华西医学

华西医学

MRI 髋关节单侧斜冠状扫描对髋关节撞击综合征的诊断价值

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目的探讨 MRI 髋关节单侧斜冠状扫描对髋关节撞击综合征(femoroacetabular impingement,FAI)的临床诊断价值。方法2014 年 2 月—10 月选取 75 例因髋关节疼痛,经过 X 线或 CT 检查后,高度怀疑为 FAI 的患者为研究对象。使用 Siemens 1.5 T MRI 扫描仪,体表相控阵柔性线圈,采用 T2 加权脂肪抑制成像序列、T1 加权成像序列和质子密度加权成像序列,对同一患者分别采用 A、B 两种扫描方式。A 扫描方式:在髋关节矢状面图像上,定位线平行于患者(单侧)股骨颈长轴方向的斜冠状面扫描。B 扫描方式:在髋关节横断面图像上,定位线平行于左右股骨头的常规髋关节冠状面扫描。对两种不同扫描方式所得到的髋关节图像进行解剖结构和病变特征对比分析,采用配对χ2 检验进行统计分析。结果A 扫描方式的 FAI 检出率为 62.6%(47/75),B 扫描方式检出率为 30.6%(23/75),A 扫描方式的 FAI 检出率高于 B 扫描方式,差异有统计学意义(P<0.001)。结论采用平行于股骨颈长轴的斜冠状获得的图像,可以更全面地展示髋臼唇及股骨头颈连接部位解剖结构的病理改变和股骨头颈交界处的损伤情况,可以为临床诊断 FAI 提供更可靠的影像学依据。

ObjectiveTo investigate the diagnostic value of MRI hip joint unilateral oblique coronary scanning in the diagnosis of femoroacetabular impingement (FAI).MethodsFrom February to October 2014, 75 patients with hip joint pain who were highly suspected of FAI after X-ray or CT examination were selected as subjects. Using Siemens 1.5 T MR, fat-suppressed T2-weighted imaging sequences, T1-weighted imaging sequences, and proton density-weighted imaging sequences were used. For each patient two scan methods were used. Method A: on the sagittal image of the hip joint, the line of sight was parallel to the oblique coronal plane scan of the (one-sided) long axis of the femoral neck. Method B: on the cross-sectional image of the hip joint, the positioning line was parallel to the conventional hip joint coronal scan of the left and right femoral heads. McNemar test was used to compare the detection rates of FAI of the two methods.ResultThe detection rate of FAI of A-scanning [62.6% (47/75)] was higher than that of B-scanning [30.6% (23/75)], and the difference was statistically significant (P<0.001).ConclusionAn image obtained from a diagonal coronal scan parallel to the long axis of the femoral neck can more fully display the pathological changes of the acetabular labrum and the anatomy of the femoral head and neck joints, and the damage of the femoral head and neck junction, which provides a more reliable imaging basis for the clinician to diagnose FAI.

关键词: 磁共振成像; 髋关节; 撞击综合征; 斜冠状扫描; 髋臼唇

Key words: Magnetic resonance imaging; Hip joint; Impingement syndrome; Oblique coronal scan; Acetabular lip

引用本文: 彭涛, 陈坜桃, 陈绪全, 赵利娜, 黄林. MRI 髋关节单侧斜冠状扫描对髋关节撞击综合征的诊断价值. 华西医学, 2018, 33(8): 1019-1022. doi: 10.7507/1002-0179.201606156 复制

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