Momwe Mungagwiritsire Ntchito MRI Kuti Muzindikire Kuvulala kwa Knee Meniscus ndi Ligament?

Meniscus ndi fibrocartilage yofanana ndi meniscus yomwe ili ndi gawo la triangular lomwe lili pakati pa tibial condyle ndi mapiri, zomwe zimathandizira kwambiri mgwirizano wa femoro-tibial ndipo zimagwira ntchito yofunika kwambiri pamagulu a mawondo.

Zomwe Zadziwika Komanso Zachilendo za Mr

Pazithunzi za sagittal ndi kutsogolo, meniscus yodziwika bwino imakhala ya katatu mu hypointense. Pa chithunzi cha sagittal kwambiri, meniscus ndi 'bow-tie' yopangidwa ndi gawo lapakati pa sagittal pamodzi ndi nyanga zam'mbuyo ndi zam'mbuyo (Chithunzi 1).

Chithunzi 1 Mawonekedwe a MRI amtundu wa medial meniscus. Maonekedwe a sagittal olemera kwambiri a proton: Makona apambuyo ndi kumbuyo kwa meniscal ndi makona atatu a hypointense. Meniscus imakhala yofanana ndi uta ndipo imakhala ndi zigawo zapakati zomwe zimagwirizanitsa nyanga zake zam'mbuyo kutsogolo kwake ndi nyanga zake zam'mbuyo kumbuyo kwake.

Ndikofunikira kumvetsetsa zolakwika zina za anatomical chifukwa zimatha kutengera kugawanika kwa meniscal:

• Mu gawo la sagittal, kusintha pakati pa mitsempha yodutsa ndi yakunja;

• popliteal tendon m'chimake;

• Humphrey ndi Wrisberg's meniscus-femoral ligament imagwirizanitsa nyanga yam'mbuyo ya meniscus ya lateral ndi condyle yapakati yachikazi;

• The oblique meniscus ligament, yomwe nthawi zina imagwirizanitsa nyanga yam'mbuyo ya meniscus ndi nyanga yam'mbuyo ya meniscus yosiyana, ikhoza kutsanzira meniscus yosuntha kapena chogwirira cha mbiya.

• Discoid meniscus ndi chosowa chobadwa nacho cha meniscus. meniscal dysplasia iyi imakhudza pafupifupi meniscus yozungulira. Zotsatira zake 'zamaphunziro' pa MRI zimachokera pakuwona kupitiriza kwa nyanga zam'mbuyo ndi zam'mbuyo pazithunzi za sagittal mu magawo osachepera 3 otsatizana a 5 mm wandiweyani (mkuyu 2). Zomwe zapezazi zimasinthidwa kutengera makonda omwe amagwiritsidwa ntchito.

Chithunzi 2 Discoid lateral meniscus. Chithunzi cholemera cha Sagittal T1. Kupitilira kwa ngodya zakutsogolo ndi zakumbuyo pazigawo zitatu zotsatizana za 5mm. Zindikirani kuwonongeka kwa myxoid kwa nyanga yam'mbuyo ya discoid meniscus iyi.

Kujambula kwa Meniscus Pathology

Ndizozoloŵera kusiyanitsa pakati pa meniscus yopweteka ndi meniscus yowonongeka. Kuvulala koopsa kumabwera chifukwa chogwiritsa ntchito mphamvu zambiri zamakina ku meniscus yathanzi. Kwa achinyamata akuluakulu, kuphulika nthawi zambiri kumayambitsidwa ndi kuvulala kwa valgus kosalunjika, kukwera kwadzidzidzi kwa tibia pambuyo pozungulira kunja kapena hyperflexion ya bondo pa 20 ° ya flexion. M'malo mwake, kuwonongeka kumachitika chifukwa cha mphamvu zamakina zomwe zimagwira pa meniscus zomwe zimawonongeka ndi kuwonongeka kwa interstitial myxoid. Mikwingwirima yopingasa ya meniscal imatha kuchitika yokha kapena chifukwa chovulala pang'ono.

