Pehea e hoʻohana ai i ka MRI no ka ʻike ʻana i nā ʻeha Knee Meniscus a me Ligament?

ʻO ka meniscus he fibrocartilage meniscus me kahi ʻāpana triangular i waena o ka condyle tibial a me ka pāpū, kahi e hoʻomaikaʻi maikaʻi ai i ka hui ʻana o ka femoro-tibial a he hana koʻikoʻi i ka hoʻoikaika ʻana o nā kuli.

Nā ʻike maʻamau a me nā ʻike ʻole ʻo Mri

Ma nā kiʻi sagittal a me mua, he triangular ka meniscus maʻamau i ka hypointense. Ma ke kiʻi sagittal ʻaoʻao loa, ʻo ka meniscus he hale 'bow-tie' me kahi ʻāpana waena-sagittal i hui pū ʻia me nā pepeiaohao mua a me hope (Figure 1).

Kiʻi 1 Nānā MRI maʻamau o ka meniscus medial. ʻO ka nānā ʻana i ka sagittal density-weighted proton: ʻO nā kihi meniscal mua a me hope he mau huinakolu hypointense homogeneous. He ʻano kakaka ka meniscus a aia nā ʻāpana o ka ʻāpana waena e hoʻopili ai i kona mau kiwi mua i mua ona a me kona mau pepeiaohao hope ma hope.

He mea pono ke hoʻomaopopo i kekahi mau meaʻino anatomical no ka mea hiki iā lākou ke hoʻohālike i ka māhele meniscal:

• Ma ka ʻāpana sagittal, ka hoʻololi ʻana ma waena o nā ligament transverse a me nā mua;

• puʻupuʻu tendon popliteal;

• Hoʻopili ʻo Humphrey lāua ʻo Wrisberg meniscus-femoral ligament i ka pepeiaohao hope o ka meniscus lateral i ka condyle femoral medial;

• ʻO ka ligament meniscus oblique, kahi e hoʻopili ai i ka pepeiaohao mua o ka meniscus i ka pepeiaohao hope o ka meniscus ʻē aʻe, hiki ke hoʻohālike i kahi meniscus a i ʻole ka pahu pahu.

• ʻO ka discoid meniscus kahi ʻano deformity meniscus congenital. Hoʻopili kēia meniscal dysplasia kokoke i ka meniscus lateral. Hoʻokumu ʻia kāna hōʻailona 'academic' ma MRI ma ka ʻike ʻana i ka hoʻomau ʻana o nā kiwi mua a me hope ma nā kiʻi sagittal ma ka liʻiliʻi he 3 mau ʻāpana 5 mm mānoanoa (Fig. 2). Hoʻoponopono ʻia kēia mau ʻike ma muli o nā hoʻonohonoho ʻāpana i hoʻohana ʻia.

Kiʻi 2 Discoid lateral meniscus. Sagittal T1-kaumaha kiʻi. Ka hoʻomau ʻana o nā kihi mua a me hope ma 3 mau ʻāpana paʻa 5mm. E nānā i ka emi ʻana o ka myxoid o ka pepeiaohao mua o kēia meniscus discoid.

Meniscus Pathology Imaging

He hana maʻamau ka hoʻokaʻawale ʻana ma waena o ka meniscus traumatic a me ka meniscus degenerative. Loaʻa nā ʻeha ʻeha ma muli o ka hoʻohana ʻana i ka ikaika mechanical i kahi meniscus olakino. I ka poʻe ʻōpio, maʻamau ka maʻi ma muli o ka ʻeha valgus indirect, kahi piʻi koke o ka tibia ma hope o ka hoʻololi ʻana o waho a i ʻole hyperflexion o ke kuli ma 20 ° o ka flexion. Akā, hiki mai ka degeneration ma muli o nā mana mechanical maʻamau e hana ana i ka meniscus i hōʻino ʻia e ka interstitial myxoid degeneration. Hiki ke hoʻomohala wale ʻia nā māwae meniscal horizontal a i ʻole ma muli o nā ʻeha liʻiliʻi.

