肩關(guān)節(jié)磁共振診斷

1、整理ppt1肩關(guān)節(jié)磁共振診斷肩關(guān)節(jié)磁共振診斷整理ppt2肩關(guān)節(jié)磁共振診斷 骨性出口與肩峰 肩袖 關(guān)節(jié)囊和盂唇 骨性結(jié)構(gòu)和關(guān)節(jié)面 肱二頭肌 其他整理ppt3MR掃描技術(shù)-T1 and T2 FS-斜冠狀面-T1 and T2 FS-斜矢狀面 -T2 FS and GRE-橫斷面整理ppt4骨性出口和肩峰 骨性弓狀結(jié)構(gòu)包圍肩袖肌腱 機(jī)械性碰撞導(dǎo)致肩袖肌腱退變 前肩峰是導(dǎo)致肩袖碰撞最重要的結(jié)構(gòu)Anterior Acromion Most Important Structure Leading to Impingement 整理ppt5整理ppt6整理ppt7正常骨性出口正常骨性出口前前 后后喙突鎖骨

2、肩峰整理ppt8肩峰形態(tài)Type I整理ppt9肩峰形態(tài)Type II整理ppt10肩峰形態(tài)Type III整理ppt11肩峰下傾正常肩峰軸位形態(tài)肩峰前下傾表現(xiàn)斜矢狀面上觀察肩峰軸位形態(tài)整理ppt12肩峰下傾在冠狀面上觀察肩峰向外側(cè)的下傾表現(xiàn)正常肩峰軸位表現(xiàn)外側(cè)下傾整理ppt13骨性肩峰發(fā)育骨性肩峰發(fā)育骨化中心常在骨化中心常在22-25歲閉合歲閉合軸位像前肩峰正常表現(xiàn)整理ppt14骨性肩峰發(fā)育異常（軸位）骨性肩峰發(fā)育異常（軸位）肩峰發(fā)育異?？赡茉斐刹环€(wěn)定，并導(dǎo)致三角肌收縮過(guò)程中肩肩峰發(fā)育異?？赡茉斐刹环€(wěn)定，并導(dǎo)致三角肌收縮過(guò)程中肩峰與肩袖碰撞峰與肩袖碰撞整理ppt15骨性肩峰發(fā)育（矢狀面）骨性

3、肩峰發(fā)育（矢狀面）肩胛小骨骨贅形成肩胛小骨整理ppt16骨性肩峰骨性肩峰肩鎖關(guān)節(jié)肩峰“雙肩鎖關(guān)節(jié)”征整理ppt17肩峰骨贅形成肩峰骨贅形成-骨贅-內(nèi)有骨髓信號(hào)-三角肌腱（類似骨贅表現(xiàn)）-低信號(hào)（內(nèi)無(wú)骨髓信號(hào)）整理ppt18肩肩 峰峰 形態(tài)分型（I，II，III） 前/外側(cè)下傾型肩峰 下緣骨贅形成整理ppt19肩鎖關(guān)節(jié)肩鎖關(guān)節(jié)-退變，關(guān)節(jié)囊增厚-較少引起肩袖卡壓整理ppt20喙肩關(guān)節(jié)喙肩關(guān)節(jié)-正常喙肩韌帶厚度3 mm-韌帶增厚可導(dǎo)致前肩袖碰撞整理ppt21喙突碰撞喙突碰撞-正常喙肱距離為 11 mm-喙肱間距狹窄可導(dǎo)致肩胛下區(qū)域碰撞整理ppt22骨性出口和肩峰骨性出口和肩峰 肩峰 形態(tài)分類，下傾

4、型肩峰，骨贅，肩峰發(fā)育異常 肩鎖關(guān)節(jié) 退變，關(guān)節(jié)囊肥厚(是否存在團(tuán)塊樣表現(xiàn)？) 喙肩韌帶(是否增厚?) 喙肱間距 (肩胛下區(qū)是否有碰撞?)整理ppt23肩肩 袖袖肩胛下肌肩胛下肌; 岡上肌岡上肌 岡下肌岡下肌; 小圓肌小圓肌; 整理ppt24肩袖（矢狀面）肩袖（矢狀面）岡上肌， 岡下肌，小圓肌，肩胛下肌整理ppt25肩袖（矢狀面）肩袖（矢狀面）岡上肌， 岡下肌，小圓肌，肩胛下肌整理ppt26肩袖（矢狀面）肩袖（矢狀面）覆蓋肱骨頭的連續(xù)低信號(hào)表現(xiàn)整理ppt27肩袖（軸位）肩袖（軸位）岡上肌腱整理ppt28肩袖（軸位）肩袖（軸位）Rotator Cuff (Axial Plane)-評(píng)價(jià)肩胛下肌的

