肩关节常见疾病MRI诊断-Ⅰ课件.ppt
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- 肩关节 常见疾病 MRI 诊断 课件
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1、(Part)Shoulder disorders mainly involve rotator cuff diseases and shoulder instability.For rotator cuff diseases,routine shoulder MR imaging as the first choice can solve most of the problems in practice.For shoulder instability and related glenoid labrum lesions,shoulder MR arthrography is the firs
2、t selection for evaluation肩关节常见病变主要为肩袖相关病变和肩关节不稳定。对于肩袖相关病变,肩关节MRI 常规扫描可作为首选;对于肩关节不稳定和盂唇病变,则一般首选肩关节MRI 造影进行评价。Rotator cuffRotator cuff tendons diseasetendons disease肩袖肌腱病Rotator cuffRotator cuff teartear肩袖撕裂SubscapularisSubscapularis rupture rupture肩胛下肌断裂AcromioclavicularAcromioclavicular joint disea
3、se joint disease肩锁关节病The sub-The sub-acromialacromial shoulder impingement syndrome shoulder impingement syndrome肩峰下撞击综合征SLAPSLAP病变(上盂唇前后向撕裂)BankartBankart病变HAGLHAGL病变(盂肱下韧带肱骨部撕脱)Labrum cyst Labrum cyst 盂唇囊肿Adhesive Adhesive capsulitiscapsulitis joints joints粘连性关节囊炎Shoulder joint Shoulder joint oste
4、oarthrosisosteoarthrosis肩关节骨关节病Etiology pathology Etiology pathology 病因病理:Excessive use,lead to degeneration and tear of rotator Excessive use,lead to degeneration and tear of rotator cuff cuff 过度使用导致肩袖的退行性变和撕裂Most often in impingementMost often in impingement最常继发于撞击综合征Can occur inCan occur in patie
5、nts with collagen vascular diseasepatients with collagen vascular disease可发生于胶原血管病患者Can be acute,but more often repeated attacks on the Can be acute,but more often repeated attacks on the basis of the already suffer from tendon diseasebasis of the already suffer from tendon disease可急性发生,但更常在已患有肌腱病的基
6、础上反复发作Tendon thickening,hardening;Partial or total Tendon thickening,hardening;Partial or total disruption;Some tear on slippery bursa,articular disruption;Some tear on slippery bursa,articular surface or in the stromasurface or in the stroma肌腱增厚、硬化;部分或完全中断;部分撕裂可在滑囊面、关节面或间质中Collagen degeneration,but
7、 there is no inflammatory Collagen degeneration,but there is no inflammatory cells,chronic tendon can appear in fatty infiltrationcells,chronic tendon can appear in fatty infiltration胶原变性,但没有炎性细胞,慢性肌腱撕裂中可出现脂肪浸润 period:rotator cuff,especially hills tendon period:rotator cuff,especially hills tendon e
8、dema and hemorrhageedema and hemorrhage肩袖特别是岗上肌腱水肿和出血Tendonitis Tendonitis or inflammatory lesions,it is better to send in or inflammatory lesions,it is better to send in less than 25 years old young man.reversibleless than 25 years old young man.reversible肌腱炎或炎性病变,最好发于小于25岁的青年人,可逆.period:inflammati
9、on further progress and period:inflammation further progress and more fibrous tissue formationmore fibrous tissue formation炎症进一步进展及更多的纤维组织形成Happens at 25Happens at 2545 years old.45 years old.好发于25-45岁。period:rotator cuff tear.period:rotator cuff tear.肩袖撕裂。Often occur Often occur in more than 45 yea
10、rs old.in more than 45 years old.常发于45岁以上。Best location:being is 1 cm,from the hills muscle to the greater Best location:being is 1 cm,from the hills muscle to the greater tuberosity attachment points(no vascular distribution).tuberosity attachment points(no vascular distribution).最好发部位:岗上肌距大结节附着点1c
