半月板损伤的MR影像

Congress: ECR 2019
Poster No.: C-3351
Type: Educational Exhibit
Keywords: Trauma, Pathology, Diagnostic procedure, MR, Musculoskeletal joint
Authors: A. C. Vieira, A. Vieira; Porto/PT
DOI: 10.26044/ecr2019/C-3351
DOI-Link: http://dx.doi.org/10.26044/ecr2019/C-3351

Findings and procedure details
The menisci are structures with intrinsic low signal intensity on all MRI sequences.

半月板在所有MRI序列上呈固有的低信号结构。

Therefore, the MRI criteria for diagnosing meniscal tears in the absence of previous surgery is either an increased intrasubstance signal unequivocally contacting the articular surface on at least two consecutive slices, “the 2-touch slice rule”, or at least in one coronal and in one orthogonal sagittal plane.

因此,在没有既往手术史的情况下诊断半月板撕裂的MRI标准是在至少两个连续层面上可见明确接触关节面的内部高信号影,“2个连续层面规则”,或者至少在一个冠状面和一个正交的矢状面。

 

Considering the anatomy of the meniscus, the posterior horn of the medial meniscus is the most commonly involved. Anterior horn tears are rare and should be carefully diagnosed as they are only reported with a prevalence of 2% of all medial meniscal tears and 16% of all lateral meniscal tears.

考虑到半月板的解剖结构,内侧半月板后角撕裂是最常见的。前角撕裂是罕见的,诊断应慎重,因为前角撕裂在所有内侧半月板撕裂中占2%的比例、在所有外侧半月板撕裂占16%的比例。


以下为病例图片:

半月板损伤的MR影像

Fig. 1: Posterior horn medial meniscal tear

内侧半月板后角撕裂

半月板损伤的MR影像

Fig. 2: Lateral meniscus anterior horn tear

外侧半月板前角撕裂

半月板损伤的MR影像

Fig. 3: Traumatic tear – young patient with a vertical tear of the posterior horn of the medial meniscus

创伤性撕裂 – 年轻患者内侧半月板后角垂直撕裂

半月板损伤的MR影像

Fig. 4: Degenerative tear – older patient with horizontal tear

退行性撕裂 – 老年患者水平撕裂

半月板损伤的MR影像

Fig. 5: Longitudinal-vertical tear with associated ACL tear

图5:纵向垂直撕裂伴有前交叉韧带撕裂

半月板损伤的MR影像

Fig. 6: Bucket handle tear showing the typical double PCL sign on sagittal image

桶柄样撕裂,矢状位图像显示典型的“双后交叉韧带”征象

半月板损伤的MR影像

Fig. 7: Horizontal tear of the lateral meniscus with an associated parameniscal cyst (secondary sign of meniscal tear presence)

外侧半月板水平撕裂伴半月板囊肿(半月板撕裂的间接征象)

半月板损伤的MR影像

Fig. 8: Radial tear

放射状撕裂

半月板损伤的MR影像

Fig. 9: Vertical flap tear

垂直瓣状撕裂

半月板损伤的MR影像

Fig. 10: Complex tear

复杂撕裂

半月板损伤的MR影像

Fig. 11: Radial posterior root tear of the medial meniscus

内侧半月板后根的放射状撕裂

半月板损伤的MR影像

Fig. 12: Radial posterior root tear associated with a subchondral insufficiency fracture

后根的放射状撕裂般软骨下不全性骨折

半月板损伤的MR影像

Fig. 13: Particular Meniscal Tears Illustration

半月板部分撕裂的示意图

半月板损伤的MR影像

Fig. 14: Wrisberg Rip

Wrisberg rips are longitudinal vertical meniscal tears. They occur at the at the junction of the ligament of Wrisberg and the posterior horn of the lateral meniscus, and are commonly associated with anterior cruciate ligament tears

Wrisberg撕裂是纵向垂直半月板撕裂。它们发生在Wrisberg韧带和外侧半月板后角的交界处,通常与前交叉韧带撕裂相关

半月板损伤的MR影像

半月板损伤的MR影像

Fig. 15: Ramp lesion

Ramp lesion特指内侧半月板后角滑膜缘的撕裂伤,是半月板损伤少见的一种,一般是陈旧性前交叉韧带断裂导致的继发性损伤

半月板损伤的MR影像

Fig. 16: Discoid meniscus

盘状半月板

半月板损伤的MR影像

Fig. 17: Degenerated discoid meniscus in a young patient

一名年轻患者的退变性盘状半月板

半月板损伤的MR影像

Fig. 18: Meniscal flounce

裙边样半月板(变异)


Secondary signs – tips to diagnose a meniscal tear

  • Injuries of the popliteomeniscal fascicles
  • Meniscal extrusion
  • Parameniscal cysts
  • Linear subchondral bone marrow edema adjacent to the meniscal posterior roots attachment sites
  • Bone contusions

诊断半月板撕裂的间接征象:

  • 腘肌半月板纤维束的损伤
  • 半月板外突
  • 半月板旁囊肿
  • 邻近半月板后根附着部位的软骨下线性骨髓水肿
  • 骨挫伤

Conclusion

Radiology has a major role in depicting meniscal tears mainly those that occur at “blind spots” for the arthroscopist (flap and mainly posterior root longitudinal tears).

放射学在诊断半月板撕裂中起主要作用,主要是针对关节镜手术的“盲点”(瓣状和后根为主的纵向撕裂)。

Although meniscus repair and transplantation are becoming more common, the majority of meniscal surgeries are still partial or subtotal meniscectomies.

尽管半月板修补和移植变得越来越普遍,但大多数半月板手术仍然是部分或次全切除术。

As treatment options for meniscal injuries continue to evolve an accurate interpretation of imaging studies becomes more complex but also necessary.

随着半月板损伤的治疗选择不断发展,对影像学的准确解读变得更加复杂,但也是必要的。

A detailed knowledge of technical factors, normal anatomy, pitfalls, subtypes of meniscal tears, surgical techniques, as well as adhering rigorously to established imaging criteria (ISAKOS classification) for the diagnosis of meniscal tear are required not only for high diagnostic accuracies but also because it has implications on patient management.

详细了解技术因素、正常解剖、诊断陷阱、半月板撕裂的亚型、手术方式,以及严格遵守既定影像标准(ISAKOS分类)是诊断半月板撕裂必要条件,不仅可以提高诊断的准确性,而且对患者的管理也有影响。


半月板损伤的MR影像

 Classification of meniscal tears as developed by ISAKOS.

 A: Types of tears. B: Location. 

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