标题：MSCT三维重建与MRI在膝关节隐匿性骨折中的诊断价值

      作者：丘武应，姚文虹，钟丽珍，赵仕懂，陈志武    佛冈县人民医院放射科，广东 清远 511600

      卷次： 2020年31卷8期

      【摘要】 目的 比较多层螺旋CT (MSCT)三维重建技术与磁共振成像(MRI)在膝关节隐匿性骨折中的诊断价值。方法 选取佛冈县人民医院2018年3月至2019年3月收治的X线检查阴性且怀疑骨折患者50例进行研究，分别应用MSCT三维重建和MRI检查，比较MSCT与MRI对膝关节隐匿性骨折的检出情况和实验评估指标情况，观察两种检查方法的影像图，评估其诊断价值。结果 所有患者均完成MSCT三维成像检查和MRI检查，MSCT三维成像检查显示骨折63处，检出率为100%，MRI检查显示骨折41处，检出率为65.08%，MSCT检查的检出率明显高于MRI检查，差异具有统计学意义(P<0.05)；MSCT检查的特异度、灵敏度、阴性预测值、阳性预测值分别为80.00%、90.00%、92.00%、94.00%，明显高于MRI的 64.29%、72.00%、38.00%、70.00%，差异均具有统计学意义(P<0.05)；MRI图像表现为T1WI低信号骨折线周围有模糊片状高信号改变，在T2WI可见骨折线或在骨折线周围有散点片状高信号，在T1WI可见皮质下或松质骨内有条状信号影或不规则线；MSCT三维重建发现10例轴位减薄、矢、冠状位图像均可见清晰骨折线，16例经调整成像角度后可见骨折线，19例可见骨折线、骨皮质中断以及骨折累及的关节面；5例漏诊患者应用MRI检查后，图像显示在T2WI处可见高信号骨髓水肿和骨折线，在T1WI处可见骨松质内低信号骨折线；10例在MSCT中清晰可见骨皮质中断，MRI检查却未见明确骨折线，仅在T2WI处可见模糊高信号水肿改变。结论 MSCT三维重建技术在膝关节隐匿性骨折中较MRI具有更高的诊断价值，可以更好显示患者骨折和骨髓水肿情况，为治疗方案的选择提供参考。
      【关键词】 隐匿性骨折；膝关节；多层螺旋CT；X线计算机；诊断价值
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2020）08—1021—04

Diagnostic value of MSCT three-dimensional reconstruction and MRI in occult fractures of knee joint.
QIUWu-ying, YAO Wen-hong, ZHONG Li-zhen, ZHAO Shi-dong, CHEN Zhi-wu. Department of Radiology, Fogang CountyPeople's Hospital, Qingyuan 511600, Guangdong, CHINA
【Abstract】 Objective To compare the multi-slice spiral CT (MSCT) three-dimensional reconstruction tech-nique and magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the knee. Methods Fifty patientswith occult fractures of the knee joint from March 2018 to March 2019 in Fogang County People's Hospital were en-rolled in the study, which all underwent MSCT three-dimensional reconstruction and MRI examination. The detectionand experimental evaluation indicators of MSCT and MRI for occult fractures of the knee joint were compared, and theimaging images of the two examination methods were observed to evaluate their diagnostic value. Results Fifty pa-tients all completed MRI examination and MSCT examination. A total of 63 fractures were detected by MSCT examina-tion, with the detection rate of 100%, and 41 fractures were detected by MRI, with the detection rate of 65.08%, showingstatistically significant difference between the two methods (P<0.05). The specificity, sensitivity, negative predictive value,and positive predictive value of MSCT were 80.00%, 90.00%, 92.00%, and 94.00%, significantly higher than 64.29%,72.00%, 38.00%, and 70.00% of MRI (P<0.05). The MRI images showed a fuzzy plate-like high signal change aroundthe T1WI low-signal fracture line; the fracture line was visible on T2WI or there was a scatter-like high signal around thefracture line; there was a strip signal shadow or irregular line in the subcortical or cancellous bone on T1WI. MSCTthree-dimensional reconstruction showed that 10 patients had clear fracture lines in the axial, sagittal, and coronal imag-es, 16 patients had fracture lines after adjusting the imaging angle, and 19 patients had fracture lines, cortical disruptions,and articular surfaces involved in fractures. MRI examination of the 5 missed patients showed high signal bone marrowedema and fracture line on T2WI, and low signal fracture line in cancellous bone on T1WI. Ten patients had clear corti-cal-cortical discontinuities in MSCT, but they did not reveal a clear fracture line by MRI examination, only with blurredhigh signal edema changes on T2WI. Conclusion MSCT three-dimensional reconstruction technique has higher diag-nostic value than MRI in occult fracture of knee joint, which can better display the diagnosis of fracture and bone mar-row edema, providing a reference for the choice of treatment options.
      【Key words】 Occult fracture; Knee joint; Multi-slice spiral CT; X-ray computed; Diagnostic value