【作者】 高哲琪；

【导师】 牛金亮；

【作者基本信息】 山西医科大学 ， 影像医学与核医学， 2011， 硕士

【摘要】 研究目的：搜集经MRI诊断髌内侧滑膜皱襞患者病例和正常同年龄阶段正常对照组进行膝关节软骨MRI扫描,进行T2图处理,分析比较正常对照组与髌内侧滑膜皱襞患者对应软骨T2值变化规律,量化分析并评价软骨的受损情况,从而间接反映滑膜皱襞病变的严重程度,以协助临床对滑膜皱襞综合征的早期诊断与治疗,同时为监测药物治疗关节软骨病损、软骨修复等的临床评价提供依据。材料与方法：1.临床资料收集2009年9月至2011年2月经MRI检查诊断髌内侧滑膜皱襞患者35例,选择同龄组22名正常对照组40个膝关节,行轴位SE序列4回波系列扫描。扫描完成后,将T2-mapping成像数据输入到工作站GE ADW 4.4,应用Functool中Research软件后处理程序得到膝关节软骨的T2-mapping伪彩图像,选择合适的感兴趣区域(region of interes t, ROI)分别测量正常对照组与病例组的软骨T2值。2.根据滑膜皱襞的宽度,将病例组分为A、B两组。3.统计分析正常对照组与各病例组之间关节软骨的T2值差异。对照组与病例A组对应软骨T2值的比较采用独立样本t检验,对照组与病例B组对应软骨T2值的比较采用独立样本t检验,病例A组与B组对应软骨T2值的比较采用独立样本t检验。结果：1.22名正常对照组40个膝关节股骨内侧面、髌骨面的T2值与滑膜皱襞患者A组13个膝关节、B组22个膝关节面软骨T2值的比较。22名正常对照组40个膝关节股骨内侧面、髌骨面的T2均值(ms)分别为：48.49±4.47;51.40±4.97。滑膜皱襞患者A组13个膝关节股骨内侧面、髌骨面的T2均值(ms)分别为：49.04±2.70;50.01±4.36。滑膜皱襞患者B组22个膝关节股骨内侧面、髌骨面的T2均值(ms)分别为：50.35±2.35；54.39±4.72。正常对照组股骨内侧面、髌骨面软骨T2值与A组软骨T2值差异无显著性(P>0.05)。5、正常对照组股骨内侧面、髌骨面软骨T2值低于B组软骨T2值,二者之间差异均有显著性(P<0.05)。6、病例A组股骨内侧面、髌骨面软骨T2值低于B组软骨T2值,二者之间差异均有显著性(P<0.05)。2.22名正常对照组40个膝关节股骨内侧面、髌骨面的T2值与滑膜皱襞患者A组13个膝关节、B组22个膝关节面软骨T2图的空间分布特征。22名正常对照组40个膝关节股骨内侧面、髌骨面的T2图与病例A组13个膝关节的T2图显示清楚,其中35个膝关节软骨T2图色阶较均匀,呈绿色色阶；另外18个膝关节软骨T2图色阶不均匀,以绿色色阶为主,其内局部区域呈蓝色色阶。病例B组22个膝关节软骨T2图表现为局部退变的黄色或红色像素区域明显增多,而相对较低T2值的蓝色或绿色像素区域减少。结论：1、髌内侧滑膜皱襞的存在增加了对应软骨损伤的危险性。2、T2值随着软骨退变程度加重而升高。T2图成像技术可以敏感地反映出关节软骨形态轮廓无明显改变之前的生化成分的改变,从而无创性间接指导临床对滑膜皱襞综合征的诊断与治疗。更多还原

【Abstract】 Objective:to measure T2 values of the articular cartilage in patients with Medial Patellar Plica (MPP) compared with healthy subjects of same age group, to analyze and evaluate the variation law of T2 values of with articular cartilage injury.MRI scanning and treatment of T2 values in order that the degree of seriousness of articular cartilage injury can be indirectly reflected and the early diagnosis and treatment can be helped in the Medial Patellar Plica(MPP)Syndrome. The ground is provided for monitoring articular cartilage injury and evaluating clinical recovery of articular cartilage.Materials and methods:1. clinical resource:By collecting the data of 35 cases of patients with MPP from September,2009 to Februry, 2011 and 40 knee articular cartilages of 22 healthy subjects of the same age group, who were examined with sagittal 4-echo SE sequence.T2-weighted images were done and then were processed on GE workstation using a FUNCTOOL 4.4 software to construct T2-mappings. Appropriate regions of interest are selected and articular cartilage T2 values of control group and patients are measured respectively.2. The cases of patient group are divided into group A and group B according to the width of MPP3. to analyze the T2 values differences of articular cartilage of control group and MPP patient group statistically. The comparison of T2 values of articular cartilage between control group and patient group A adopts independent-sample t test, while the comparison of T2 values of corresponding articular cartilage surface between control group and patient group B adopts independent-sample t test. The comparison of T2 values of corresponding articular cartilage between patient group A and group B adopts independent-sample t test.Results 1. The comparison of T2 values in the medial femoral cartilage and patella cartilage between 40 articular cartilages of 22 control group and 13 MPP patient group A and 22 MPP patient group B.The T2 average values in the medial femoral cartilage and patella cartilage of 40 articular cartilages of 22 control group respectively are:48.49±4.47ms; 51.40±4.97ms. The T2 average values in the medial femoral cartilage and patella cartilage of 13 MPP patient group A are: 49.04±2.70ms; 50.01±4.36ms. The T2 average values in the medial femoral cartilage and patella cartilage of 22 MPP patient group B are:50.35±2.35ms; 54.39±4.72ms. There was no significant difference between T2 values of control group and those of patient group A (P> 0.05). The T2 values of control group were lower than those of group B and there was significant difference between the two (P<0.05). The T2 values of patient group A were lower than those of group B and there is significant difference between the two (P<0.05)2.The space distributing features of T2-mappings in the medial femoral cartilage and patella cartilage of 40 knees in 22 control group,13 MPP patient group A and 22 MPP patient group B:The T2 mappings in the medial femoral cartilage and patella cartilage of 40 knees in 22 control group,13 MPP patient group A were demonstrated clearness,35 of them were contained homogeneous green color-coded pixels,and the rest were showed mainly green color-coded pixels with focal blue color-coded pixels.22 MPP patient group B were showed the focal yellow or red color-coded pixels regions with higher T2 values were increased than that of normal,while the bule and green pixel areas with comparatively low T2 values decrease.Conclusion1. The MPP existence increases the risks of corresponding cartilage injury.2. T2 values become higher with the degree of seriousness of articular cartilages. T2 mapping image technique can sensitively reflect the component change of articular cartilage before the evident change of morphology outline and help with the clinical diagnosis and therapy of MPP symptom.更多还原