腕关节MRI影像诊断

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,*,腕关节MRI影像诊断,复旦大学华山医院 放射科,陈 爽,Artoscan,EMRI,ESAOTE,手腕关节EMRI线圈,standard,Phased array,手腕关节的参考序列,矢状面: SE T1W,冠状面: SE T1W, TME T2W, GE-STIR,横断面: TME T2W,Scan Thickness Slices TE TR FA,FOV,Matrix Excitation Time,SE 3.5 12 24 540 -,14,192x160 2 3.13,TME 3.5 12 90 2800 -,14,GE 3.5 12 17 540 75,14,GE3D 0.8 - 15 1050 -,14,192X160 2 4.58,补充序列,冠状面:,GE,冠状面: 3D-GE (mm),SE T1,GE,3D GE T1,High resolution,SE T1,460/26, 352X256,360/26, 256X192,3“58,2“21,腕关节的解剖,腕管的解剖,腕管的解剖,伸肌腱,拇伸短,拇长展,桡腕伸,拇长伸,伸肌腱,尺腕伸,指伸,腕骨间韧带,远端尺桡关节,腕关节内造影检查,(intra-articular contrast),病人和医生的观念,适应症,发展方向,腕关节内造影检查技术及问题,造影剂成分：GD-DTPA + 0.9% NaCl,造影剂量：5-7 ml,造影剂浓度：0.3%,穿刺部位: 拇长伸肌腱和指总伸肌腱之间,检查序列：SE T1W + GE,造影有关解剖,纤维三角软骨,造影有关解剖,纤维三角软骨复合体,T,riangular,f,ibro,c,artilage,c,omplex(,TFCC,),桡腕关节与尺桡关节分开,周边血供:,尺侧副韧带和掌背侧韧带血管, 中心无,组成:,远端桡尺骨韧带, 三角纤维软骨, 尺侧韧带, 掌尺 韧带.,功能:,稳定远端桡尺关节, 固定尺掌区域的稳定性及力量的传导.,腕关节内造影检查的临床应用,纤维三角软骨损伤,(TFCC),SE,GE,CASE 1,intra-articular contrast,SE,GE,intra-articular contrast,CASE 2,CASE 3,纤维三角软骨损伤,纤维三角软骨损伤,Palmer,TFCC,:,创伤和退变,创伤,:,A,中心穿孔;,B,尺侧撕脱;,C,远端撕脱;,D,桡侧撕脱;,E,整体损伤,退变,:,A,TFCC撕脱;,B,TFCC伴月或尺侧软骨软化(有或无尺骨远端骨折);,C,TFCC伴月或尺侧软骨软化(有或无桡骨乙状切迹骨折);,D,TFCC伴月或尺侧软骨软化, 月三角韧带穿孔;,E,TFCC伴月或尺侧软骨软化, 月三角韧带穿孔, 尺桡关节炎,.,手腕关节的疾病,炎症,外伤,肿瘤,炎 症,病因:,全身: 类风关,局部: 反复的微创伤,明确范围,腱滑膜炎和腱鞘炎,肿胀积液,腱鞘低信号,Fungus infection,Acute-Chronic infection,感染,Bone involved or not,手腕类风湿关节炎,MRI 检查的重要性,时间窗概念,临床意义,手腕类风湿关节炎检查序列选择,静脉增强前后T1W:,观察滑膜情况,平扫T2W,GE, STIR:,软组织肿胀,关节积液及骨侵蚀,手腕类风湿关节炎MRI表现,炎性充血,关节积液,滑膜增厚,伴发肌腱炎,囊性骨侵蚀,类风关,治疗前,SE T1,GE-STIR,治疗后一周,类风关,-C,+C,类风关,-C,+C,STIR,类风关,-C,+C,滑膜囊肿,-C,+C,肌肉撕裂,Conservative or surgical treatment?,韧带损伤,Ulnar collateral lig,韧带损伤,Surgery is need to repair for stability,骨关节损伤,hemorrhage,occult fracture,dislocation,腕骨无菌性坏死,舟,月骨常见,临床表现: 局部压痛, 僵硬,乏力,临床分期,月骨无菌性坏死临床分期,期,X线正常, 有时可见细小骨折线,期,骨密度增高, 无腕不稳定,A,加舟骨可复性半脱位,B,加舟骨不可复性半脱位,期,加弥漫性,退行性关节炎,无菌性坏死,Limits of T1W:,viable, necrosis, fibrosis, edema, hypermia,Viable(,edema,granulation,) not fibrosis or necrosis,Viable:,edema or granuloma,Lunate AVN,Less trauma than scaphoid,Dominant hand,Short ulna,+C,Viable and better prognosis,腕管综合征 (CTS),定义:,任何导致腕管体积缩小或病变使正中神经受压,导致其水肿及脱髓鞘, 造成分布范围内的感觉,运动麻痹.,腕管综合征MRI检查的意义,临床与肌电图不符,确定范围,肿瘤可能,术后症状继续存在,术中未发现病因,腕管综合征MRI表现,掌側环状韧带膨出,正中神经受压水肿,体积大, T2高信号,伴发表现: 腱鞘炎, 滑膜囊肿等,腕管综合征 (CTS),Narrowest level at hamate,腕管综合征,Inflammation:,thicken,腕管综合征,Mass,Ganglion cyst,Others:,lipoma, hemangioma,腕管综合征,Another reason:,Carpal instability caused by disruption of scaphoid-lunate lig,Tanks for your attention,