摘要
目的研究MRI多征象及扫描序列分析在创伤性肩关节脱位并盂肱下韧带(inferior glenohumeral ligament,IGHL)损伤诊断中的临床应用价值。方法回顾性分析2016年1月—2019年12月重庆市大足区人民医院放射科经关节镜证实创伤性肩关节脱位并IGHL损伤患者105例和95例非IGHL损伤患者的肩关节MRI图像,观察IGHL横轴位、斜冠状位、斜矢状位及T1WI、T2WI、PDWI-FS序列对IGHL损伤显示的敏感度、特异度、阳性预测值、阴性预测值、准确度以及Kappa值一致性,分析IGHL损伤MRI征象并计算各征象的诊断效能,应用二元Logistic回归分析对损伤诊断价值最大的序列、方位及征象。结果PDWI-FS为最优扫描序列,诊断敏感度91.40%、特异度74.74%、阳性预测值80.00%、阴性预测值91.84%、准确度83.50%、Kappa值为0.67;斜冠状位为最佳扫描方位,诊断IGHL损伤敏感度76.20%、特异度74.74%、阳性预测值76.93%、阴性预测值76.96%、准确度73.96%;IGHL损伤显示为5种征象,分别为韧带走行消失伴周围积液或积血、韧带萎缩变细、韧带不连续伴周围积液或积血、韧带走行异常及韧带水肿增粗。其中韧带走行异常敏感度最高为87.80%,约登指数最高为0.80,Kappa值为0.74;韧带走行消失伴周围积液或积血特异度和阳性预测值最高为100%。与IGHL损伤相关性最大的是PDWI-FS序列、斜冠状扫描方位、韧带走行异常。结论对怀疑有创伤性肩关节脱位并IGHL损伤的患者,斜冠状位及PDWI-FS序列能够清晰显示IGHL损伤情况,韧带走行异常为诊断IGHL损伤的最佳征象。
Objective To explore the value of MRI multi-sign and scanning sequence analysis in the diagnosis of inferior glenohumeral ligament(IGHL)injury after traumatic dislocation of shoulder joint.Methods MRI images of 105 patients'damaged IGHL with traumatic dislocated shoulder joint diagnosed by arthroscopy were retrospectively analyzed and 95 intact IGHL were involved as controls from Jan.2016 to Dec.2019 in our hospital.The sensitivity,specificity,positive predictive value,negative predictive value,ccuracy rating and kappa value on the T1WI,T2WI,PDWI-FS sequences in oblique coronal,oblique sagittal,and transverse axial positions were calculated respectively,and the MRI signs of IGHL injury were analyzed and the diagnostic efficacy of each sign was also calculated.The MRI sequence,scanning location and signs with the greatest correlations with IGHL injuries were analyzed by bivariate Logist method.Results PDWI-FS sequences was the best scanning sequence,for which the diagnostic sensitivity was 91.40%,the specificity was 74.74%,the positive predictive value was 80.00%,the negative predictive value was 91.84%,the accuracy was 83.50%,and the Kappa value was 0.67;Oblique coronal position was the best scanning position,for which the sensitivity of diagnosis was 76.20%,the specificity was 74.74%,the positive predictive value was 76.93%,the negative predictive value was 76.96%,and the accuracy was 73.96%.The injury of the inferior glenohumeral ligament showed five signs:disappearance of the ligament with peripheral effusion or hematocele,atrophy and thinning of the ligament,ligament continuous interruption with peripheral effusion or hematocele,walking abnormality of the ligament and thickening of the ligament edema.The abnormal sensitivity of ligament walking was the highest(about 87.80%),the highest Youden index was 0.80,the highest Kappa value was 0.74,and the specificity and positive predictive value of ligament walking disappearance with surrounding effusion or hematoma were the highest(both 100%).PDWI-FS sequence,oblique coronal azimuth and abnormal ligament movement are most greatly correlated with IGHL injuries.Conclusion In patients with suspected traumatic dislocation of the shoulder and injury of the IGHL,the oblique coronal position and PDWI-FS sequence can clearly show the injury of the IGHL,and the IGHL gait abnormality is the best diagnostic MRI sign.
作者
吴绍全
郎海燕
杨正彬
李燕
Wu Shaoquan;Lang Haiyan;Yang Zhengbin;Li Yan(Department of Radiology,Chongqing Dazu District People’s Hospital,Dazu,Chongqing 402360,China)
出处
《创伤外科杂志》
2021年第3期216-221,共6页
Journal of Traumatic Surgery
基金
重庆市大足区科学技术委员会基金项目(DZKJ,2019ACC1003)。
关键词
创伤性肩关节脱位
盂肱下韧带损伤
MRI多征象
扫描序列
traumatic dislocation of shoulder joint
inferior glenohumeral ligament injury
MRI multiple sign
scanning sequence
