0.35 T MRI对肩袖撕裂的应用价值研究

【】　目的　探讨0.35TMRI各方位各序列扫描对肩袖撕裂的诊断价值。　方法　对2010年3月-2011年4月就诊的38例肩关节疼痛患者，分别在斜冠状位、斜矢状位及横轴位行T1加权像（T1weightedimage，T1WI）、T2加权像（T2weightedimage，T2WI）、质子密度加权像（protondensityweightedimage，PWI）及脂肪抑制像（turboinversionrecoverymagnitude，TIRM）扫描。将38例患者的冈上肌及冈下肌肌腱合并为A组、肩胛下肌及小圆肌肌腱合并为B组进行研究，分别比较A、B组采用各方位的扫描表现；再将A组患者分为斜冠状位T1WI+T2WI组与斜冠状位PWI+TIRM组，将B组患者分为横轴位T1WI+T2WI组与横轴位PWI+TIRM组，分别比较各序列组的扫描表现。　结果　A组患者在3个方位扫描像以及斜冠状位T1WI+T2WI组与PWI+TIRM组之间诊断准确度差异有统计学意义（P<0.05），其斜冠状位诊断肩袖撕裂的灵敏度为88.9%，特异度为81.8%，准确度为86.8%，为最佳扫描方位，而PWI+TIRM组诊断肩袖撕裂的灵敏度为88.9%，特异度为90.9%，准确度为89.5%，为优选扫描序列；B组患者在3个方位扫描像以及横轴位T1WI+T2WI组与PWI+TIRM组之间诊断准确度差异有统计学意义（P<0.05），其横轴位诊断肩袖撕裂的灵敏度为87.5%，特异度为86.4%，准确度为86.8%，为最佳扫描方位，而PWI+TIRM组诊断肩袖撕裂的灵敏度为100%，特异度为83.3%，准确度为94.7%，为优选扫描序列。　结论　低场MRI诊断冈上肌、冈下肌肌腱撕裂以斜冠状位PWI及TIRM扫描序列为首选，诊断小圆肌、肩胛下肌肌腱撕裂则以横轴位PWI及TIRM扫描序列为主。【Abstract】　Objective　Toexploretheclinicalvalueof0.35TMRIdiagnosingrotatorcufftearswithdifferentscansequenceandpatientposition.　Methods　FromMarch2010toApril2011,therewere38patientswithshoulderpainwereseparatelyscannedbyMRIatthepositionofobliquecoronal,obliquesagittalandtransaxialplanes.Otherwise,theMRIimagescompletedwithT1weighted,T2weighted,PDWIandTIRMtechnique.The38casesweredividedintotwogroups(groupAtostudythesupraspinatusandinfraspinoustendonsofthe38cases;groupBtostudythemusculusteresminorandmusculussubscapularistendonsofthe38cases).Afterwards,thediagnosticresultswerecomparedamongimagesatdifferentpatientpositions.Furthermore,theimagesatobliquecoronalplaneofT1WI+T2WIandPWI+TIRMtechniqueingroupAwerecompared;ontheotherhands,theimagesattransaxialplaneofT1WI+T2WIandPWI+TIRMtechniqueingroupBwerecompared.　Results　ThedifferenceofdiagnosticaccuracyingroupAatdifferentpatientpositionsandscansequenceswerestatisticalsignificant(P<0.05),andobliquecornalplanewasthebestpatientpositionwithsensitivityof88.9%,specificityof81.8%andaccuracyof86.8%;atthesametime,thePWI+TIRMsequencewasbettersequencewithsensitivityof88.9%,specificityof90.9%andaccuracyof89.5%.ThedifferenceofdiagnosticaccuracyingroupBatdifferentpatientpositionsandscansequenceswerestatisticalsignificant(P<0.05),andtransaxialplanewasthebestpatientpositionwithsensitivityof87.5%,specificityof86.4%andaccuracyof86.8%;atthesametime,thePWI+TIRMsequencewasbettersequencewithsensitivityof100%,specificityof83.3%andaccuracyof94.7%.　Conclusion　InlowfieldMRI,theobliquecornalplanewithPWI+TIRMsequenceareafirst-linemethodfordiagnosingsupraspinatustendontearsorinfraspinoustendontears;ontheotherhands,thetransaxialplanewithPWI+TIRMsequenceareafirst-linemethodfordiagnosingmusculusteresminorhurtormusculussubscapularishurt.