,Villonodular,Synovitis,T,1,W,STIR,血友病性关节炎,Hemophilia arthritis,腕关节类风湿关节炎,Rheumatoid arthritis of wrist,其他关节炎,MR,表现,神经性关节炎,X,线示关节面的不规则缺损,Neuroarthritis,X plain film demonstrates,articular,surface irregular defect,脊髓空洞症,Neuroarthritis,syringomyelia,神经性关节炎,T,2,W,神经性关节炎撕脱的软骨片,Neuroarthritis,结核性关节炎,Tuberculosis Arthritis,膝关节痛风,Podagra,of Knee,滑膜软骨瘤病,Synovial,Chondromatosis,化脓性关节炎,Suppuration arthritis,T,1,W,STIR,类风湿性关节炎表现,Rheumatoid arthritis,Tarsal Sinus:,Arthrographic,MR,Imaging,MR,Arthrographic,Schematic drawings of the tarsal sinus,ligamentous,system, seen in an overhead view and a coronal view, and of the,calcaneus,show the course and attachment sites of the cervical ligament (,1,); the,interosseous,talocalcaneal,ligament (,3,); and the medial (,2,), intermediate (,4,), and lateral (,5,) roots of the inferior extensor,retinaculum,.,AF,= anterior facet,MF,= medial facet,PF,= posterior facet.,Coronal,(a),T1-weighted (600/11) and,(b),T2-weighted (2,000/80),MR,arthrograms,of a specimen from a male cadaver (age at death, 87 years) show irregular thickening of the cervical ligament (arrow).,(c),Sagittal,T1-weighted,MR,arthrogram,(600/11) and,(d),reconstructed,MR,arthrogram,perpendicular to the course of the cervical ligament show a partial tear (arrow).,(e),The partial tear (arrow) was confirmed on the anatomic section.,Internal Derangement of the Wrist: Indirect,MR,Arthrography,versus Unenhanced,MR,Imaging,1,Images in two different patients with a normal central disk of the TFCC.,(a),Coronal three-dimensional gradient-echo indirect,MR,arthrogram,(46/15, 45 flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows).,(b),Unenhanced coronal three-dimensional gradient-echo,MR,image (58/12, 10 flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).,triangular,fibrocartilage,complex (TFCC),Images in two different patients with a normal central disk of the TFCC.,(a),Coronal three-dimensional gradient-echo indirect,MR,arthrogram,(46/15, 45 flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the central disk of the TFCC (arrows).,(b),Unenhanced,coronal three-dimensional gradient-echo,MR,image (58/12, 10 flip angle) in a 21-year-old woman demonstrates a normal low-signal-intensity central disk of the TFCC (arrows).,Images in two different patients with tears of the central disk of the TFCC.,(a),Coronal three-dimensional gradient-echo indirect,MR,arthrogram,(46/15, 45 flip angle) in a 42-year-old man illustrates absence of the central disk of the TFCC (black arrows), which is consistent with a large central tear. There is also abnormal marrow signal intensity (white arrows) in the,ulnar,side of the,lunate, which is consistent with,ulnar,impaction syndrome.,(b),Unenhanced,coronal three-dimensional gradient-echo,MR,image (58/12, 10 flip angle) in a 23-year-old woman demonstrates abnormal high signal intensity extending through the central disk of the TFCC (arrows).,Images in two different patients with normal,scapholunate,ligaments.,(a),Coronal three-dimensional gradient-echo indirect,MR,arthrogram,(46/15, 45 flip angle) in a 30-year-old woman illustrates a normal low-signal-intensity appearance of the,scapholunate,ligament (arrows).,(b),Unenhanced,coronal three-dimensional gradient-echo,MR,image (58/12, 10 flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity,scapholunate,ligament (arrows).,5,a.,Images in two different patients with torn,scapholunate,ligaments.,(a),Coronal T1-weighted fat-suppressed indirect,MR,arthrogram,(500/14) in a 53-year-old woman demonstrates fluid signal intensity (arrows) between the,scaphoid,and the,lunate,.,(b),Unenhanced,coronal three-dimensional gradient-echo,MR,image (58/12, 10 flip angle) in a 46-year-old man demonstrates abnormal high signal intensity tracking through the,scapholunate,ligament (arrows).,Abnormal,ulnar,collateral ligament.,E,= medial,epicondyle,F,= common flexor tendon,U,= ulna.,(a),Longitudinal US image of the,ulnar,collateral ligament shows focal,hypoechoic,disruption (arrow) of ligament fibers with relatively normal ligament