Hoʻokaʻawale

E like me ke kuhikuhi o ka mokulele cleavage, hiki ke hoʻokaʻawale ʻia nā māwae i nā māwae ākea, nā māwae kū a i ʻole nā ​​māwae paʻakikī.

ʻAha Horizontal

Aia kekahi mokulele ʻokiʻoki e like me ka pāpū tibial e hoʻokaʻawale i ka meniscus i nā ʻāpana kiʻekiʻe a haʻahaʻa. ʻO kēia mau ʻeha ākea ākea, hiki ke hoʻopilikia nui i ka meniscus medial a i ʻole lateral meniscus, a ua manaʻo ʻia he kūpaʻa, ʻoiai ua wehewehe ʻia nā ʻōpala i neʻe i loko o ke awāwa ma hope o ka hōʻino ʻana i ka meniscus medial.

ʻAha kū pololei

Kū pololei i ka mokulele tibial a ma ke anapuni o ka meniscus. Hoʻopili pinepine kēia i ka meniscus medial. Manaʻo ʻia kahi hōʻeha piha ʻaʻole paʻa a hoʻokaʻawale i ka meniscus i nā ʻāpana medial a me ka ʻaoʻao. Aia pū ka pae scanning i ke kino meniscus lateral a me ka pepeiaohao hope o ka meniscus, he mea maʻalahi ke kuhi hewa ʻia e like me ka haʻihaʻi ʻana o ka pahu pahu, ʻoi aku ka nui o ke ʻano i ka wā e hoʻohuli ʻia ka hui kuli ma waho. Hoʻohui pū ʻia me nā kiʻi sagittal, hiki ke hoʻokuʻu ʻia ka haʻalulu o ka pahu pahu (Figure 3).

A. Coronal MRI, e kuhikuhi ana ka pua i ka pepeiaohao hope o ka meniscus aoao, he mea maʻalahi ke kuhi hewa ʻia e like me ka māwae pahu; B. I ka hana ʻana i ka nānā ʻana i ka MRI e like me ke kūlana i hōʻike ʻia e ka laina kikoʻī ma ke kiʻi, e ʻike ʻia kahi pseudo barrel handle waimaka.

He kū pololei nā māwae Radial i ka ʻāpana o ka meniscus a pili pinepine i ka lihi kūʻokoʻa o ka meniscus.

Haehae nuku Parrot

ʻO kahi pōʻino kūpaʻa hui pū ʻia me kahi ʻāpana longitudinal a me kahi ʻāpana radial e hoʻolōʻihi ana i ka lihi manuahi.

ʻO ka mea hope loa, aia nā hōʻeha meniscal paʻakikī, me ka ʻole o ka wehewehe ʻana, e pili ana i nā māwae ākea a me ke kūpaʻa.

Hoike Mri No ka Eha Meniscus

Haehae Meniscus

Stoller et al. manaʻo ʻia he 3 mau māka o ka meniscus (Figure 4)

Papa 1: Hoʻopaʻa ʻia ka meniscus nodular hyperintensity ma ka ʻili meniscus;

Papa 2: Hoʻopaʻa ʻia ka meniscus linear hōʻailona kiʻekiʻe ma ka ʻili meniscus;

Papa 3: Hoʻonui ka Hyperintensity i hoʻokahi ʻili o ka meniscus.

Helu 4 Stoller scale. a: Papa 1: Hoʻokahi a ʻoi aʻe paha nā wahi nodular hyperintensity waena e pili ana i ka ʻili o ka meniscus; b: Papa 2: Linear intermediate hyperintensity ma ka ʻili o ka meniscus; c: Papa 3: Linear intermediate hyperintensity e hoʻonui ana i kahi ʻili o ka meniscus.

ʻOiai he haʻahaʻa ka hoʻokaʻawale ʻana ma waena o nā papa 2 a me 3, hoʻokaʻawale ia i ka hyperintensity intrameniscal degenerative (Figure 5) mai nā fissures maoli. ʻAʻole maʻalahi kēia ʻokoʻa ma waena o ka meniscus degenerated a haehae ʻia, a he nui nā kumu o ka hewa ma muli o ke ʻano o ke keu a i ʻole nalo.

