不同序列的磁振造影冠狀切面位影像對膝關節半月板病變的評估

Evaluation of Coronal Magnetic Resonence Images of Meniscal Lesions with Different Pulse Sequences

10.6200/TCMJ.2014.11.2.07

蔡建昇(Chien-Shen Tsai)；程勇清(Yung-Ching Chong)；楊展明(Chan-Ming Yang)；陳秋如(Chiu-Ju Chen)；姚義豐(Yi-Feng Yao)

磁振造影 ； 擾相快速自旋回波 ； 快速自旋回波 ； 質子密度加脂肪抑制 ； MRI ； T2 FrFSE ； T1 FSE ； PD FS

北市醫學雜誌

11卷2期（2014 / 06 / 01）

192 - 199

繁體中文

目的：探討膝關節半月板損傷，在磁振造影冠狀切面上不同序列之表現，藉以評估最適合觀察膝關節半月板損傷之掃描序列，以提高膝關節半月板損傷之診斷率。方法：回溯性分析在本院2013年元月份至2013年六月份期間，其影像經醫師判讀後，認定有半月板損傷者，共有58位，為此次研究之對象，本研究採用GE公司之超導型MRI掃描儀，機型為Signa 1.5T HDe及膝關節專用線圈Quad Knee coil，進行冠狀切面之三種不同波序（快速自旋回波T1 FSE、擾相快速自旋回波T2 FrFSE、質子密度加脂肪抑制PD FS）做掃描，針對膝關節半月板病變，在冠狀切面上做觀察，評估最適合膝關節半月板損傷之掃描序列。結果：本研究之對象，其影像上認定有明確半月板損傷，經由兩位醫師評分判定，數據應用SPSS 20.0，統計軟體進行統計學處理，其結果Kappa值等於0.636，代表兩位不同醫師之觀察，具有高度的一致性；而應用三種不同波序做出之冠狀切面影像表現，經醫師對膝關節半月板觀察後，採用ANOVA之Post Hoc檢定，經Tukey法之多重比較分析結果，對組間數據進行不同波序之多重比較分析，其結果COR T2 FrFSE 和COR PD FS間有差異性，顯著性水平為P＜0.05，認為有統計學意義，由結果得知質子密度加脂肪抑制（PD FS）序列在顯示膝關節半月板損傷比擾相快速自旋回波（T2 FrFSE）為更佳之選擇序列。結論：半月板因缺乏參予MRI成像的游離氫原子核（質子），故在所有MRI序列中均呈低訊號，當膝關節半月板損傷時，半月板才會出現異常之高訊號，此次研究結果，最適合膝關節半月板損傷之掃描序列為質子密度加脂肪抑制（PD FS）序列，因其去除了脂肪組織信號的影響，更提高了半月板損傷之診斷率。

Objective: This study aimed to investigate the performance of different pulse sequences on coronal magnetic resonance images (MRI) of the meniscus of knee and identify the most appropriate pulse sequence for detecting the meniscal lesion. The findings may improve the diagnostic accuracy of the meniscal lesion of knee. Methods: Fifty eight patients in our hospital diagnosed with meniscal tear by magnetic resonance images between January and June 2013 were included in this retrospective study. This study made use of a superconducting MRI scanner (GE Signa 1.5T HDe) and a coil dedicated for knee (Quad Knee coil), generating coronal view images of knee with three different pulse sequences (fast spin-echo T1 FSE, spoiled fast spin-echo T2 FrFSE, and proton density plus fat-suppressed PD FS). All images were evaluated by two radiologists to find the most suitable pulse sequence in detecting the meniscal lesion. Results: All the meniscal images of all patients were rated by two radiologists. The data was analyzed by using SPSS 20.0. The Kappa value was 0.636, representing consistency between two radiologists. The observed results were analyzed by ANOVA Post Hoc test and Tukey's multiple comparison method, for comparison of inter-application performance of coronal images made from different pulse sequences. Data analysis of different pulse sequences with multiple comparisons revealed a performance difference between COR T2 FrFSE and COR PD FS (P＜0.05). Proton density plus fat-suppressed PD FS was better in detecting the meniscal lesion in comparison with spoiled fast spin-echo T2 FrFSE. Conclusion: Due to lack of free proton participating in MRI, the meniscus shows low signal intensity on all pulse sequences, while on patients with meniscal tear, the injury parts of the meniscus appear abnormal high signal in all pulse sequences. This study showed that the most suitable pulse sequence for scanning the meniscus injury of knee is PD FS because it removes the effects of adipose tissue signals and improves the diagnostic sensitivity of the meniscal lesions.