seen distally (arrowheads).,(b),Coronal T1-weighted spin-echo,MR,image (700/14) and,(c),coronal anatomic slice obtained after,intraarticular,administration of contrast material show abnormal contrast material extension (arrow) into the proximal aspect of the,ulnar,collateral ligament (arrowhead).,Chronic Adult Hip Pain,Evaluation of the patient with chronic mechanical hip pain has,remained a diagnostic dilemma for physicians. The differential,diagnosis is diverse including common entities such as osteoarthritis,fracture, and,avascular,necrosis, as well as less common entities,including pigmented,villonodular,synovitis,synovial,osteochondromatosis,snapping hip syndrome, and hemorrhage into the,ligamentum,teres,(,1,2,). Similar to findings in the knee and shoulder, radiographs,appear normal in the vast majority of patients with internal,derangement as a cause for hip symptoms (,2,). In one study,labral,lesions were identified at arthroscopy in 55% of patients with,intractable hip pain (,2,). Owing to the previous lack of a reliable,imaging examination, diagnosis was often delayed. In another,study, patients averaged 25 months of symptoms before the cause,was established (,3,).,Normal anatomy in a 43-year-old man with chronic hip pain is depicted on T1-weighted (repetition time,msec,/echo time,msec,=600/17),MR,images obtained with,intraarticular,contrast material.,(a),Axial,MR,image demonstrates the normal triangular cross section of the anterior and posterior labrum (arrowheads), small,perilabral,sulci,(short arrows), and cross section of,ligamentum,teres,(long arrow).,(b),Sagittal,MR,image along the medial joint includes the transverse ligament (arrowheads).,(c),Midline coronal,MR,image shows the long axis of the,ligamentum,teres,(short arrow) and its insertion onto the transverse ligament (long arrow). A normal superior labrum (curved arrow) and the larger superior,perilabral,recess (arrowhead) are seen.,(d),On a more posterior coronal,MR,image, the circular fibers of the,zona,orbicularis,(arrowheads) are evident, as are the longitudinal fibers of the,iliofemoral,ligament (short arrow). A cleft is seen where the transverse ligament and labrum start to merge (long arrow).,Normal anatomy in a 43-year-old man with chronic hip pain is depicted on T1-weighted (repetition time,msec,/echo time,msec,=600/17),MR,images obtained with,intraarticular,contrast material.,(a),Axial,MR,image demonstrates the normal triangular cross section of the anterior and posterior labrum (arrowheads), small,perilabral,sulci,(short arrows), and cross section of,ligamentum,teres,(long arrow).,(b),Sagittal,MR,image along the medial joint includes the transverse ligament (arrowheads).,(c),Midline coronal,MR,image shows the long axis of the,ligamentum,teres,(short arrow) and its insertion onto the transverse ligament (long arrow). A normal superior labrum (curved arrow) and the larger superior,perilabral,recess (arrowhead) are seen.,(d),On a more posterior coronal,MR,image, the circular fibers of the,zona,orbicularis,(arrowheads) are evident, as are the longitudinal fibers of the,iliofemoral,ligament (short arrow). A cleft is seen where the transverse ligament and labrum start to merge (long arrow).,Extensive,labral,tear in a 38-year-old woman who is an avid runner. T1-weighted (600/17) axial,MR,image depicts contrast material throughout the,labral,substance. The labrum is enlarged and maintains its triangular shape (arrowheads). An extensive linear,intralabral,collection of contrast material is present (short arrow). Communication between the joint and the,iliopsoas,bursa is evident (long arrow).,Bucket handle,labral,detachment in a 17-year-old girl with developmental,dysplasia,whose pain was out of proportion to radiographic changes.,(a),T1-weighted (450/17) coronal,MR,image obtained with,intraarticular,contrast material demonstrates contrast material interposed along the entire superior,acetabular-labral,interface (arrowheads).,(b),Fat-suppressed T1-weighted (980/14),sagittal,MR,image obtained