Kiʻi 5. ʻO ke ʻano degenerative o ka meniscus. Sagittal proton density nānā me ka momona saturation. Hiki ke ʻike ʻia nā wahi hōʻailona kiʻekiʻe me ka ʻole o ke kiʻi linear fracture maoli.

Nā mea e mālama ai:

He hana maikaʻi loa ka MRI, me ka ʻike a me ka kikoʻī ma waena o 90% a me 95%. Ma ka MRI, ʻike ʻia kahi ʻāpana meniscal ma ke ʻano he hoʻonui hypointense linear intermediate i kekahi o nā ʻaoʻao articular o ka meniscus (Stoller grade 3), a i ʻole kahi maʻi morphological maʻemaʻe.

Ke ʻike ʻia ka waimaka ma kahi ʻāpana hoʻokahi, aia kekahi mau pilikia, ʻoi aku ka nui o ka hopena o nā hopena maikaʻi ʻole. Inā pili nui ka hyperintensity i loko o ka meniscus linear i ka ʻili meniscal, ʻo ia hoʻi ma ka liʻiliʻi o ʻelua mau ʻāpana pili, pono ia e manaʻo ʻia he pathological. Pono e hoʻololi ʻia kēia manaʻo ma muli o ke ʻano kiʻi kiʻi i hoʻohana ʻia (3 a 4 mm mau ʻāpana a i ʻole ka loaʻa ʻana o kahi leo 3D me nā ʻāpana isotropic mm).

ʻOi aku ka paʻakikī o nā clefts radial meniscal i kekahi manawa, hāʻawi ʻia i kā lākou ʻano. Ke alakaʻi nui nei kēia i nā abnormalities morphological:

• Hoʻokiʻoki ʻia a ʻoki ʻia paha ma ke kiʻi mua;

• ʻO ka hiʻohiʻona hoʻopau a ʻoki ʻia paha o ka meniscus bowtie ma ke kiʻi sagittal (Figure 6);

Kiʻi 6. ʻO ka māwae Radial i ka māhele mua o ka meniscus medial i ka sagittal proton density-weighted view. ʻO ke ʻano maʻamau o ka meniscus medial truncated bow tie (arrow).

• He meniscus nalo a i ʻole 'ʻuhane' me kahi āwaha radial paʻa.

ʻO ka uhaki ʻana o ka meniscus me kahi pahu bakeke e paʻakikī ma kahi o 10% o ka spondylolisthesis lōʻihi. I kēia hihia, ʻo ka sensitivity o MRI ma kahi o 70%, e pili ana i nā pae diagnostic i hoʻohana ʻia.

ʻO nā ʻike MRI e pono e nānā:

'O ka 'ike ma'amau 'o ia ka 'ike pono 'ana o ka ne'e 'ana i nā ʻāpana i loko o ka ʻāpana intercondylar: ʻo ka 'double posterior cruciate ligament (PCL)' kahi hiʻohiʻona i ka wā i poino ʻia ai ka meniscus medial a paʻa ka ligament cruciate mua. Hōʻike ʻia ka ʻāpana i hoʻokaʻawale ʻia ma ke ʻano he arcuate hypointense band e like me ka ligament cruciate hope maʻamau, e hana ana i kahi hiʻohiʻona 'PCL pālua' (Fig. 7). Hiki ke hōʻike ʻia ke ʻano o kahi pahu pahu (Figure 8). I kēia hihia, ua hoʻopili ʻia ka ʻāpana meniscus i hoʻoheheʻe ʻia i ka pepeiaohao mua olakino.

Kiʻi 7 ʻO ka hiʻohiʻona o ka lima meniscus medial he hōʻailona 'double PCL'. Nānā Sagittal PD-kaumaha me ka hoʻopaʻa ʻana i ka momona: Aia ka ʻāpana meniscus (arrow) ma lalo o ka PCL maʻamau (arrow) a hana i ke ʻano o ka hiʻohiʻona 'double PCL'.

Kiʻi 8 ʻO ke ʻano o ka pu nui mua. Nānā paona proton sagittal. Hoʻopili ʻia ka ʻaoʻao mua o ka ʻāpana dislocated (arrow) i ka anterior meniscus angle (arrow). E hoʻomaopopo ʻaʻole i hōʻike ʻia nā kihi hope (*).

