MR在關(guān)節(jié)疾患中應(yīng)用價值

1、MR在關(guān)節(jié)疾患中應(yīng)用價值l無無X線輻射線輻射l可作任意切面的成像可作任意切面的成像l成像參數(shù)多，所含信息量大成像參數(shù)多，所含信息量大l軟組織分辨率高軟組織分辨率高l可同時顯示關(guān)節(jié)內(nèi)的各種結(jié)構(gòu)可同時顯示關(guān)節(jié)內(nèi)的各種結(jié)構(gòu)MR表現(xiàn)具有特征性表現(xiàn)具有特征性,可以確立診斷可以確立診斷: 外傷、退行性變、滑膜病外傷、退行性變、滑膜病變、腫瘤變、腫瘤MR表現(xiàn)有一定特征性表現(xiàn)有一定特征性,可以幫助確立診斷可以幫助確立診斷:需需結(jié)合其他檢查結(jié)合其他檢查 滑膜病變、腫瘤滑膜病變、腫瘤MR表現(xiàn)缺乏特征性，需依靠其他其他檢查表現(xiàn)缺乏特征性，需依靠其他其他檢查 滑膜病變、腫瘤滑膜病變、腫瘤關(guān)節(jié)損傷：半月板撕裂、韌帶撕裂

2、、肌腱損傷、關(guān)節(jié)損傷：半月板撕裂、韌帶撕裂、肌腱損傷、 軟骨缺損（如果采用關(guān)節(jié)造影，其軟骨缺損（如果采用關(guān)節(jié)造影，其 準(zhǔn)確率更高）準(zhǔn)確率更高） 、骨挫傷、骨挫傷退行性變：退行性變：滑膜病變：絨毛結(jié)節(jié)滑膜炎、滑膜皺襞滑膜病變：絨毛結(jié)節(jié)滑膜炎、滑膜皺襞腫腫 瘤：動脈瘤樣骨囊腫、滑膜軟骨瘤病、瘤：動脈瘤樣骨囊腫、滑膜軟骨瘤病、 脂肪瘤脂肪瘤半月板修補(bǔ)手術(shù)后半月板修補(bǔ)手術(shù)后上盂唇撕裂肩袖（岡上肌肌腱）部分撕裂上盂唇撕裂肩袖部分撕裂上盂唇撕裂男,12歲,右髖關(guān)節(jié)痛6月X線線 vs MR 對顯示骨質(zhì)侵蝕的比較對顯示骨質(zhì)侵蝕的比較正常關(guān)節(jié)軟骨正常關(guān)節(jié)軟骨Normal Articular CartilageT

3、2WT1W軟骨表面光整，軟骨表面光整，信號均一信號均一SPIR/FFEMIP/3D正常關(guān)節(jié)軟骨正常關(guān)節(jié)軟骨Normal Articular Cartilage層次模糊消失表面毛糙層次模糊消失表面毛糙類風(fēng)關(guān)軟骨表現(xiàn)類風(fēng)關(guān)軟骨表現(xiàn)Rheumatoid arthritisCoarse chondral surface小囊狀缺損小囊狀缺損Cystiform defect彌漫性變薄彌漫性變薄Diffuse thinning局部全層丟失局部全層丟失Focal loss類風(fēng)關(guān)軟骨表現(xiàn)類風(fēng)關(guān)軟骨表現(xiàn) Rheumatoid arthritis髕骨關(guān)節(jié)軟骨髕骨關(guān)節(jié)軟骨局部全層缺失局部全層缺失關(guān)節(jié)軟骨三維重建圖關(guān)節(jié)