with,intraarticular,contrast material shows that the detachment involves the anterior and,anterosuperior,labrum (arrowheads).,MR,Imaging of the,Metacarpophalangeal,Joints of the Fingers,Although uncommon, injuries of the,metacarpophalangeal,(MCP),joints of the fingers necessitate accurate diagnosis, because,the loss of function of even one MCP joint can seriously impair,overall hand function (,1,). To ensure appropriate treatment,the identification of the damaged structures at the time of,injury is essential. Advances in magnetic resonance (,MR,) imaging,technology that improve spatial resolution enable the visualization,of important intra- and,periarticular,structures, even in small,joints such as the MCP joints, with standard clinical equipment.,Detailed knowledge of the normal anatomy remains essential to,the analysis of,MR,images of this area.,Drawing illustrates transverse view of the main structures of the MCP joint after removal of the metacarpal head.,Drawing of the extensor hood. The,sagittal,bands are located above the joint line, and the transverse fibers of the,lumbrical,and,interosseous,tendons are more distal, over the proximal phalanx.,Sagittal,MR,arthrograms,of the MCP joint of the third finger in extension, with anatomic correlation.,(a),T1-weighted spin-echo,MR,arthrogram,(500/12) and,(b),corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule.,(c),T1-weighted spin-echo,MR,arthrogram,(500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.,Sagittal,MR,arthrograms,of the MCP joint of the third finger in extension, with anatomic correlation.,(a),T1-weighted spin-echo,MR,arthrogram,(500/12) and,(b),corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule.,(c),T1-weighted spin-echo,MR,arthrogram,(500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.,Sagittal,MR,arthrograms,of the MCP joint of the third finger in extension, with anatomic correlation.,(a),T1-weighted spin-echo,MR,arthrogram,(500/12) and,(b),corresponding anatomic section show the PP (curved arrow), distal recess of the PP (short solid arrow), and loose proximal recess (arrowheads). A bare area (open arrow) can be seen between the cartilage (long straight arrows) and the dorsal insertion of the capsule.,(c),T1-weighted spin-echo,MR,arthrogram,(500/12) of the MCP of the third finger in flexion shows that the PP is angled, the distal recess (white arrow) is compressed, and the flexor tendons (black arrow) are applied to the surface of the bone.,Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo,(a),conventional,MR,image (500/12) and,(b),MR,arthrogram,(500/12) and,(c),the corresponding anatomic specimen show the proximal (black arrowheads in,a,and,b,) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The,interosseous,tendons (white arrowheads) are well demonstrated. Note the,intermetacarpophalangeal,spaces (curved arrows in,c,) between the main collateral ligaments and the,interosseous,tendons.,Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo,(a),conventional,MR,image (500/12) and,(b),MR,arthrogram,(500/12) and,(c),the corresponding anatomic specimen show the proximal (black arrowheads in,a,and,b,) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The,interosseous,tendons (white arrowheads) are well demonstrated. Note the,intermetacarpophalangeal,spaces (curved arrows in,c,) between the main collateral ligaments and the,interosseous,tendons.,Coronal views of the MCP joints of the second and third fingers in extension, with anatomic correlation. T1-weighted spin-echo,(a),conventional,MR,image (500/12) and,(b),MR,arthrogram,(500/12) and,(c),the corresponding anatomic specimen show the proximal (black arrowheads in,a,and,b,) and distal (straight arrows) attachments of the main collateral ligament. Note the heterogeneous signal intensity of the main collateral ligaments. The,interosseous,tendons (white arrowheads) are well demonstrated. Note the,intermetacarpophalangeal,spaces (curved arrows in,c,) between the main collateral ligaments and the,interosseous,tendons.,谢 谢,