Gulu

Malinga ndi malangizo a ndege yodutsa, mikwingwirima imatha kugawidwa kukhala mikwingwirima yopingasa, mikwingwirima yowongoka kapena mikwingwirima yovuta.

Kupasuka kwa Horizontal

Pali ndege yogawanika yofanana ndi chigwa cha tibial chomwe chimagawaniza meniscus kukhala magawo apamwamba ndi otsika. Zilonda zopingasa izi ndizofala, zimatha kukhudza kwambiri meniscus yapakati kapena yozungulira, ndipo imaonedwa kuti ndi yokhazikika, ngakhale kuti zinyalala zomwe zimasamukira ku groove pambuyo powonongeka kwa meniscus yapakati yafotokozedwa.

Vertical Fissure

Perpendicular kwa tibial ndege ndi mozungulira meniscus. Izi nthawi zambiri zimakhudza meniscus yapakati. Kuvulala kwathunthu kumaonedwa kuti sikukhazikika ndipo kumagawaniza meniscus kukhala zigawo zapakati ndi zam'mbali. Mlingo wa scanning umaphatikizansopo thupi la meniscus lateral ndi nyanga yam'mbuyo ya meniscus, zomwe zimakhala zosavuta kuzizindikira ngati mbiya ya mbiya ikung'ambika, yomwe imakhalapo nthawi zambiri pamene mawondo amazungulira kunja. Kuphatikizidwa ndi zithunzi za sagittal, kung'ambika kwa mbiya kumatha kuchotsedwa (Chithunzi 3).

A. Coronal MRI, muviwo umaloza ku nyanga yam'mbuyo ya meniscus yotsatizana, yomwe ndi yosavuta kuizindikira molakwika ngati chogwirira cha mbiya; B. Mukamapanga sikani ya MRI molingana ndi malo omwe akuwonetsedwa ndi mzere wamadontho pachithunzichi, pseudo mbiya chogwirizira chidzang'ambika.

Ma radial fissures amakhala perpendicular to perimeter of meniscus ndipo nthawi zambiri amakhudza m'mphepete mwaulere wa meniscus.

Parrot Beak Misozi

Ndi kuwonongeka kosakanikirana kophatikizika kokhala ndi gawo lotalikirapo komanso gawo lozungulira lomwe limafalikira pamphepete mwaulere.

Pomaliza, pali kuvulala kovutirapo kwa meniscal, popanda kufotokozera momveka bwino, komwe kumakhudza mikwingwirima yopingasa komanso yopingasa.

Zizindikiro za Mri Za Kuvulala kwa Meniscus

Meniscus Misozi

Stoller ndi al. adapangira 3 magiredi a meniscus (Chithunzi 4)

Kalasi 1: Hyperintensity nodular meniscus yosungidwa pamtunda wa meniscus;

Kalasi ya 2: meniscus yapamwamba yodziwika bwino yomwe imasungidwa pamtunda wa meniscus;

Kalasi 3: Kuthamanga kwambiri kumafikira pamtunda umodzi wa meniscus.

Chithunzi 4 Stoller scale. a: Kalasi 1: Malo amodzi kapena angapo apakati a nodular hyperintensity omwe amagwirizanitsidwa ndi articular pamwamba pa meniscus; b: Kalasi 2: Linear intermediate hyperintensity pa articular pamwamba pa meniscus; c: Kalasi 3: Linear intermediate hyperintensity yofikira ku An articular surface of the meniscus.

Ngakhale kusiyana pakati pa magiredi 2 ndi 3 ndikocheperako, kumasiyanitsa kuwonongeka kwa intrameniscal hyperintensity (Chithunzi 5) ndi mafinya owona. Kusiyanitsa kumeneku pakati pa meniscus yowonongeka ndi yong'ambika sikumakhala yolunjika nthawi zonse, ndipo pali magwero ambiri olakwika chifukwa cha maonekedwe owonjezera kapena osowa.