5、最好平面Primary Plane for Evaluating Subscapularis岡下肌位于肩胛下肌對(duì)應(yīng)的關(guān)節(jié)后側(cè)區(qū)域-Infraspinatus Located Posteriorly整理ppt29肩袖（冠狀面）肩袖（冠狀面）Rotator Cuff (Coronal)評(píng)估岡上肌腱的最佳層面評(píng)估岡上肌腱的最佳層面肌肉肌腱連接部位于12點(diǎn)方向整理ppt30肩袖（冠狀面）肩袖（冠狀面）岡下肌腱位置偏后斜行走向肩胛下肌位置偏前多根肌腱組成整理ppt31肩袖病變肩袖病變 Tendonopathy肌腱病變 Tear撕裂 Partial Thickness, Full Thickness, C

6、omplete 部分撕裂，全層撕裂，完全撕裂 Musculotendinous Retraction肌肉肌腱回縮 Fatty Atrophy脂肪肥厚 HADD/ Calcific Tendonitis鈣化性肌腱炎整理ppt32肌腱病變-Increased T1-signal; Thick tendonT1W信號(hào)增高，肌腱增厚-Intermediate T2-signal (No Fluid Signal)T2W中等信號(hào)，無(wú)液體信號(hào)整理ppt33關(guān)節(jié)囊部分撕裂（關(guān)節(jié)面）關(guān)節(jié)囊部分撕裂（關(guān)節(jié)面）Partial Thickness Tear (Articular)Extensive Intermed

7、iate T1-SignalT1W延續(xù)性中等信號(hào)表現(xiàn)T2: Fluid Signal T2：出現(xiàn)液性信號(hào) Partial Thickness 部分撕裂Undersurface Tear肌腱表面下撕裂整理ppt34部分撕裂（關(guān)節(jié)囊面）部分撕裂（關(guān)節(jié)囊面）Partial Thickness Tear (Bursal)-Fluid Signal Extending into the Bursal Surface of the Supraspinatus Tendon 液性信號(hào)延伸至岡上肌腱關(guān)節(jié)囊面表面整理ppt35肩袖部分撕裂（肌腱內(nèi)型）肩袖部分撕裂（肌腱內(nèi)型） Partial Thickness

8、Tear (Interstitial)-Fluid Signal within the Substance of the Tendon液性信號(hào)存在于肌腱內(nèi)-Does Not Touch the Surface不影響到肌腱表面整理ppt36肩袖肌間囊腫肩袖肌間囊腫Intramuscular Cyst Rotator Cuff-High Association with與以下因素有關(guān)P.T. Undersurface Tear創(chuàng)傷性表層下撕裂2. Small F.T. Tear小的全層撕裂3. DDX: Paralabral Cyst鑒別診斷：盂唇旁囊腫整理ppt37肌間囊腫肌間囊腫 Intram

9、uscular Cyst Rotator CuffIntramuscular Cyst Supraspinatus岡上肌肌間囊腫Small Undersurface P.T. Tear小的創(chuàng)傷后撕裂整理ppt38全層撕裂全層撕裂 Full Thickness Tear-Fluid extends through the entire thickness of the tendon (top - bottom)液性信號(hào)延伸至肌腱全層（從頂部到底部）-Mild retraction of musculotendinous junction肌肉肌腱連接部輕度回縮整理ppt39-Fluid Signa

10、l within SST岡上肌腱內(nèi)出現(xiàn)液性信號(hào)-Sag Image: Fluid from Top to Bottom矢狀面：液性信號(hào)從頂層到底層全層撕裂全層撕裂 Full Thickness Tear整理ppt40-Gad Arthrogram: Demonstrates Full Thickness Tear-肩關(guān)節(jié)造影：顯示全層撕裂T1T2全層撕裂全層撕裂 Full Thickness Tear整理ppt41-Intermediate T1-Signal-T1W中等信號(hào)-Musculotendinous Retraction-肌肉肌腱回縮-Fluid Signal on T2-T2W出現(xiàn)

11、液性信號(hào)-Full thickness Tear-全層撕裂全層撕裂全層撕裂 Full Thickness Tear整理ppt42完全撕裂完全撕裂 Complete Tear特征：肌肉肌腱回縮特征：肌肉肌腱回縮 Musculotendinous retraction-Greater than 3 cm retraction- poor prognosis for repair-肌肉肌腱出現(xiàn)超過(guò)3cm的回縮-預(yù)后不佳整理ppt43脂肪增厚脂肪增厚 Fatty Atrophy-Grade as Mild, Moderate, Severe-分為輕度，中度和重度-Streaks of High Sig

