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1、MR在关节疾患中的应用价值在关节疾患中的应用价值瑞金临床医学院影像医学教研室1资料借鉴1无无X线辐射线辐射可作任意切面的成像可作任意切面的成像成像参数多，所含信息量大成像参数多，所含信息量大软组织分辨率高软组织分辨率高可同时显示关节内的各种结构可同时显示关节内的各种结构MR在骨关节检查中的优点在骨关节检查中的优点2资料借鉴1MR诊断价值诊断价值MR表现具有特征性表现具有特征性,可以确立诊断可以确立诊断: 外伤、退行性变、滑膜病外伤、退行性变、滑膜病变、肿瘤变、肿瘤MR表现有一定特征性表现有一定特征性,可以帮助确立诊断可以帮助确立诊断:需结合其他检查需结合其他检查 滑膜病变、肿瘤滑膜病变、肿瘤M
2、R表现缺乏特征性，需依靠其他其他检查表现缺乏特征性，需依靠其他其他检查 滑膜病变、肿瘤滑膜病变、肿瘤3资料借鉴1MR表现具有特征性表现具有特征性关节损伤：半月板撕裂、韧带撕裂、肌腱损伤、关节损伤：半月板撕裂、韧带撕裂、肌腱损伤、 软骨缺损软骨缺损（如果采用关节造影，其（如果采用关节造影，其 准确率更高）准确率更高） 、骨挫伤、骨挫伤退行性变：退行性变：滑膜病变：绒毛结节滑膜炎、滑膜皱襞滑膜病变：绒毛结节滑膜炎、滑膜皱襞肿肿 瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、瘤：动脉瘤样骨囊肿、滑膜软骨瘤病、 脂肪瘤脂肪瘤4资料借鉴1桶柄状撕裂桶柄状撕裂5资料借鉴1半月板囊肿半月板囊肿6资料借鉴1盘盘状状半半月
3、月板板7资料借鉴1前交叉韧带完全撕前交叉韧带完全撕裂裂8资料借鉴1后后交交叉叉韧韧带带完完全全撕撕裂裂9资料借鉴1双双交交叉叉韧韧带带撕撕裂裂10资料借鉴1内侧副韧带撕裂内侧副韧带撕裂11资料借鉴1内侧副韧带撕裂内侧副韧带撕裂12资料借鉴1外侧副韧带撕裂外侧副韧带撕裂13资料借鉴1内侧支持带撕内侧支持带撕裂裂14资料借鉴1髌韧带撕裂髌韧带撕裂15资料借鉴1骨挫伤骨挫伤MRI和和CT16资料借鉴1骨软骨骨折骨软骨骨折17资料借鉴1半月板修补手术后关节造影关节造影18资料借鉴1半月板修补手术后关节造影关节造影19资料借鉴1肩袖完全撕裂肩袖完全撕裂MR平扫平扫20资料借鉴1肩袖完全撕裂肩袖完全撕裂
4、MR造影造影21资料借鉴1上盂唇撕裂肩袖（冈上肌肌腱）部分撕裂上盂唇撕裂肩袖部分撕裂上盂唇撕裂上盂唇撕裂上盂唇撕裂22资料借鉴1前盂前盂唇撕唇撕裂裂前前前前盂盂盂盂唇唇唇唇撕撕撕撕裂裂裂裂前盂唇撕裂前盂唇撕裂前盂唇撕裂前盂唇撕裂23资料借鉴1软骨缺损软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损肱骨头软骨缺损24资料借鉴1跟腱撕裂25资料借鉴126资料借鉴1男,12岁,右髋关节痛6月27资料借鉴128资料借鉴129资料借鉴1X线线 vs MR 对显示骨质侵蚀的比较对显示骨质侵蚀的比较30资料借鉴1正常关节软骨正常关节软骨Normal
5、Articular CartilageT2WT1W软骨表面光整，软骨表面光整，信号均一信号均一31资料借鉴1SPIR/FFEMIP/3D正常关节软骨正常关节软骨Normal Articular Cartilage32资料借鉴1层次模糊消失表面毛糙层次模糊消失表面毛糙类风关软骨表现类风关软骨表现Rheumatoid arthritisCoarse chondral surface小囊状缺损小囊状缺损Cystiform defect33资料借鉴1弥漫性变薄弥漫性变薄Diffuse thinning局部全层丢失局部全层丢失Focal loss类风关软骨表现类风关软骨表现 Rheumatoid art
6、hritis34资料借鉴1髌髌骨关节软骨骨关节软骨局部全层缺失局部全层缺失关节软骨三维重建图关节软骨三维重建图像直观显示缺失区域像直观显示缺失区域T1/SPIR/3D/FFE35资料借鉴1血管翳侵入边缘部骨质血管翳侵入边缘部骨质Pannus involving bone36资料借鉴1骨质囊变骨质囊变T1WC+T1WT2WCyst of Bone37资料借鉴1 T1W、T2W和和GE-T1W显示髌骨显示髌骨和股骨髁的软骨厚度变薄，软骨下和股骨髁的软骨厚度变薄，软骨下骨增生硬化，髌上囊积液骨增生硬化，髌上囊积液关节退关节退 变变Articular Degeneration38资料借鉴1ACL破坏消
7、失破坏消失ACL滑膜增生包滑膜增生包绕绕Synovial proliferationDestruction of ACLNormal ACL正常正常ACL39资料借鉴1腘窝囊肿形成腘窝囊肿形成Popliteal Fossa CystT1WT2W40资料借鉴1皮下结节形成皮下结节形成subcutaneous noduleT1/SPIR/3D/FFET1WC+T1WT2W41资料借鉴1绒毛结节性滑膜炎42资料借鉴1膝关节绒毛结节性关节炎膝关节绒毛结节性关节炎Pigment Villonodular SynovitisT2WT1WSTIR43资料借鉴1踝关节绒毛结节性滑膜炎踝关节绒毛结节性滑膜炎Pi
8、gment Villonodular SynovitisT1WSTIR44资料借鉴1血友病性关节炎血友病性关节炎Hemophilia arthritis45资料借鉴1腕关节类风湿关节炎腕关节类风湿关节炎Rheumatoid arthritis of wrist46资料借鉴147资料借鉴1其他关节炎其他关节炎MRMR表现表现48资料借鉴1神经性关节炎神经性关节炎X线示关节面的不规则缺损线示关节面的不规则缺损Neuroarthritis X plain film demonstrates articular surface irregular defect49资料借鉴1脊髓空洞症脊髓空洞症Neur
9、oarthritissyringomyelia神经性关节炎神经性关节炎T2W神经性关节炎神经性关节炎撕脱的软骨片撕脱的软骨片Neuroarthritis50资料借鉴1结核性关节炎结核性关节炎Tuberculosis Arthritis51资料借鉴1膝关节痛风膝关节痛风Podagra of Knee52资料借鉴153资料借鉴154资料借鉴155资料借鉴1滑膜软骨瘤病滑膜软骨瘤病Synovial Chondromatosis56资料借鉴1化脓性关节炎化脓性关节炎Suppuration arthritisT1WSTIR57资料借鉴1类风湿性关节炎表现类风湿性关节炎表现Rheumatoid arthr
