积水潭膝关节MRI.ppt

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1、J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Practical Interpretation of Knee MRIRoutine MRI protocolRoutine MRI protocolSagittal,Coronal,AxialSpin echo(SE)FSE,STIRT1,T2,PDJSTCoronal:T2FFE T2 STIRSaggital:T1 T2 T2FFE T2 STIRJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组 TR和TE决定成像加权 短TE 长TE短TR T1 无用途 长TR PD T2T1 weighted image (TR1000

2、msec,TE1500msec,TE60msec)“pathology”Fat suppression Chemical saturation Short tau inversion recovery(STIR)J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Tissue characterization T1 T2Adipose tissue Fat white gray Yellow marrowWater dark whiteCortical bone black blackCartilage gray grayTendon/ligament/meniscus black/gra

3、y black/grayMuscle gray grayHematoma white white Chronic hemorrhage dark darkAnterior Cruciate Ligamentextension extension ER 15 20ER 15 20Normal MR appearance Normal MR appearance J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组 direct sign of torn ACL discontinuity J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组abnornal orientation(fal

4、len ACL)nonvisualizationAvulsion fxIndirectuBone bruise signuDeep sulcus signuSegond fxugeneralized increase in signal intensity thickness increaseuAnterior drawer signuAcute hemarthrosisuBuckling of PCL pivot-shift patternKissing signSegond signJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Deep sulcus sign 2 2mmmm g

5、eneralized increase in signal intensity thickness increaseBuckling of PCL nonspecificnonspecificAnt.drawer signJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Associated soft tissue injuriesuPosterior horn of medial meniscusuBucket handle tearuMCLPosterior Cruciate LigamentNormal MR appearance Meniscus-Femoral ligament

6、J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Primary sign of PCL complete tear partial tear“peel off”injuryComplete tearGrade1Grade3Grade2partial tearSecondary sign of PCL injurybone marrow edema(BME)avulsion fxDashboard injury signBone Marrow EdemaTibial avuls

7、ion fxAssociated ligament injuryuACL injuryuMCL injuryuPLC/LCL injuryCollateral ligamentNormal Anatomy of MCLGrading MCL InjuriesGrade 1(sprain)Grade 2(partial tear)Grade 3(complete tear)Normal Anatomy of the LCL Complex/Posterolateral Corner ComplexIliotibial bandLCLPopliteal plexBiceps tendonVisib

8、le disruption of one of the posterolateral capsule structuresExtensive surrounding soft tissue edemaAvulsion fracture or marrow edema involving the medial aspect of the fibular headSigns of Posterolateral Corner InjuryMeniscibow ties 2triangularrectangularJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Criterial to det

9、ect meniscal tearugrade 3 signaluabnormal meniscal morphologyudisplaced or missing meniscal tissueumeniscocapsular separationGrade III meniscus tearmissing fragmentDisplaced fragmentsmall PHMMsmall PHMMJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组MRI signsuabsent bow ties sign(1 or fewer)

10、udouble PCL signularge anterior horn signutoo many bow ties(3 or more)unotch signLarge°eneration ant.hornLarge°eneration ant.horn3 or more bow-tiesBucket handle teardouble PCL signdiscoid meniscus3 or more bow-tiesJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Pitfalls in meniscus diagnosisuGrade II signaluTrans

11、verse meniscus lig.uPopliteal hiatus uMeniscofemoral lig.uBursa or fat plane of MCLJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组 J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组J.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Popliteal hiatusJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组内侧半月板后角的上隐窝 垂直 光滑 不连通Postoperative Meniscus Grade 3 signal o

12、n T1-weighted images only is indeterminate for tear:it may represent postoperative change or retear of the meniscus Grade 3 signal on a T1-weighted image that is bright as fluid on a T2-weighted image is diagnostic of retear.A displaced meniscal fragment is diagnostic of retear.Grade 3 signal in new

13、 a location is diagnostic of retearJ.S.T 北京积水潭医院关节镜组北京积水潭医院关节镜组Bone Marrow Edema(BME)upivot-shift injuryudashboard injuryuhyperextension injury:”kissing sign”uclip injuryupatellar dislocationclip injurypatellar dislocationOCDpopliteal cystMeniscus cystPVNScruciate cystACL cystPatellar dislocationpatellar tendonJumpers kneeHousemaids kneeHousemaids kneeDeep&Deep&Superficail Superficail infrapatellarinfrapatellar bursa bursa