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低场MRI对早期股骨头缺血坏死的诊断价值

时间:2017-11-27 15:00:04 来源: 代写硕士论文

【摘要】目的:研究低场MRI对对早期股骨头缺血坏死的诊断价值和影像学表现。方法 回顾性分析43例86个股骨头经临床证实股骨头坏死患者X线平片、CT及低场MRI检查资料,对其影像学改变进行分期及敏感性对照。结果  86个股骨头X线平片正常38个,其中Ⅰ期20个,表现为骨质疏松和骨硬化;Ⅱ期28个,表现为骨硬化及囊状低密度区。CT表现正常21个,其中Ⅰ期27个,表现为骨小梁星芒状结构消失,骨质疏松及骨硬化;Ⅱ期38个,表现为骨硬化和囊状透亮区。低场MRI表现Ⅰ期30个,表现为斑点状T1WI低信号;Ⅱ期35个,表现为T1WI、T2WI序列上斑片状或不规则低、等、高混杂信号;Ⅲ期21个,在T1WI、T2WI序列上呈片状低信号,并见高信号环绕。三者比较差异教大,意义显著。结论 CT及低场MRI可早期显示ANFH病变,而低场MRI对ANFH的敏感性及找诊断价值高于X线平片及CT.
【关键词】股骨头坏死;磁共振成像;体层摄影术;X线计算机

【Abstract】 Objective To study the finding of early avascular necrosis of the femoral head(ANFH)on low field MRI and their diangnostic significance.Methods Low Field MRI findings in 43 patients with 86 ANFH proved by pathology were analyzed retrospectively and ompared with X-ray and CT finding. Rank sum H test and sensitivity were completed. Result  On X-ray film, no abnormality of femoral head was visibl e in 38 places,stage Ⅰshowed as osteoporosis and osteosclerosis in 20 places, stage Ⅱshowed as osteoscleroses and cystiform hyaline regions in 28 places.On CT image, no abnormality of femoral head was visible in 21 places, stage Ⅰshowed as stelliform sign distortion, osteoscleroses and osteoporosis in 27 places, stage Ⅱshowed as osteoscleroses and cystiform hyaline regions in 38 places.On Low Field MRI stage Ⅰshowed as mottling hypointensity on T1WI in 30 places, stage Ⅱshowed as patchy or irregular shape hypointensity,isointensity,hyperintensity and heterogeneous intensity on T1WI and T2WI in 35 places, stage Ⅲ showed as patchy hypointensity on T1WI and T2WI in 21 places,the periphery was circled with hyperintense band.Rank sum H test and sensitivity compar were striking.ConclusionCT and Low Field MRI could exactly display early ANFH Sensitivity and diagnostic value of Low Field MRI is superior to CT and X-ray film.
【Key words】Femur head necrosis,Tomography,X-raycomputed, Magnetic resonance imaging

        股骨头缺血坏死是一种常见的骨关节病,临床发现典型ANFH大多已进入不可逆转的中晚期,往往失去最佳治疗时机,因此,早发现、早诊断、早治疗对提高患者生活质量意义重大。为能早期发现病变已成为当前研究的重点。本文通过X线平片、CT及低场MRI的影响学分析及对照研究,着重对低场MRI的表现进行探讨。
        1 资料和方法
        1.1 一般资料  抽取我院2004年至2009年间,均经X线平片、CT及MRI检查并经病理或临床证实的股骨头坏死43例。其中男33例,女10例。年龄17-77岁。临床表现为患侧腹股沟或髋区,大腿内侧深在性刺痛,可放射至膝或臀部,疼痛可为间断或进行性加重,体检时屈曲、内收、外展及内旋功能受限。
        1.2 检查方法  全部患者均行双侧股骨头X线摄片、CT、MRI检查。采用西门子16层螺旋CT扫描仪扫描,进行层厚5mm,层间距5mm,窗宽2000HU,窗位600HU,距阵320X320的横断、冠状、矢状面重建。采用GE0.2T永磁开放型磁共振,选用体线圈,扫描序列:SE、TSE序列及STIR序列;扫描参数:SET1WI TR 300ms,TE15ms,TSET2WI TR 4480ms,TE 108ms,STIR TR 6145ms,TE 108ms,TI 118ms;层厚6mm,层间隔7mm;矩阵320X320.所有患者均常规行横断面和冠状面T1WI、T2WI及STIR序列成像。
        1.3  影像学分期标准  参照Ficat、Frobergy[1]Hungr ford及Seteinberg分期法,采用六期分期标准。
0期:临床及X线前期,MRI为正常黄骨髓信号;Ⅰ期:X线平片示正常,CT示骨小梁“星芒结构”变形及斑片状骨质疏松和骨硬化,MRI示股骨头髓内出现不规则斑点状短T1长T2信号灶;Ⅱ期:X线平片示斑片状混杂密度,CT示除见“星芒结构”变形及硬化外,还可见囊变,MRI示T1WI、T2WI均为斑片状、条片状混杂信号;Ⅲ期:X线平片及CT均可见明显的骨硬化、囊变及轻度关节面下塌陷,MRIT1WI为斑片状低信号,T2WI为斑片状低信号外围包绕一环形或半圆形高信号带;Ⅳ期:X线平片及CT均表现为明显的股骨头变扁、碎裂、塌陷,MRIT1WI、T2WI均为大片状或不规则形低信号影;Ⅴ期:合并关节肥大畸形、关节间隙狭窄等退行性骨关节病。
        2 结果 
        2.1  X线  0期:38个部位,表现正常。Ⅰ期:20个部位,主要表现,骨小梁模糊或轻度骨质疏松。Ⅱ期28个部位,表现为关节面不整,股骨头密度不均匀,可见不规则囊性低密度区及斑片状骨硬化;43例86个股骨头中共发现Ⅰ期、Ⅱ期早期ANFH48个部位。阳性率为:55.8‰.

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