10、itis58资料借鉴1Tarsal Sinus: Arthrographic, MR Imaging, MR ArthrographicSchematicdrawingsofthetarsalsinusligamentoussystem,seeninanoverheadviewandacoronalview,andofthecalcaneusshowthecourseandattachmentsitesofthecervicalligament(1);theinterosseoustalocalcanealligament(3);andthemedial(2),intermediate(4),
11、andlateral(5)rootsoftheinferiorextensorretinaculum.AF=anteriorfacet,MF=medialfacet,PF=posteriorfacet.59资料借鉴1Coronal(a) T1-weighted(600/11)and(b) T2-weighted(2,000/80)MRarthrogramsofaspecimenfromamalecadaver(ageatdeath,87years)showirregularthickeningofthecervicalligament(arrow).(c) SagittalT1-weighte
12、dMRarthrogram(600/11)and(d) reconstructedMRarthrogramperpendiculartothecourseofthecervicalligamentshowapartialtear(arrow).(e) Thepartialtear(arrow)wasconfirmedontheanatomicsection.60资料借鉴1Internal Derangement of the Wrist: Indirect MR Arthrography versus Unenhanced MR Imaging1 Imagesintwodifferentpat
13、ientswithanormalcentraldiskoftheTFCC.(a) Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthecentraldiskoftheTFCC(arrows).(b) Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina21
14、-year-oldwomandemonstratesanormallow-signal-intensitycentraldiskoftheTFCC(arrows).triangularfibrocartilagecomplex(TFCC)61资料借鉴1ImagesintwodifferentpatientswithanormalcentraldiskoftheTFCC.(a) Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanor
15、mallow-signal-intensityappearanceofthecentraldiskoftheTFCC(arrows).(b) Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina21-year-oldwomandemonstratesanormallow-signal-intensitycentraldiskoftheTFCC(arrows).62资料借鉴1ImagesintwodifferentpatientswithtearsofthecentraldiskoftheTFCC
16、.(a) Coronalthree-dimensionalgradient-echoindirectMRarthrogram(46/15,45flipangle)ina42-year-oldmanillustratesabsenceofthecentraldiskoftheTFCC(blackarrows),whichisconsistentwithalargecentraltear.Thereisalsoabnormalmarrowsignalintensity(whitearrows)intheulnarsideofthelunate,whichisconsistentwithulnari
17、mpactionsyndrome.(b) Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina23-year-oldwomandemonstratesabnormalhighsignalintensityextendingthroughthecentraldiskoftheTFCC(arrows).63资料借鉴1Imagesintwodifferentpatientswithnormalscapholunateligaments.(a) Coronalthree-dimensionalgradi
18、ent-echoindirectMRarthrogram(46/15,45flipangle)ina30-year-oldwomanillustratesanormallow-signal-intensityappearanceofthescapholunateligament(arrows).(b) Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10flipangle)ina37-year-oldmandemonstratesanormallow-signal-intensityscapholunateligamen