Chithunzi 5. Maonekedwe owonongeka a meniscus. Mawonedwe a Sagittal proton density okhala ndi kuchuluka kwamafuta. Magawo amazidziwitso apamwamba amatha kuwoneka popanda chithunzi choduka chowona.

Kusamalitsa:

MRI imagwira ntchito bwino kwambiri, yokhala ndi chidwi komanso tsatanetsatane pakati pa 90% ndi 95%. Pa MRI, kung'ambika kwa meniscal kumawoneka ngati kufalikira kwapakati pamtundu wina wa meniscus (Stoller grade 3), kapena kusakhazikika bwino kwa morphological.

Pamene misozi imangowonekera pa kagawo kamodzi, pali zovuta zina, makamaka chiopsezo chachikulu cha zotsatira zabodza. Ngati hyperintensity mkati mwa liniya meniscus kwambiri amakhudza meniscal pamwamba, mwachitsanzo mu zigawo ziwiri moyandikana, Ndi bwino kuti kuonedwa pathological. Lingaliro ili liyenera kusinthidwa malinga ndi njira yopezera zithunzi zomwe zimagwiritsidwa ntchito (magawo 3 mpaka 4 mm kapena kupeza voliyumu ya 3D yokhala ndi magawo a isotropic mm).

Ma radial meniscal clefts nthawi zina amakhala ovuta kuwazindikira, malinga ndi momwe akuzungulira. Izi zimabweretsa zovuta za morphological:

• Kusokoneza m'mphepete mwaulere kapena kudulidwa pachithunzi chakutsogolo;

• Kuwoneka kosalekeza kapena kocheperako kwa meniscus bowtie pa chithunzi cha sagittal (Chithunzi 6);

Chithunzi 6. Radial fissure in the anterior segment of medial meniscus in sagittal proton density-weighted view. Mawonekedwe anthawi zonse a meniscus yapakati yodulira uta (muvi).

• Kusowa kapena 'mzimu' meniscus wokhala ndi mpata wowonekera.

Kuphulika kwa meniscus ndi chogwirira cha ndowa kumasokoneza pafupifupi 10% ya spondylolisthesis yotalikirapo. Pankhaniyi, kutengeka kwa MRI kumakhala pafupifupi 70%, malingana ndi zomwe zimagwiritsidwa ntchito.

Zotsatira za MRI zomwe zimafunikira chisamaliro:

Zomwe zimapezeka kwambiri ndizowonetseratu zowonongeka zowonongeka m'dera la intercondylar: chizindikiro cha 'double posterior cruciate ligament (PCL)' chimadziwika pamene meniscus yapakati ikuwonongeka ndipo anterior cruciate ligament imakhala yokhazikika. Gawo losokonekera likuwoneka ngati gulu la arcuate hypointense lofanana ndi ligament ya posterior cruciate ligament, kutulutsa mawonekedwe a 'double PCL' (Mkuyu 7). Nyanga zochulukira (zoposa 6 mm kukula kwake) zitha kuwonetsanso kukhalapo kwa chogwirira cha mbiya (Chithunzi 8). Pachifukwa ichi, chidutswa cha meniscus chosunthika chimamangiriridwa ku nyanga yathanzi yakutsogolo.

Chithunzi 7 Maonekedwe a chogwirira chapakati cha meniscus chili ndi 'double PCL'. Mawonedwe olemera a Sagittal PD okhala ndi kuponderezana kwamafuta: Chidutswa cha meniscus (muvi) chosunthika chimakhala pansi pa PCL (muvi) wamba ndipo chimapanga mawonekedwe a 'double PCL'.

Chithunzi 8 Maonekedwe a nyanga yayikulu yakutsogolo. Sagittal proton kachulukidwe mawonekedwe. Mbali yam'mbuyo ya chidutswa chosokonekera (muvi) imamangiriridwa ku ngodya ya meniscus (muvi). Dziwani kuti ngodya zakumbuyo sizikuwonetsedwa (*).

