【摘要】 目的 探討0.35 T MRI各方位各序列掃描對肩袖撕裂的診斷價值。 方法 對2010年3月-2011年4月就診的38例肩關節疼痛患者，分別在斜冠狀位、斜矢狀位及橫軸位行T1加權像（T1 weighted image，T1WI）、T2加權像（T2 weighted image，T2WI）、質子密度加權像（proton density weighted image，PWI）及脂肪抑制像（turbo inversion recovery magnitude，TIRM）掃描。將38例患者的岡上肌及岡下肌肌腱合并為A組、肩胛下肌及小圓肌肌腱合并為B組進行研究，分別比較A、B組采用各方位的掃描表現；再將A組患者分為斜冠狀位T1WI+T2WI組與斜冠狀位PWI+TIRM組，將B組患者分為橫軸位T1WI+T2WI組與橫軸位PWI+TIRM組，分別比較各序列組的掃描表現。 結果 A組患者在3個方位掃描像以及斜冠狀位T1WI+T2WI組與PWI+TIRM組之間診斷準確度差異有統計學意義（Plt;0.05），其斜冠狀位診斷肩袖撕裂的靈敏度為88.9%，特異度為81.8%，準確度為86.8%，為最佳掃描方位，而PWI+TIRM組診斷肩袖撕裂的靈敏度為88.9%，特異度為90.9%，準確度為89.5%，為優選掃描序列；B組患者在3個方位掃描像以及橫軸位T1WI+T2WI組與PWI+TIRM組之間診斷準確度差異有統計學意義（Plt;0.05），其橫軸位診斷肩袖撕裂的靈敏度為87.5%，特異度為86.4%，準確度為86.8%，為最佳掃描方位，而PWI+TIRM組診斷肩袖撕裂的靈敏度為100%，特異度為83.3%，準確度為94.7%，為優選掃描序列。 結論 低場MRI診斷岡上肌、岡下肌肌腱撕裂以斜冠狀位PWI及TIRM掃描序列為首選，診斷小圓肌、肩胛下肌肌腱撕裂則以橫軸位PWI及TIRM掃描序列為主。【Abstract】 Objective To explore the clinical value of 0.35 T MRI diagnosing rotator cuff tears with different scan sequence and patient position. Methods From March 2010 to April 2011, there were 38 patients with shoulder pain were separately scanned by MRI at the position of oblique coronal, oblique sagittal and transaxial planes. Otherwise, the MRI images completed with T1 weighted, T2 weighted, PDWI and TIRM technique. The 38 cases were divided into two groups (group A: to study the supraspinatus and infraspinous tendons of the 38 cases; group B: to study the musculus teres minor and musculus subscapularis tendons of the 38 cases). Afterwards, the diagnostic results were compared among images at different patient positions. Furthermore, the images at oblique coronal plane of T1WI+T2WI and PWI+TIRM technique in group A were compared; on the other hands, the images at transaxial plane of T1WI+T2WI and PWI+TIRM technique in group B were compared. Results The difference of diagnostic accuracy in group A at different patient positions and scan sequences were statistical significant (Plt;0.05), and oblique cornal plane was the best patient position with sensitivity of 88.9%, specificity of 81.8% and accuracy of 86.8%; at the same time, the PWI+TIRM sequence was better sequence with sensitivity of 88.9%, specificity of 90.9% and accuracy of 89.5%. The difference of diagnostic accuracy in group B at different patient positions and scan sequences were statistical significant (Plt;0.05), and transaxial plane was the best patient position with sensitivity of 87.5%, specificity of 86.4% and accuracy of 86.8%; at the same time, the PWI+TIRM sequence was better sequence with sensitivity of 100%, specificity of 83.3% and accuracy of 94.7%. Conclusion In low field MRI, the oblique cornal plane with PWI+TIRM sequence are a first-line method for diagnosing supraspinatus tendon tears or infraspinous tendon tears; on the other hands, the transaxial plane with PWI+TIRM sequence are a first-line method for diagnosing musculus teres minor hurt or musculus subscapularis hurt.
目的 采用低場MRI非增強掃描探討強直性脊柱炎（AS）累及脊柱的MRI表現。 方法 從2010年3月－2013年3月間就診的76例AS患者的MRI圖像中選取19例脊柱受累者資料，對病變部位MRI圖像進行分析，評價AS累及脊柱在低場MRI非增強掃描狀態下的MRI表現特點。 結果 19例患者中頸椎病變3例，胸椎病變9例，腰椎病變7例；MRI表現為椎體終板炎17例、椎間盤炎13例、脊柱滑膜關節炎15例、椎旁韌帶炎11例、韌帶骨化和骨性強直9例。 結論 低場MRI非增強掃描能直觀顯示AS脊柱病變，主要表現為椎體終板炎、椎間盤炎、脊柱滑膜關節炎、椎旁韌帶炎、韌帶骨化和骨性強直，壓脂T2WI序列對活動性炎性病變顯示良好，T1WI、T2WI序列能較好顯示結構性病變。
目的:通過分析平山病的磁共振成像(MRI)表現特點和結合文獻復習，提高其診斷水平。方法:報道1例經臨床證實的平山病患者的MRI表現，并復習文獻，探討MRI表現的相關發病機制及病理解剖基礎。結果:采用西門子Sonata 1.5T磁共振機，先取生理狀態下頸椎MRI檢查，顯示脊髓前角非對稱性萎縮和脊髓背側硬膜外靜脈叢擴張；再行屈頸狀態下MRI檢查，可見頸髓的硬脊膜后壁向前推移，下段頸髓局限受壓變細征。結論:平山病有特征性MRI表現，結合臨床、常規位和功能位屈頸狀態的MRI檢查，可以提示平山病。
Objective To explore the MRI features of juvenile-onset ankylosing spondylitis (JoAS) for improving the level of diagnosis and therapy. Methods MRI findings of JoAS in 25 patients confirmed by clinical and laboratory results between October 2010 and September 2014 were retrospectively analyzed. Results There were a total of 67 locations of lesion in the 25 cases, including 19 in sacroiliac joint, 21 in hip joint, 6 in ischial tuberosity, 6 in crista iliaca, 9 in knee joint, 4 in ankle joint, and 2 in foot. MRI showed 63 locations with bone marrow edema, 36 with joint effusion, 26 with bone destruction, and 19 with enthesitis. Conclusions Bone marrow edema is the most common MRI manifestation of JoAS, and the main bone destruction is middle axis joint. MRI is sensitive but not specific to lesions, so differential diagnosis is needed and helpful.
目的 探討數字X線攝影（DR）的全景拼接技術在骨關節系統疾病中的臨床應用價值。 方法 回顧分析2011年1月－2013年3月采用“連續多次曝光后手動軟件拼接技術”及“狹縫連續拍攝自動軟件拼接技術”所得的各100例（全脊柱50例，下肢全長50例）全景拼接圖像，對圖像質量進行評價，分析其技術特點及應用優勢。 結果 兩種拼接技術所得的全景拼接圖像都清晰、連續、完整、質量合格，能有效滿足臨床診療需求，在質量上兩者無明顯差異。前者所需時間稍長，對操作者技術及經驗要求較高，后者操作更顯快捷方便，但設備較昂貴。 結論 DR全景拼接技術在骨關節系統疾病中有很好的普及推廣應用價值，能為骨科臨床提供新的更有價值的信息。