11、m处(无血管分布)。On all pulseOn all pulse sequence,signals are increasedsequence,signals are increased在所有脉冲序列上,信号均增高Tendon thickening,signal not usually Tendon thickening,signal not usually homogeneoushomogeneous肌腱常常增厚、信号不均匀Partial tear,visible water signal in the Partial tear,visible water signal in the t
12、endons,but only partial tendon involvementtendons,but only partial tendon involvement 部分撕裂,在肌腱中可见水样信号,但只是部分肌腱受累Tendon full-thickness tear,liquid into tendon Tendon full-thickness tear,liquid into tendon fractures,with varying degrees of tendon fractures,with varying degrees of tendon retractionretra
13、ction肌腱全层撕裂,液体进入肌腱裂隙中,伴不同程度的肌腱回缩Tendon full-thickness tear of the chronic Tendon full-thickness tear of the chronic patients to merge muscle fat atrophypatients to merge muscle fat atrophy肌腱全层撕裂的慢性患者可合并肌肉脂性萎缩 Thin contrast sketch below outline of the rotator cuff(white arrow)薄的造影剂勾画出肩袖的下面轮廓(白长箭头),No
14、rmal joint capsule(black arrow),正常关节囊(黑箭头),axillary fossae(white triangle arrows).腋隐窝(白三角箭头)。Fig 1 Subdeltoidsubacromial bursitis.肩峰下滑囊炎。Coronal oblique MR images of the shoulder show fluid in the dilated subdeltoidsubacromial bursa(arrow head).常规MRI斜冠状位示肩峰下滑囊积液(箭头);1A:SE T1W;1B:TSE T2W.Fig 2 Acromi
15、al morphology.肩峰形态。A.Shape of the Acromion.Type I,flat型,肩峰下表面为一平面;Type II,curved型,肩峰下表面为弧形凹面;Type III,hooked 型,肩峰下表面前部呈钩状突;B.Sagittal oblique image shows a Type II acromion and a degenerative spur at the anteroinferior edge of the acromion(arrow).MRI造影斜矢状位示肩峰前下缘的骨刺(箭),型肩峰 Fig 3 Tendinitis.肩袖变性。Coron
16、al oblique MR images of the shoulder show the supraspinatus tendon is diffuse thickening,with intrasubstance intermediate signal on T1-weighted and T2-weighted MR images(arrow).常规MRI斜冠状位示冈上肌腱增粗,连续性好,T1W和T2W信号均增高(箭)4AFig 4:Bursal-sided partial thickness tear of the subscapularis.冈上肌腱上表面部分撕裂.4A:Obliqu
17、e coronal T2-weighted image shows partial disrupture of the bursal-sided tendon fibers(arrow).The articular-sided fibers are intact.常规MRI 斜冠状位FS T2W 示冈上肌腱止点处上表面部分撕裂,局部见液性高信号(箭),伴肩峰下滑囊积液,下表面完整.4B:partial thickness tear of the subscapularis.Oblique coronal T2-weighted MR image shows partial discontinu
18、ity of the articular-sided tendon fi bers(arrow).The bursal-sided fi bers are intact.冈上肌腱下表面部分撕裂。常规MRI 斜冠状位FS T2W示冈上肌腱止点处下表面撕裂(箭),信号增高,但上表面完整4B4C4DFig4C:Intratendinous partial thickness tear of the subscapularis.冈上肌腱腱内部分撕裂。Oblique coronal T2-weighted MR image shows abnormal intratendinous fluid accu
19、mulation(arrows).The bursal-sided and articular-sided fi bers are intact常规MRI 斜冠状位FS T2W示冈上肌腱止点处腱内限局液性高信号影(箭),肌腱上下表面均完整.Fig4D:Articular-sided partial thickness tear of the subscapularis.冈上肌腱下表面部分撕裂。Oblique coronal T1-weighted MR arthrographic image shows partial discontinuity of the articular-sided
20、fi bers(arrows),with contrast material leaking into the substance of the tendon,and intact bursal-sided fi bers.MRI造影斜冠状位示高信号对比剂进入冈上肌腱下表面(箭),但未进入肩峰下滑囊Fig 5:Different MRI techniques for labral tear.盂唇撕裂对比。Fig5A:An axial routine MR image shows intact anteroinferior labrum.常规MRI 轴位示盂唇未见撕裂征象;Fig5B:An ax
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