12、nal on T1 -T1W出現(xiàn)高信號(hào)改變整理ppt44-Normal muscle bulk-正常岡上肌-Fatty Atrophy: Does not fill supraspinatus fossa-脂肪增厚：肌肉信號(hào)未充填岡上肌窩脂肪增厚脂肪增厚 Fatty Atrophy整理ppt45鈣化性肌腱炎鈣化性肌腱炎 Calcific Tendonitis-Dark Globular Area on all Pulse Sequences-在所有的脈沖序列上均為低信號(hào)-Blooming Artifact on Gradient Echo Images-GE圖像上可出現(xiàn)偽影整理ppt46肩袖病

13、變肩袖病變Rotator Cuff PathologyRotator Cuff Pathology Tendonopathy 肌腱病變 Tear 撕裂 Partial Thickness, Full Thickness, Complete 部分撕裂，全層撕裂，完全撕裂 Musculotendinous Retraction肌肉肌腱回縮 Fatty Atrophy 脂肪增厚 Calcific Tendonitis 鈣化性肌腱炎整理ppt47關(guān)節(jié)囊結(jié)構(gòu)和盂唇關(guān)節(jié)囊結(jié)構(gòu)和盂唇Capsular Structures and LabrumCapsular Structures and Labrum Pa

14、tient under 35 y. o. with GH Instability or Unexplained Shoulder Pain35歲以下患者出現(xiàn)肩關(guān)節(jié)不穩(wěn)定或無(wú)法解釋的肩部疼痛 MR Arthrography 適合進(jìn)行MR關(guān)節(jié)造影 Labral Lesions Common 盂唇病變較為常見(jiàn) Subtle Lesions (nondisplaced, resynovialized) -Distention Effects of Contrast小病變（未移位，滑膜化）-對(duì)比劑的遮蔽效應(yīng)整理ppt48Bankart病變病變 Bankart Lesion-Conventional MR

15、I: Loss of Normal Morphology of Anterior Labrum-常規(guī)MR：前盂唇正常形態(tài)消失整理ppt49-Subtle Lesions Best Demonstrated on MR Arthrography-MR肩關(guān)節(jié)造影能更好的顯示盂唇微小病變Bankart病變病變 Bankart Lesion整理ppt50Hill Sach病變病變Hill Sachs Lesion Top 3 Axial Images Through Humeral Head Should Be Round正常：肱骨頭軸位像最上面3幅圖像應(yīng)為圓形 Flattening or Conve

16、xity on Top 3 Images最上面3幅圖像扁平或不規(guī)則表現(xiàn) Posterior Humeral Sulcus: Can Mimic A Hill Sachs后肱骨凹：易與Hill Sachs病變混淆整理ppt51SLAP病病 SLAP Tears Superior Labrum is Dark on Pulse Sequences in Coronal Plane冠狀面脈沖序列顯示上盂唇出現(xiàn)低信號(hào)表現(xiàn)冠狀面脈沖序列顯示上盂唇出現(xiàn)低信號(hào)表現(xiàn) Any Signal in Triangle of Superior Labrum = SLAPSLAP病變：上盂唇在任何序列上出現(xiàn)三角形異常信

17、號(hào)病變：上盂唇在任何序列上出現(xiàn)三角形異常信號(hào) MR Arthrography Improves SensitivityMR關(guān)節(jié)造影提升了診斷敏感度關(guān)節(jié)造影提升了診斷敏感度整理ppt52肩關(guān)節(jié)表面和骨性結(jié)構(gòu)肩關(guān)節(jié)表面和骨性結(jié)構(gòu)Osseous Structures and Articular SurfacesOsseous Structures and Articular Surfaces Hematopoietic Bone Marrow Hematopoietic Bone Marrow 局部紅骨髓變局部紅骨髓變 Subcortical Cystic ChangeSubcortical Cys

18、tic Change皮質(zhì)下囊變皮質(zhì)下囊變 Trauma (Fracture)Trauma (Fracture)創(chuàng)傷（骨折）創(chuàng)傷（骨折） Arthritis Arthritis 關(guān)節(jié)炎關(guān)節(jié)炎 Infection Infection 感染感染 Tumor Tumor 腫瘤腫瘤整理ppt53紅骨髓變紅骨髓變 Hematopoietic Marrow-Humeral epiphysis: Only Epiphysis that Normally contains Hematopoietic Marrow肱骨紅骨髓變：正常情況下僅骨骺保留紅骨髓-Females; Curvilinear; Subcort