ʻO nā ʻike MRI ʻē aʻe:

Ua hōʻoia ʻia nā hōʻailona MRI ʻē aʻe, e like me ka nalo ʻana o ke kaula kakaka, ka hōʻailona meniscus inverted, a i ʻole nā ​​ʻāpana meniscal i hoʻoneʻe pololei ʻia i ka ʻāpana intercondylar ma nā kiʻi mua millimeter (Fig. 9) a i ʻole nā ​​kiʻi axial.

Kiʻi 9 Wehe ʻia ka pahu bakeke ma ka slot. Frontal PD-kaumaha ʻike ma hope o ka hoʻopau ʻana i ka momona. Hoʻopili ka ʻāpana meniscus (arrow) me ka ACL (arrow).

ʻO kekahi hōʻailona maʻamau o ka meniscal instability ka ʻike ʻana o ka neʻe ʻana o nā ʻāpana meniscal i loko o ka male meniscal recess a i ʻole ka femoral-tibial recess. ʻO kēia mau hoʻoneʻe ʻana e pili ana i ka meniscus lapaʻau wale nō a he hoʻopiʻi ia o kekahi mau hihia cleft ākea i 10% o nā hihia. ʻO nā ʻāpana coronal a me ka transverse ke ala maikaʻi loa e ʻike ai i kēia mau ʻāpana.

Meniscus Detachment

ʻO ka wehe ʻana o ka meniscal ma muli o ka ʻeha valgus koʻikoʻi a ma muli o ka haki ʻana o ka ʻāpana capsular meniscus. Hoʻopili kēia mau mea i ka pepeiaohao hope o ka meniscus medial e pili ana i ka capsule hui ma o ka mānoanoa o ka capsule hui (ka hope oblique ligament).

ʻO ia ka hopena i ka 5 mm offset i ka meniscus kiʻekiʻe mai ka palena hope o ka pā tibial ma nā kiʻi sagittal (Fig. 11), aiʻole ka hoʻokomo wai ma waena o ke kumu o ka meniscus a me ka mokulele o ka capsule hui.

Kiʻi 11 ʻO ka wehe ʻana o ka pepeiaohao hope o ka meniscus. Sagittal proton density nānā. Ua hoʻoneʻe ʻia ka meniscus i hoʻokaʻawale ʻia ma mua. Aia kahi ʻāpana nui o ka hyperintensity (*) ma waena o ke kumu o ka meniscus a me ka capsule hope (arrow).

Meniscus lana

ʻO kēia ka hopena o kahiʻehaʻeha a ma muli o ka hakiʻana o ka ligament meniscal-tibial a me ka weheʻana o ka māhele medial o ka meniscus. Ma ka MRI, ua ho'opuni piha 'ia ka meniscus i ho'oka'awale 'ia e ka wai a 'ike 'ia e 'float' ma ka pāpū tibial (Figure 12).

Helu 12 Meniscus lana. Nānā mua proton density me ka momona momona. Hoʻopuni ʻia ka meniscus i hoʻokaʻawale ʻia e ka wai, ʻoi aku ka nui ma waena o kona ʻili haʻahaʻa a me ka pāpū tibial (arrow).

Meniscus postoperative

ʻO ka ʻeha mau ma hope o ka meniscectomy e hōʻike ana i nā pilikia diagnostic he nui: nā maʻi hou, postmeniscectomy, chondrolysis, subchondral necrosis, a i ʻole arthralgia. ʻAʻole ʻike pinepine ʻo MRI i nā māwae hou no ka haʻalele ʻana o ka meniscectomy i nā hyperintensities waena e 'hewa' e kamaʻilio me ka ʻili meniscus. ʻO ka ʻike wale nō i manaʻo ʻia he pathological a unuhi ʻia ma ke ʻano he maʻi maʻi hou, ʻo ia ka hyperintensity intrameniscal fluid ma nā kiʻi paona T2. ʻO kēia mau palena o ka MRI maʻalahi wale nō i koi i kekahi mau mea kākau e noi i ka hoʻohana ʻana i ka MRI arthroscopy, ʻoiai ʻaʻole kūlike nā hopena ma aneʻi.

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