積水潭膝關(guān)節(jié)MRI-課件

1、Practical Interpretation of Knee MRIRoutine MRI protocolSagittal,Coronal,AxialSpin echo(SE)FSE,STIRT1, T2, PDJSTCoronal: T2FFE T2 STIRSaggital: T1 T2 T2FFE T2 STIR TR和TE決定成像加權(quán) 短TE 長TE短TR T1 無用途 長TR PD T2T1 weighted image (TR1000msec,TE1500msec,TE60msec) “pathology”Fat suppression Chemical saturation

2、 Short tau inversion recovery (STIR)Tissue characterization T1 T2Adipose tissue Fat white gray Yellow marrowWater dark whiteCortical bone black blackCartilage gray grayTendon / ligament/meniscus black/gray black/grayMuscle gray grayHematoma white white Chronic hemorrhage dark darkAnterior Cruciate L

3、igamentextension ER 15 20Normal MR appearance direct sign of torn ACL discontinuity abnornal orientation (fallen ACL)nonvisualizationAvulsion fxIndirectBone bruise signDeep sulcus signSegond fxgeneralized increase in signal intensity thickness increaseAnterior drawer signAcute hemarthrosisBuckling o

4、f PCL pivot-shift patternKissing signSegond signDeep sulcus sign 2mm generalized increase in signal intensity thickness increaseBuckling of PCL nonspecificAnt.drawer signAssociated soft tissue injuriesPosterior horn of medial meniscusBucket handle tearMCLPosterior Cruciate LigamentNormal MR appearan

5、ce Meniscus-Femoral ligamentPrimary 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 avulsion fxAssociated ligament injuryACL injuryMCL injuryP

6、LC/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 tendonVisible disruption of one of the posterolateral capsule st

7、ructuresExtensive surrounding soft tissue edemaAvulsion fracture or marrow edema involving the medial aspect of the fibular headSigns of Posterolateral Corner InjuryMeniscibow ties 2triangularrectangularCriterial to detect meniscal teargrade 3 signalabnormal meniscal morphologydisplaced or missing m

8、eniscal tissuemeniscocapsular separationGrade III meniscus tearmissing fragmentDisplaced fragmentsmall PHMMMRI signsabsent bow ties sign(1 or fewer)double PCL signlarge anterior horn signtoo many bow ties(3 or more)notch signLarge & degeneration ant.horn3 or more bow-tiesBucket handle teardouble PCL

9、 signdiscoid meniscus3 or more bow-tiesPitfalls in meniscus diagnosisGrade II signalTransverse meniscus lig. Popliteal hiatus Meniscofemoral lig.Bursa or fat plane of MCL Popliteal hiatus內(nèi)側(cè)半月板后角的上隱窩 垂直 光滑 不連通Postoperative Meniscus Grade 3 signal on T1-weighted images only is indeterminate for tear:

10、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 a location is diagnostic of retearBone Marrow Edema(BME)pivot-shift injurydashboard injuryhyperextension injury: ”kissing sign”clip injurypatellar dislocationclip injurypatellar di