Diagnostic value of high field intensity MRI and multi-slice CT in occult fracture of knee joint
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摘要:
目的 研究高场强MRI与多层螺旋CT（MSCT）对膝关节隐匿性骨折的检出情况及其诊断价值。 方法 以2019年1月~ 2022年1月我院收治的疑似膝关节隐匿性骨折患者90例为研究对象，所有患者均进行关节镜、高场强MRI及MSCT检查，以关节镜检查结果作为金标准，比较高场强MRI、MSCT对膝关节隐匿性骨折的检查结果与关节镜检出情况、诊断价值及对骨折塌陷程度、水平错位程度显示情况。 结果 90例疑似膝关节隐匿性骨折患者经关节镜检查确诊56例，高场强MRI检出率为92.86%，高于MSCT（78.57%，P < 0.05）。高场强MRI诊断膝关节隐匿性骨折的敏感度、特异性、阳性预测值、阴性预测值、准确度及曲线下面积（92.86%、94.12%、96.30%、88.89%、93.33%、0.935）均高于MSCT（78.57%、67.65%、80.00%、65.71%、74.44%、0.731，P < 0.05）。高场强MRI对骨折塌陷程度、水平错位程度显示率（64.44%、73.33%）均高于MSCT（43.33%、47.78%，P < 0.05）。 结论 与MSCT相比，高场强MRI对膝关节隐匿性骨折的检出率和诊断价值更高，对折塌陷程度、水平错位程度显示情况更好，可为膝关节隐匿性骨折的临床诊断提供可靠信息。 Abstract:Objective To investigate the diagnostic value of high field intensity MRI and multi-slice CT (MSCT) for occult fracture of knee joint. Methods A total of 90 patients with suspected occulted fracture of knee joint admitted to our hospital from January 2019 to January 2022 were studied. All patients underwent arthroscopy, high field intensity MRI and MSCT examination. With arthroscopy as the gold standard, compare the examination results of high field intensity MRI and MSCT on occult fracture of knee joint with the arthroscopic detection, diagnostic value, fracture collapse degree and horizontal dislocation degree. Results Among 90 suspected occult fracture of knee joint, 56 cases were diagnosed by arthroscopy. The detection rate of high field intensity MRI was higher than that of MSCT (92.86% vs 78.57%, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under curve (92.86%, 94.12%, 96.30%, 88.89%, 93.33%, 0.935) of high field intensity MRI in the diagnosis of latent fracture of knee joint were higher than those of MSCT (78.57%, 67.65%, 80.00%, 65.71%, 74.44%, 0.731, P < 0.05). High field intensity MRI showed higher rates of fracture collapse degree and horizontal dislocation degree (64.44%, 73.33%) than MSCT (43.33%, 47.78%, P < 0.05). Conclusion Compared with MSCT, high-field MRI had a higher detection rate and diagnostic value for occult fracture of knee joint, and had a better indication of the degree of collapse and horizontal dislocation, which could provide reliable information for the clinical diagnosis of occult fracture of knee joint. -
图 1 高场强MRI、MSCT诊断膝关节隐匿性骨折的ROC曲线
Figure 1. ROC curve of high field intensity MRI and MSCT in diagnosing occult fracture of knee joint.
图 2 左膝胫骨外侧平台骨折伴轻度塌陷
Figure 2. A fracture of the lateral tibial plateau of the left knee with a mild collapse.
图 3 患者左膝胫骨外侧平台轻度塌陷，可见大片骨髓水肿
Figure 3. A mild collapse of the lateral tibial plateau of the left knee with large bone marrow edema
表 1 高场强MRI、MSCT对膝关节隐匿性骨折的检查结果与关节镜检出情况对比
Table 1. Comparison between the examination results of occult fracture of knee joint by high field intensity MRI and MSCT and arthroscopy(n)
检查方法 关节镜 总计 膝关节隐匿性骨折 膝关节非隐匿性骨折 高场强MRI 膝关节隐匿性骨折 52 2 54 膝关节非隐匿性骨折 4 32 36 总计 56 34 90 MSCT 膝关节隐匿性骨折 44 11 55 膝关节非隐匿性骨折 12 23 35 总计 56 34 90 MSCT: 多层螺旋CT. 
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表 2 高场强MRI、MSCT对膝关节隐匿性骨折的诊断价值比较
Table 2. Comparison of the diagnostic value of high field intensity MRI and MSCT in occult fracture of knee joint
检查方法 敏感度（%） 特异性（%） 阳性预测值（%） 阴性预测值（%） 准确度（%） 曲线下面积 95% CI 高场强MRI 92.86(52/56) 94.12(32/34) 96.30(52/54) 88.89(32/36) 93.33(84/90) 0.935 0.863~0.976 MSCT 78.57(44/56) 67.65(23/34) 80.00(44/55) 65.71(23/35) 74.44(67/90) 0.731 0.627~0.819 χ2 4.667 6.087 5.425 4.213 11.879 4.522 - P 0.031 0.014 0.020 0.040 0.001 ＜0.001 -
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表 3 高场强MRI、MSCT对骨折塌陷程度、水平错位程度显示情况比较
Table 3. Comparison of high field intensity MRI and MSCT on fracture collapse degree and horizontal dislocation degree [n=90, n(%)]
检查方法 骨折塌陷程度 水平错位程度 0级 Ⅰ级 Ⅱ级 Ⅲ级 显示率 0级 Ⅰ级 Ⅱ级 Ⅲ级 显示率 高场强MRI 32(35.56) 28(31.11) 22(24.44) 8(8.89) 58(64.44) 24(26.67) 32(35.56) 24(26.67) 10(11.11) 66(73.33) MSCT 51(56.67) 17(18.89) 16(17.78) 6(6.67) 39(43.33) 47(52.22) 22(24.44) 18(20) 3(3.33) 43(47.78) χ2 8.071 12.304 P 0.004 ＜0.001
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