19、t(arrows).64资料借鉴15a.Imagesintwodifferentpatientswithtornscapholunateligaments.(a) CoronalT1-weightedfat-suppressedindirectMRarthrogram(500/14)ina53-year-oldwomandemonstratesfluidsignalintensity(arrows)betweenthescaphoidandthelunate.(b) Unenhancedcoronalthree-dimensionalgradient-echoMRimage(58/12,10f
20、lipangle)ina46-year-oldmandemonstratesabnormalhighsignalintensitytrackingthroughthescapholunateligament(arrows).65资料借鉴1Abnormalulnarcollateralligament.E=medialepicondyle,F=commonflexortendon,U=ulna.(a) LongitudinalUSimageoftheulnarcollateralligamentshowsfocalhypoechoicdisruption(arrow)ofligamentfibe
21、rswithrelativelynormalligamentseendistally(arrowheads).(b) CoronalT1-weightedspin-echoMRimage(700/14)and(c) coronalanatomicsliceobtainedafterintraarticularadministrationofcontrastmaterialshowabnormalcontrastmaterialextension(arrow)intotheproximalaspectoftheulnarcollateralligament(arrowhead).66资料借鉴1C
22、hronic Adult Hip PainEvaluationofthepatientwithchronicmechanicalhippainhasremainedadiagnosticdilemmaforphysicians.Thedifferentialdiagnosisisdiverseincludingcommonentitiessuchasosteoarthritis,fracture,andavascularnecrosis,aswellaslesscommonentitiesincludingpigmentedvillonodularsynovitis,synovialosteo
23、chondromatosis,snappinghipsyndrome,andhemorrhageintotheligamentumteres(1,2).Similartofindingsinthekneeandshoulder,radiographsappearnormalinthevastmajorityofpatientswithinternalderangementasacauseforhipsymptoms(2).Inonestudy,labrallesionswereidentifiedatarthroscopyin55%ofpatientswithintractablehippai
24、n(2).Owingtothepreviouslackofareliableimagingexamination,diagnosiswasoftendelayed.Inanotherstudy,patientsaveraged25monthsofsymptomsbeforethecausewasestablished(3).67资料借鉴1Normalanatomyina43-year-oldmanwithchronichippainisdepictedonT1-weighted(repetitiontimemsec/echotimemsec=600/17)MRimagesobtainedwit
25、hintraarticularcontrastmaterial.(a)AxialMRimagedemonstratesthenormaltriangularcrosssectionoftheanteriorandposteriorlabrum(arrowheads),smallperilabralsulci(shortarrows),andcrosssectionofligamentumteres(longarrow).(b)SagittalMRimagealongthemedialjointincludesthetransverseligament(arrowheads).(c)Midlin
26、ecoronalMRimageshowsthelongaxisoftheligamentumteres(shortarrow)anditsinsertionontothetransverseligament(longarrow).Anormalsuperiorlabrum(curvedarrow)andthelargersuperiorperilabralrecess(arrowhead)areseen.(d)OnamoreposteriorcoronalMRimage,thecircularfibersofthezonaorbicularis(arrowheads)areevident,as
27、arethelongitudinalfibersoftheiliofemoralligament(shortarrow).Acleftisseenwherethetransverseligamentandlabrumstarttomerge(longarrow).68资料借鉴1Normalanatomyina43-year-oldmanwithchronichippainisdepictedonT1-weighted(repetitiontimemsec/echotimemsec=600/17)MRimagesobtainedwithintraarticularcontrastmaterial
