积水潭膝关节MRI-课件.ppt

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 protocolSagittal,Coronal,AxialSpin echo(SE)FSE,STIRT1,T2,PDCoronal: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 (TR1000msec,TE1500msec,TE60mse

2、c)“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/gray black/grayMuscle gray

3、 grayHematoma white white Chronic hemorrhage dark darkAnterior Cruciate LigamentJ.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(fallen ACL)nonvisualizationAvulsion fxIndirectuBone bruise signuDeep sulcus signuSegond fxugeneralized i

4、ncrease in signal intensity thickness increaseuAnterior drawer signuAcute hemarthrosisuBuckling of PCL pivot-shift patternJ.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 generalized increase in signal intensity thickness increaseJ.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

5、 of medial meniscusuBucket handle tearuMCLPosterior Cruciate LigamentJ.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 PCLComplete tearGrade1Grade3Grade2Associated ligament injuryuACL injuryuMCL injuryuPLC/LCL injuryCollateral ligamentNormal Anatomy

6、of MCLGrading MCL InjuriesGrade 1(sprain)Grade 2(partial tear)Grade 3(complete tear)Normal Anatomy of the LCL Complex/Posterolateral Corner ComplexIliotibial bandBiceps tendonVisible disruption of one of the posterolateral capsule structuresExtensive surrounding soft tissue edemaAvulsion fracture or

7、 marrow edema involving the medial aspect of the fibular headSigns of Posterolateral Corner InjuryMenisciJ.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 detect meniscal tearugrade 3 signaluabnormal meniscal morphologyudisplaced or missing meniscal tissueumeniscocapsular separationmissing fragmentJ.S.T 北京积水

8、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)udouble PCL signularge anterior horn signutoo many bow ties(3 or more)unotch 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Pitfalls in meniscus diagnosisuGrade II signaluTransverse meniscus lig.uPopliteal hiatus uMeniscofemora

9、l 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内侧半月板后角的上隐窝 垂直 光滑 不连通Postoperative Meniscus Grade 3 signal on T1-weighted images only is indeterminate for tear:it may represen

10、t 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 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 dislocation