CAJ | 학술논문

目的：探讨肩关节肩袖损伤的MRI扫描序列最佳组合的影像诊断价值。方法前瞻性的分析对经关节镜下手术证实的38例临床资料完整的病例行MRI扫描序列常规组合及最佳组合来判定有无肩袖损伤以及各自的准确性、敏感性、特异性，在MRI扫描序列常规组合t2-blade-cor-fs-256，t2-me2d-cor （2D-MEDIC技术）t2-me2d-tra（2D-MEDIC 技术），t2-me2d-sag（2D-MEDIC 技术）的基础上将 t2-me2d-sag （2D-MEDIC技术）序列改为t2-me3d-sag-fs-2mm（3D-MEDIC技术及脂肪抑制技术）组成的序列最佳组合与肩关节镜下手术对比，从而来判定序列最佳组合对肩袖损伤的价值。结果肩袖损伤的38例患者组成肩袖主要各肌肉及其肌腱损伤共152个病变中经肩关节镜下手术证实：其中冈上肌损伤及冈上肌腱撕裂损伤27个病变，冈下肌及肌腱损伤14个病变，肩胛下肌及肌腱损伤16个病变，小圆肌损伤1个病变。肩袖损伤的MRI扫描序列最佳组合与常规组合对肩袖损伤的敏感性分别为86．56％及77．33％，特异性分别为95．29％及76．66％，准确性分别为91．44％及76．97％。与镜下手术对比，MRI扫描序列最佳组合对肩袖损伤的诊断价值无明显统计学差异（ P＞0．05）。结论肩袖损伤MRI扫描序列最佳组合的检查方法，对组成肩袖各肌肉及肌腱都显示清晰、完整、准确性高，是肩关节准确、可靠、实用的MRI检查扫描技术。对临床术前及术后的评估具有指导性作用及较高的临床价值。因此我们运用MRI扫描序列常规组合外，另将t2-me2d-sag改为t2-me3d-sag-fs-2mm（3D-MEDIC技术及脂肪抑制技术）组成的MRI扫描序列最佳组合，增加了检出率，准确性、敏感性、特异性都大大的提高，给临床对肩袖损伤的治疗具有指导意义。
목적：탐토견관절견수손상적MRI소묘서렬최가조합적영상진단개치。방법전첨성적분석대경관절경하수술증실적38례림상자료완정적병례행MRI소묘서렬상규조합급최가조합래판정유무견수손상이급각자적준학성、민감성、특이성，재MRI소묘서렬상규조합t2-blade-cor-fs-256，t2-me2d-cor （2D-MEDIC기술）t2-me2d-tra（2D-MEDIC 기술），t2-me2d-sag（2D-MEDIC 기술）적기출상장 t2-me2d-sag （2D-MEDIC기술）서렬개위t2-me3d-sag-fs-2mm（3D-MEDIC기술급지방억제기술）조성적서렬최가조합여견관절경하수술대비，종이래판정서렬최가조합대견수손상적개치。결과견수손상적38례환자조성견수주요각기육급기기건손상공152개병변중경견관절경하수술증실：기중강상기손상급강상기건시렬손상27개병변，강하기급기건손상14개병변，견갑하기급기건손상16개병변，소원기손상1개병변。견수손상적MRI소묘서렬최가조합여상규조합대견수손상적민감성분별위86．56％급77．33％，특이성분별위95．29％급76．66％，준학성분별위91．44％급76．97％。여경하수술대비，MRI소묘서렬최가조합대견수손상적진단개치무명현통계학차이（ P＞0．05）。결론견수손상MRI소묘서렬최가조합적검사방법，대조성견수각기육급기건도현시청석、완정、준학성고，시견관절준학、가고、실용적MRI검사소묘기술。대림상술전급술후적평고구유지도성작용급교고적림상개치。인차아문운용MRI소묘서렬상규조합외，령장t2-me2d-sag개위t2-me3d-sag-fs-2mm（3D-MEDIC기술급지방억제기술）조성적MRI소묘서렬최가조합，증가료검출솔，준학성、민감성、특이성도대대적제고，급림상대견수손상적치료구유지도의의。
Objective To investigate the image diagnostic value of the best combination of MRI scanning sequences for rotator cuff injury of shoulder.Methods Applied prospective analysis for the general MRI scanning routine and for the best sequence-combination to determine accuracy, sensitive and specificity of shoulder cuff injury for the 38 patients who were confirmed by arthroscopy with integrated clinical data.Based on the general routine which was composed of t2-blade-cor-fs-256, t2-me2d-cor (2D-MEDIC technique), t2-me2d-tra (2D-MEDIC technique) and t2-me2d-sag (2D-MEDIC technique), the t2-me3d-sag-fs-2mm (3D-MEDIC and fat saturated technique) was used instead of t2-me2d-sag (2D-MEDIC technique) for the best combination. The value of this combination was investigated compared with shoulder arthroscopy.Results 152 lesions of the muscle and tendon in shoulder cuff were confirmed by shoulder arthroscopy for the 38 patients, including 27 lesions of supraspinatus, 14 lesions of infraspinatus, 16 lesions of subscapular muscle, and 1 lesion of teres minor.The sensibility of the best combination of sequences and the general MRI routine for shoulder cuff injury were 86.56% and 77.33% respectively; the specificity were 95.59% and 76.66% respectively; and the accuracy were 91.44%and 76.97%respectively.There was no significant statistical difference (P>0.05) for diagnostic value of the best combination of sequences compared with arthroscopy.Conclusions The best combination of sequences for shoulder cuff injury was accurate, reliable and practical MRI scanning technique because the muscle and tendon of the shoulder cuff was displayed distinctly, perfectly and precisely.The combination took the guidance and had superior clinical value for the assessments before and after operations. Therefore, the best combination of sequences with t2-me3d-sag-fs-2mm (3D-MEDIC and fat saturated technique) instead of t2-me2d-sag besides the general routine increased detective efficiency, veracity, sensitivity, and specificity greatly, which could be guide of treatments for shoulder cuff injury.