28、.(a)AxialMRimagedemonstratesthenormaltriangularcrosssectionoftheanteriorandposteriorlabrum(arrowheads),smallperilabralsulci(shortarrows),andcrosssectionofligamentumteres(longarrow).(b)SagittalMRimagealongthemedialjointincludesthetransverseligament(arrowheads).(c)MidlinecoronalMRimageshowsthelongaxis
29、oftheligamentumteres(shortarrow)anditsinsertionontothetransverseligament(longarrow).Anormalsuperiorlabrum(curvedarrow)andthelargersuperiorperilabralrecess(arrowhead)areseen.(d)OnamoreposteriorcoronalMRimage,thecircularfibersofthezonaorbicularis(arrowheads)areevident,asarethelongitudinalfibersoftheil
30、iofemoralligament(shortarrow).Acleftisseenwherethetransverseligamentandlabrumstarttomerge(longarrow).69资料借鉴1Extensivelabraltearina38-year-oldwomanwhoisanavidrunner.T1-weighted(600/17)axialMRimagedepictscontrastmaterialthroughoutthelabralsubstance.Thelabrumisenlargedandmaintainsitstriangularshape(arr
31、owheads).Anextensivelinearintralabralcollectionofcontrastmaterialispresent(shortarrow).Communicationbetweenthejointandtheiliopsoasbursaisevident(longarrow).70资料借鉴1Buckethandlelabraldetachmentina17-year-oldgirlwithdevelopmentaldysplasiawhosepainwasoutofproportiontoradiographicchanges.(a)T1-weighted(4
32、50/17)coronalMRimageobtainedwithintraarticularcontrastmaterialdemonstratescontrastmaterialinterposedalongtheentiresuperioracetabular-labralinterface(arrowheads).(b)Fat-suppressedT1-weighted(980/14)sagittalMRimageobtainedwithintraarticularcontrastmaterialshowsthatthedetachmentinvolvestheanteriorandan
33、terosuperiorlabrum(arrowheads).71资料借鉴1MR Imaging of the Metacarpophalangeal Joints of the Fingers Althoughuncommon,injuriesofthemetacarpophalangeal(MCP)jointsofthefingersnecessitateaccuratediagnosis,becausethelossoffunctionofevenoneMCPjointcanseriouslyimpairoverallhandfunction(1).Toensureappropriate
34、treatment,theidentificationofthedamagedstructuresatthetimeofinjuryisessential.Advancesinmagneticresonance(MR)imagingtechnologythatimprovespatialresolutionenablethevisualizationofimportantintra-andperiarticularstructures,eveninsmalljointssuchastheMCPjoints,withstandardclinicalequipment.Detailedknowle
35、dgeofthenormalanatomyremainsessentialtotheanalysisofMRimagesofthisarea.72资料借鉴1DrawingillustratestransverseviewofthemainstructuresoftheMCPjointafterremovalofthemetacarpalhead.73资料借鉴1Drawingoftheextensorhood.Thesagittalbandsarelocatedabovethejointline,andthetransversefibersofthelumbricalandinterosseou
36、stendonsaremoredistal,overtheproximalphalanx.74资料借鉴1SagittalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a) T1-weightedspin-echoMRarthrogram(500/12)and(b) correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(
37、arrowheads).Abarearea(openarrow)canbeseenbetweenthecartilage(longstraightarrows)andthedorsalinsertionofthecapsule.(c) T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothe
