论文标题:膝关节软骨早期退变的MRI及临床应用研究
Clinical Study on MRI of the Early Degeneration of the Knee Articular Cartilage in Osteoarthritis
论文作者 李俊峰
论文导师 王峻,论文学位 硕士,论文专业 影像医学与核医学
论文单位 山西医科大学,点击次数 171,论文页数 32页File Size5830k
2004-04-01论文网 http://www.lw23.com/lunwen_45777582/ 关节软骨;早期退变;MRI;关节镜
Articular cartilage;Osteoarthritis;Early degeneration; MRI; Arthroscopy
目的?探索骨性关节炎(Osteoarthritis,OA)时关节软骨早期退变的MRI诊断及临床应用价值。方法 搜集符合1995年美国风湿病协会诊断标准的OA患者68例共69个关节,其中40例41个关节有关节镜对照,男24例,女16例,行关节镜术前均行MRI检查,并作对比分析; 28例无关节镜对照,男15例,女13例。所有患者均行临床症状调查问卷积分和MRI检查,并作对比分析。选10例无膝关节症状的志愿者对照, 均行临床症状调查问卷积分和MRI检查。MR扫描采用SE T1WI、GE T2WI和STIR 序列行矢状面扫描,GE T1WI 序列行冠状面扫描,高分辨 GE T2WI 序列行横断面扫描。结果 40例符合1995年美国风湿病协会诊断标准的OA患者41个关节共246个关节软骨面,以关节镜检查结果为金标准作四格表,MRI诊断关节软骨病损的灵敏度为96.55%,特异度为88.05%, 约登指数( Youden Index)为0.856,接近于1,说明诊断正确率高。关节软骨退变MRI分级Ⅰ、Ⅱ级组与Ⅲ、Ⅳ组的临床症状调查问卷积分比较有统计学差异(P〈0.05)。关节软骨退变MRI分级Ⅰ、Ⅱ级组与Ⅲ、Ⅳ组的关节积液、软骨下小囊肿、软骨下骨硬化的比较,P值分别为0.000、0.000、0.000,都小于0.01,有统计学差异。结论 MRI可早期、准确评价关节软骨病变,与关节镜结合有极高的正确诊断价值。关节软骨退变的MRI分级有助于弥补早期OA关节镜诊断的不足,对OA患者早期及时的治疗有明显的临床意义和卫生经济学意义。
Objective To investigate the role of MR imaging in the diagnosis and clinical application of early articular cartilage degeneration with knee osteoarthritis.Methods 40 patients,fulfilled 1995 American Rheumation Association(ARA) criteria,underwent MR scanning before arthroscopy operation.Another 28 patient with OA symptom`s were recruited.These patients underwent MR examination and clinical symptom`s questionair score(including the Western Ontario and Mcmaster University Osteoarthritis Index and Knee Outcome Survey Activities of Daily Living Scale).10 healthy voulenteer entered the study.T1-weighted spin echo,T2-weighted gradient echo,short time inversion recovery(STIR) sequence were perfermed in the saggital planes.T1-weighted geadient echo sequence was performed in the coronal plane.T2-weighted High resolution gradient sequence was performed in the transverse plane.Results With arthroscopic result as golden standard,the sensitivity and specifity of MRI in articular cartilage defect were 96.55% and 88.05%,respectively.The Youden Index was 0.856,closed to 1,the accuracy is high.There are significant difference in the Western Ontario and Mcmaster University Osteoarthritis Index,Knee Outcome Surcey Activities of Daily Living Scale,joint effusion,under-cartilage cyst and bone sclerosis(p<0.05).Conclusion MRI can early display the abnormality of articular cartilage,it has extraordinary use combined with arthroscopy.The MRI grade of articular cartilage degeneration is useful to compensate arthroscopic inadequacy .
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