积水潭膝关节MRI.ppt

J.S.T,北京积水潭医院关节镜组,Practical Interpretation,of,Knee MRI,Routine MRI protocol,Sagittal,Coronal,Axial,Spin echo(SE),FSE,STIR,T1,T2,PD,JST,Coronal:T2FFE T2 STIR,Saggital,:T1 T2,T2FFE T2 STIR,TR,和,TE,决定成像加权,短,TE,长,TE,短,TR T1,无用途,长,TR PD T2,T1,weighted image (TR1000msec,TE1500msec,TE60msec),“pathology”,Fat suppression,Chemical saturation,Short,tau,inversion recovery,(STIR),Tissue characterization,T1 T2,Adipose tissue,Fat,white gray,Yellow marrow,Water dark white,Cortical bone black black,Cartilage gray gray,Tendon/ligament/meniscus black/gray black/gray,Muscle gray gray,Hematoma,white white,Chronic hemorrhage dark dark,Anterior,Cruciate,Ligament,extension ER 15 20,Normal MR appearance,direct sign of torn,ACL,discontinuity,abnornal,orientation(fallen ACL),nonvisualization,Avulsion,fx,Indirect,Bone bruise sign,Deep,sulcus,sign,Segond fx,generalized increase in,signal intensity thickness increase,Anterior drawer sign,Acute,hemarthrosis,Buckling of PCL,pivot-shift pattern,Kissing sign,Segond,sign,Deep,sulcus,sign,2,mm,generalized increase in,signal intensity thickness increase,Buckling of PCL,nonspecific,Ant.drawer sign,Associated soft tissue injuries,Posterior horn of medial meniscus,Bucket handle tear,MCL,Posterior,Cruciate,Ligament,Normal MR appearance,Meniscus-Femoral ligament,Primary sign of PCL,complete tear partial tear“peel off”injury,Complete tear,Grade1,Grade3,Grade2,partial,tear,Secondary sign of PCL injury,bone marrow edema(BME),avulsion,fx,Dashboard injury sign,Bone Marrow Edema,Tibial,avulsion,fx,Associated ligament injury,ACL injury,MCL injury,PLC/LCL injury,Collateral ligament,Normal Anatomy of MCL,Grading MCL Injuries,Grade 1(sprain),Grade 2(partial tear),Grade 3(complete tear),Normal Anatomy of the LCL Complex/,Posterolateral,Corner Complex,Iliotibial,band,LCL,Popliteal,plex,Biceps tendon,Visible disruption of one of the,posterolateral,capsule structures,Extensive surrounding soft tissue edema,Avulsion fracture or marrow edema involving the medial aspect of the fibular head,Signs of,Posterolateral,Corner Injury,Menisci,bow ties 2,triangular,rectangular,Criterial,to detect,meniscal,tear,grade 3 signal,abnormal,meniscal,morphology,displaced or missing,meniscal,tissue,meniscocapsular,separation,Grade III meniscus tear,missing fragment,Displaced fragment,small PHMM,MRI signs,absent bow ties sign(1 or fewer),double PCL sign,large anterior horn sign,too many bow ties(3 or more),notch sign,Large&degeneration ant.horn,3,or more bow-ties,Bucket handle tear,double PCL sign,discoid meniscus,3,or more bow-ties,Pitfalls in meniscus diagnosis,Grade II signal,Transverse meniscus,lig,.,Popliteal,hiatus,Meniscofemoral lig,.,Bursa or fat plane of MCL,Popliteal,hiatus,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 represent 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,retear,Bone Marrow Edema(BME),pivot-shift injury,dashboard injury,hyperextension injury:”kissing sign”,clip injury,patellar dislocation,clip injury,patellar dislocation,OCD,popliteal,cyst,Meniscus cyst,PVNS,cruciate,cyst,ACL cyst,Patellar dislocation,patellar tendon,Jumpers knee,Housemaids knee,Deep&,Superficail,infrapatellar,bursa,