4、軟骨三維重建圖像直觀顯示缺失區(qū)域像直觀顯示缺失區(qū)域T1/SPIR/3D/FFE血管翳侵入邊緣部骨質(zhì)血管翳侵入邊緣部骨質(zhì)Pannus involving bone骨質(zhì)囊變骨質(zhì)囊變T1WC+T1WT2WCyst of Bone T1W、T2W和和GE-T1W顯示髕骨和股骨髁顯示髕骨和股骨髁的軟骨厚度變薄，軟骨下骨增生硬化，髕的軟骨厚度變薄，軟骨下骨增生硬化，髕上囊積液上囊積液關(guān)節(jié)退關(guān)節(jié)退 變變Articular DegenerationACL破壞消失破壞消失ACL滑膜增生包繞滑膜增生包繞Synovial proliferationDestruction of ACLNormal ACL正常正常AC

5、L腘窩囊腫形成腘窩囊腫形成Popliteal Fossa CystT1WT2W皮下結(jié)節(jié)形成皮下結(jié)節(jié)形成subcutaneous noduleT1/SPIR/3D/FFET1WC+T1WT2W膝關(guān)節(jié)絨毛結(jié)節(jié)性關(guān)節(jié)炎膝關(guān)節(jié)絨毛結(jié)節(jié)性關(guān)節(jié)炎Pigment Villonodular SynovitisT2WT1WSTIR踝關(guān)節(jié)絨毛結(jié)節(jié)性滑膜炎踝關(guān)節(jié)絨毛結(jié)節(jié)性滑膜炎Pigment Villonodular SynovitisT1WSTIR血友病性關(guān)節(jié)炎血友病性關(guān)節(jié)炎Hemophilia arthritis腕關(guān)節(jié)類風(fēng)濕關(guān)節(jié)炎腕關(guān)節(jié)類風(fēng)濕關(guān)節(jié)炎Rheumatoid arthritis of wrist神經(jīng)性

6、關(guān)節(jié)炎神經(jīng)性關(guān)節(jié)炎X線示關(guān)節(jié)面的不規(guī)則缺損線示關(guān)節(jié)面的不規(guī)則缺損Neuroarthritis X plain film demonstrates articular surface irregular defect脊髓空洞癥脊髓空洞癥Neuroarthritissyringomyelia神經(jīng)性關(guān)節(jié)炎神經(jīng)性關(guān)節(jié)炎T2W神經(jīng)性關(guān)節(jié)炎神經(jīng)性關(guān)節(jié)炎撕脫的軟骨片撕脫的軟骨片Neuroarthritis結(jié)核性關(guān)節(jié)炎結(jié)核性關(guān)節(jié)炎Tuberculosis Arthritis膝關(guān)節(jié)痛風(fēng)膝關(guān)節(jié)痛風(fēng)Podagra of Knee滑膜軟骨瘤病滑膜軟骨瘤病Synovial Chondromatosis化膿性關(guān)節(jié)炎化膿性

7、關(guān)節(jié)炎Suppuration arthritisT1WSTIR類風(fēng)濕性關(guān)節(jié)炎表現(xiàn)類風(fēng)濕性關(guān)節(jié)炎表現(xiàn)Rheumatoid arthritisTarsal Sinus: Arthrographic, MR Imaging, MR ArthrographicSchematic 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 cervi

8、cal 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 arthrogram

9、s 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 parti

10、al tear (arrow) was confirmed on the anatomic section. Internal Derangement of the Wrist: Indirect MR Arthrography versus Unenhanced MR Imaging1 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

11、 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 T

12、FCC (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

13、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.

14、(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

15、 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 dif

16、ferent 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 gr

17、adient-echo MR image (58/12, 10 flip angle) in a 37-year-old man demonstrates a normal low-signal-intensity scapholunate ligament (arrows). 5a. 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 w

18、oman 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

19、 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

20、 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 PainEvaluation of the patient with chronic me

21、chanical 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, snap

22、ping 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

23、 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

24、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 liga

25、mentum 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

26、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 ligame

27、nt 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

28、 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 ligamentu

29、m 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, a

30、s 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

31、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

32、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 (arrowhea

33、ds). (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 metacar

34、pophalangeal (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 ma

35、gnetic 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 analysi

36、s 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 mor

37、e 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),

38、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

39、 (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 sho

40、w 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

41、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-

42、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 sh