38、surfaceofthebone.75资料借鉴1SagittalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a) T1-weightedspin-echoMRarthrogram(500/12)and(b) correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(arrowheads).Abarearea(openar
39、row)canbeseenbetweenthecartilage(longstraightarrows)andthedorsalinsertionofthecapsule.(c) T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothesurfaceofthebone.76资料借鉴1Sagi
40、ttalMRarthrogramsoftheMCPjointofthethirdfingerinextension,withanatomiccorrelation.(a) T1-weightedspin-echoMRarthrogram(500/12)and(b) correspondinganatomicsectionshowthePP(curvedarrow),distalrecessofthePP(shortsolidarrow),andlooseproximalrecess(arrowheads).Abarearea(openarrow)canbeseenbetweenthecarti
41、lage(longstraightarrows)andthedorsalinsertionofthecapsule.(c) T1-weightedspin-echoMRarthrogram(500/12)oftheMCPofthethirdfingerinflexionshowsthatthePPisangled,thedistalrecess(whitearrow)iscompressed,andtheflexortendons(blackarrow)areappliedtothesurfaceofthebone.77资料借鉴1CoronalviewsoftheMCPjointsofthes
42、econdandthirdfingersinextension,withanatomiccorrelation.T1-weightedspin-echo (a) conventionalMRimage(500/12)and(b) MRarthrogram(500/12)and(c) thecorrespondinganatomicspecimenshowtheproximal(blackarrowheadsinaandb)anddistal(straightarrows)attachmentsofthemaincollateralligament.Notetheheterogeneoussig
43、nalintensityofthemaincollateralligaments.Theinterosseoustendons(whitearrowheads)arewelldemonstrated.Notetheintermetacarpophalangealspaces(curvedarrowsinc)betweenthemaincollateralligamentsandtheinterosseoustendons.78资料借鉴1CoronalviewsoftheMCPjointsofthesecondandthirdfingersinextension,withanatomiccorr
44、elation.T1-weightedspin-echo (a) conventionalMRimage(500/12)and(b) MRarthrogram(500/12)and(c) thecorrespondinganatomicspecimenshowtheproximal(blackarrowheadsinaandb)anddistal(straightarrows)attachmentsofthemaincollateralligament.Notetheheterogeneoussignalintensityofthemaincollateralligaments.Theinte
45、rosseoustendons(whitearrowheads)arewelldemonstrated.Notetheintermetacarpophalangealspaces(curvedarrowsinc)betweenthemaincollateralligamentsandtheinterosseoustendons.79资料借鉴1CoronalviewsoftheMCPjointsofthesecondandthirdfingersinextension,withanatomiccorrelation.T1-weightedspin-echo (a) conventionalMRi
46、mage(500/12)and(b) MRarthrogram(500/12)and(c) thecorrespondinganatomicspecimenshowtheproximal(blackarrowheadsinaandb)anddistal(straightarrows)attachmentsofthemaincollateralligament.Notetheheterogeneoussignalintensityofthemaincollateralligaments.Theinterosseoustendons(whitearrowheads)arewelldemonstrated.Notetheintermetacarpophalangealspaces(curvedarrowsinc)betweenthemaincollateralligamentsandtheinterosseoustendons.80资料借鉴1谢 谢81资料借鉴1