19、ical Distribution; Bilateral女性多見(jiàn)；弧形表現(xiàn)；皮質(zhì)下分布；雙側(cè)整理ppt54皮質(zhì)下囊變皮質(zhì)下囊變 Subcortical Cystic Change-Commonly Seen Near SST Insertion Site岡上肌附著處最為常見(jiàn)-Mimic Hill Sachs與Hill Sach病易混淆整理ppt55創(chuàng)傷創(chuàng)傷 Trauma-24 y.o. Female: Persistent Painful Shoulder After Skiing Accident女性，女性，24歲，滑雪事故后持續(xù)性肩關(guān)節(jié)疼痛歲，滑雪事故后持續(xù)性肩關(guān)節(jié)疼痛整理ppt56肱骨頭

20、無(wú)菌性壞死肱骨頭無(wú)菌性壞死 AVNT1T2“Double Line” Sign- Seen On T2 Images雙線征整理ppt57非特異性骨髓信號(hào)異常非特異性骨髓信號(hào)異常Nonspecific Marrow Signal-DDX: Infection, Tumor, Trauma鑒別診斷：感染，腫瘤，創(chuàng)傷-T1 Image: Use Muscle as Internal StandardT1加權(quán)：肌肉作為對(duì)照-T1 Signal Darker than Muscle: Pathologic異常信號(hào)：T1加權(quán)像上病灶信號(hào)低于肌肉整理ppt58腫瘤腫瘤 Tumor-Osteosarcoma

21、Proximal Humerus 肱骨近端骨肉瘤-Mass with Cortical Destruction 皮質(zhì)破壞合并軟組織腫塊形成-Low Signal T1; High Signal T2 Images整理ppt59關(guān)節(jié)軟骨關(guān)節(jié)軟骨 Articular Cartilage-Normal Cartilage 正常軟骨-Intermediate Signal 中等信號(hào)-Smooth 表面平整-Articular Cartilage Defect軟骨缺損-Gap: Fills With Contrast關(guān)節(jié)造影：顯示軟骨裂隙整理ppt60肱二頭肌病變肱二頭肌病變Biceps TendonB

22、iceps Tendon Tendonitis 肌腱炎 Tear 肌腱撕裂 Dislocation 脫位 Intra-articular 關(guān)節(jié)內(nèi)脫位 Extra-articular 關(guān)節(jié)外脫位整理ppt61肱二頭肌病變肱二頭肌病變Biceps TendonBiceps Tendon整理ppt62肱二頭肌病變肱二頭肌病變Biceps TendonBiceps Tendon整理ppt63-Extra-articular Biceps: Best Seen on Axial Image關(guān)節(jié)外肱二頭肌腱：軸位顯示最佳關(guān)節(jié)外肱二頭肌腱：軸位顯示最佳-In Bicipital Groove; Transv

23、erse Ligament肌腱位于二頭肌溝內(nèi)，外有橫韌帶保護(hù)肌腱位于二頭肌溝內(nèi)，外有橫韌帶保護(hù)肱二頭肌病變肱二頭肌病變Biceps TendonBiceps Tendon整理ppt64肱二頭肌腱脫位肱二頭肌腱脫位Biceps Tendon Dislocation-Extra-articular: Transverse Ligament Torn; Subscapularis Intact關(guān)節(jié)外脫位：橫韌帶撕裂；肩胛下肌完整-Intra-articular: Subscapularis Torn or Avulsed關(guān)節(jié)內(nèi)脫位：肩胛下肌撕裂或撕脫整理ppt65-Biceps Tendon Int

24、ra-articular Dislocation:肌腱關(guān)節(jié)內(nèi)脫位： Subscapularis Tendon Avulsed肩胛下肌腱撕脫肱二頭肌腱脫位肱二頭肌腱脫位Biceps Tendon Dislocation整理ppt66肱二頭肌腱脫位肱二頭肌腱脫位Biceps Tendon Dislocation整理ppt67肱二頭肌腱炎肱二頭肌腱炎/撕裂撕裂Biceps Tendonitis/ Tear-Thick Tendon; Increased Signal肌腱增厚；信號(hào)增加-Longitudinal Splits縱向撕裂整理ppt68盂唇旁囊腫盂唇旁囊腫Paralabral Cyst Hi