Zotsatira zina za MRI:

Zizindikiro zina za MRI zatsimikiziridwa, monga kusowa kwa uta, chizindikiro cha meniscus inverted, kapena zidutswa za meniscal zomwe zimathamangitsidwa mwachindunji kudera la intercondylar pazithunzi za millimeter kutsogolo (mkuyu 9) kapena zithunzi za axial.

Chithunzi 9 Chogwirizira chidebe chosokonekera mu slot. Kuwona kwapatsogolo kwa PD pambuyo pochotsa mafuta. Chidutswa cha meniscus chosunthika (muvi) chikukhudzana ndi ACL (muvi).

Chizindikiro china chodziwika bwino cha kusakhazikika kwa meniscal ndikuzindikiritsa kusuntha kwa tizidutswa ta meniscal kupita kumalo achikazi a meniscal recess kapena femoral-tibial recess. Kusamutsidwa kumeneku kumakhudza pafupifupi meniscus yachipatala ndipo ndizovuta za milandu yopingasa yopingasa mu 10% ya milandu. Magawo a Coronal ndi transverse ndi njira yabwino yodziwira tizidutswa tating'ono.

Kusintha kwa Meniscus

Kutsekedwa kwa meniscal kumachitika chifukwa cha kuvulala kwakukulu kwa valgus ndipo kumayambitsidwa ndi kuphulika kwa meniscus 'capsular appendage. Izi zimakonda kukhudza nyanga yam'mbuyo ya meniscus yamkati yomwe imamangiriza ku kapsule yolumikizana kudzera mukukula kwa kapsule yolumikizana (posterior oblique ligament).

Zimapangitsa kuti 5 mm iwonongeke ku meniscus yapamwamba kuchokera kumalire ambuyo a tibial mbale pazithunzi za sagittal (mkuyu 11), kapena kuika madzimadzi pakati pa maziko a meniscus ndi ndege ya capsule yolumikizana.

Chithunzi 11 Kutsekedwa kwa nyanga yam'mbuyo ya meniscus. Sagittal proton density view. Meniscus yopatulidwa imachotsedwa kunja. Pali malo ambiri a hyperintensity (*) pakati pa tsinde la meniscus ndi posterior capsule (muvi).

Meniscus yoyandama

Izi ndi zotsatira za kuvulala koopsa ndipo chifukwa cha meniscal-tibial ligament rupture ndi kutsekedwa kwa gawo lapakati la meniscus. Pa MRI, meniscus yopatukana imazunguliridwa kwathunthu ndi madzimadzi ndipo ikuwoneka 'kuyandama' pamtunda wa tibial (Chithunzi 12).

Chithunzi 12 Meniscus yoyandama. Mawonedwe akutsogolo kachulukidwe a proton okhala ndi kuchuluka kwamafuta. Meniscus yopatukana imazunguliridwa ndi madzi, makamaka pakati pa malo ake otsika ndi tibial plateau (muvi).

Postoperative Meniscus

Kupweteka kwapang'onopang'ono pambuyo pa meniscectomy kumabweretsa zovuta zambiri zozindikiritsa: kufinya mobwerezabwereza, postmeniscectomy, chondrolysis, subchondral necrosis, kapena arthralgia. MRI nthawi zambiri imalephera kuzindikira ming'alu yobwerezabwereza chifukwa meniscectomy imasiya zovuta zapakati zomwe 'zolakwika' zimalankhulana ndi meniscus pamwamba. Kupeza kokha komwe kunkaonedwa kuti ndi matenda komanso kutanthauziridwa ngati kuphulika kobwerezabwereza kunali madzi a intrameniscal hyperintensity pazithunzi zolemera za T2. Zolepheretsa izi za MRI zosavuta zokha zapangitsa olemba ena kuti afotokoze kugwiritsa ntchito MRI arthroscopy, ngakhale kuti zotsatira zake pano sizikugwirizana.

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