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：
Fig. 1: Posterior horn medial meniscal tear
内侧半月板后角撕裂
Fig. 2: Lateral meniscus anterior horn tear
外侧半月板前角撕裂
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
Fig. 4: Degenerative tear – older patient with horizontal tear
退行性撕裂 – 老年患者水平撕裂
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
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
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）
Fig. 8: Radial tear
放射状撕裂
Fig. 9: Vertical flap tear
垂直瓣状撕裂
Fig. 10: Complex tear
复杂撕裂
Fig. 11: Radial posterior root tear of the medial meniscus
内侧半月板后根的放射状撕裂
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
Fig. 13: Particular Meniscal Tears Illustration
半月板部分撕裂的示意图
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
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
Fig. 16: Discoid meniscus
盘状半月板
Fig. 17: Degenerated discoid meniscus in a young patient
一名年轻患者的退变性盘状半月板
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。
Classification of meniscal tears as developed by ISAKOS.
A: Types of tears. B: Location.