25、gh Association with Labral Tears and GH Instability 與盂唇撕裂和盂肱關(guān)節(jié)不穩(wěn)定密與盂唇撕裂和盂肱關(guān)節(jié)不穩(wěn)定密切相關(guān)切相關(guān) Analogous to Meniscal Cysts of the Knee 類似于膝關(guān)節(jié)半月板囊腫類似于膝關(guān)節(jié)半月板囊腫T2 Images- Multi-lobulated Fluid Collections T2加權(quán)像加權(quán)像-多房液性信號(hào)多房液性信號(hào)Location: Posterior, Superior, Inferior 部位：盂唇后，上，下部部位：盂唇后，上，下部Can Cause Neurovascular

26、 Entrapment 可導(dǎo)致神經(jīng)血管卡壓可導(dǎo)致神經(jīng)血管卡壓整理ppt69肩胛上神經(jīng)卡壓肩胛上神經(jīng)卡壓Suprascapular Nerve Entrapment-Suprascapular Notch肩胛上切跡肩胛上切跡-Denervation of Supra- and Infraspinatus Muscles岡上肌和岡下肌去神經(jīng)化岡上肌和岡下肌去神經(jīng)化-Spinoglenoid Notch岡盂切跡岡盂切跡-Denervation of Infraspinatus Muscle岡下肌去神經(jīng)化岡下肌去神經(jīng)化整理ppt70岡上肌岡上肌/岡下肌去神經(jīng)化岡下肌去神經(jīng)化Denervation Su

27、pra/Infraspinatus-Entrapment of the Suprascapular Nerve in Suprascapular Notch肩胛上切跡囊腫導(dǎo)致肩胛上神經(jīng)卡壓肩胛上切跡囊腫導(dǎo)致肩胛上神經(jīng)卡壓-MR Findings: Early- Denervation edema (High Signal on T2)MR表現(xiàn)：表現(xiàn)：早期早期-去神經(jīng)水腫（去神經(jīng)水腫（T2加權(quán)高信號(hào)）加權(quán)高信號(hào)）Late- Fatty Replacement (High Signal on T1)晚期：脂肪替代（晚期：脂肪替代（T1加權(quán)高信號(hào)）加權(quán)高信號(hào)）整理ppt71岡下去神經(jīng)化岡下去神經(jīng)化D

28、enervation Infraspinatus-Entrapment of Suprascapular Nerve in Spinoglenoid Notch岡盂切跡囊腫導(dǎo)致肩胛上神經(jīng)卡壓岡盂切跡囊腫導(dǎo)致肩胛上神經(jīng)卡壓-Early Denervation Edema of Infraspinatus Muscle岡下肌去神經(jīng)水腫岡下肌去神經(jīng)水腫整理ppt72四邊孔綜合征四邊孔綜合征Quadrilateral Space Syndrome旋肱后動(dòng)脈和腋神經(jīng)旋肱后動(dòng)脈和腋神經(jīng)在四邊孔處受壓后所引起的一系在四邊孔處受壓后所引起的一系列臨床癥候群。其主要表現(xiàn)是腋神經(jīng)支配的肩臂外側(cè)列臨床癥候群。其主要

29、表現(xiàn)是腋神經(jīng)支配的肩臂外側(cè)的感覺(jué)障礙和三角肌功能受限。的感覺(jué)障礙和三角肌功能受限。由于當(dāng)肩關(guān)節(jié)外展外旋時(shí)，組成四邊孔的肌肉均受牽由于當(dāng)肩關(guān)節(jié)外展外旋時(shí)，組成四邊孔的肌肉均受牽拉，從三個(gè)方向?qū)λ倪叜a(chǎn)生擠壓而致本癥發(fā)生。拉，從三個(gè)方向?qū)λ倪叜a(chǎn)生擠壓而致本癥發(fā)生。 -Axillary Nerve Compression Neuropathy腋神經(jīng)受壓癥狀腋神經(jīng)受壓癥狀-Poorly Localized Shoulder Pain in ABER PositionABER位局部嚴(yán)重肩痛位局部嚴(yán)重肩痛-Atrophy of Teres Minor and Deltoid Muscles小圓肌和三角肌萎縮小圓肌和三角肌萎縮Etiologies: Fibrous Bands- Seen with Repetitive Overhead Activity; Paralabral Cyst; Mass病因：反復(fù)過(guò)伸過(guò)頭運(yùn)動(dòng)導(dǎo)致的纖維束帶；盂唇旁囊病因：反復(fù)過(guò)伸過(guò)頭運(yùn)動(dòng)導(dǎo)致的纖維束帶；盂唇旁囊腫；腫塊腫；腫塊整理ppt73-Chronic Fatty Atrophy of Teres Minor and Deltoid小圓肌和三角肌慢性萎縮和脂肪化小圓肌和三角肌慢性萎縮和脂肪化-High Signal on T1 ImagesT1加權(quán)高信號(hào)表現(xiàn)加權(quán)高