髋关节常见病变MR诊断

正常髋关节的MRI表现髋关节的主要组织成分为以下四个部分：（一）骨性部分包括髋臼与股骨头、颈。

髋臼为髂、耻、坐骨之膨大体部所构成。

儿童发育期间，髋臼部为Y型骨骺。

股骨头为球形，上覆软骨，表面光滑，对向髋臼。

股骨头中心有一浅窝，为圆韧带窝。

在磁共振图像上骨皮质呈半环形低信号区，内为高信号松质骨。

头颈骨小梁束呈向心状排列，形成粗大放射状低信号区。

干骺端愈合的骨板仍清晰可见，呈波浪状低信号线。

由于股骨头的松质骨被皮质及致密的骨小梁所包绕，形成相对闭合的系统。

髓腔内处于正压状态，骨血运与髓腔内压力关系密切，动脉血流减少时压力下降，而静脉血流减少时压力上升。

反之，压力的升降又可以直接影响血运。

磁共振T1与T2加权像可直接反映股骨头血运的变化。

血管充血、静脉滞流可引起长T1与长T2信号改变，细胞外液的增加也使T2弛豫延长。

（二）软骨部分包括软骨关节面和关节盂唇。

软骨关节面由透明软骨构成，被覆于股骨头和髋臼表面，在髋臼前、上、后壁形成半月状关节面，髋臼内面中心凹陷为镜臼窝。

透明软骨约2mm厚，在MRI所有序列上均为中等信号强度。

透明软骨含水量高，弹性强，为关节内的承重结构，其T2值较纤维软骨高，但低于关节内滑液。

因此，透明软骨在信号上易与纤维软骨及关节液相鉴别。

关节盂唇由纤维软骨构成，附着于关节盂边缘，使髋臼加深，髋臼唇缘及下缘的软骨唇最宽，约10mm。

纤维软骨内所含蛋白成分及水分均与透明软骨不同。

纤维软骨含水量低，致密胶原组织的T2弛豫时间短，因而在T2加权像上其信号低于透明软骨。

（三）韧带与肌腱部分髋关节包括3个纵行韧带、1个圆韧带和2个附属韧带，其中以髋臼横韧带、股骨头圆韧带在髋关节病变的诊断中较为重要。

韧带与肌腱属于纤维结构，在MRI所有扫描序列上均呈低信号或无信号。

（四）关节囊关节囊与髋关节纵行韧带交织在一起。

关节囊起于髋臼的骨缘及横韧带，包括软骨唇、股骨头、颈。

关节囊在MRI所有序列上均为低信号，囊内少量滑液呈条形高信号。

* 器材应用与技术研究 *MR、CT检查对强直性脊柱炎髋关节病变的诊断价值比较邓洪波，，曾宪春刘宗才刘宗才，，邓洪波贵州省人民医院医学影像科，贵州贵阳550001摘要目的比较核磁共振（magnetic resonance， MR）、电子计算机断层摄影（computer Tomography， CT）检查对强直性脊柱炎髋关节病变的诊断价值。

方法以贵州省人民医院于2017年10月—2022年10月收治的95例强直性脊柱炎疑似髋关节病变患者作为研究对象，收集患者MR、CT检查的影像资料进行分析，并以临床综合诊断作为“金标准”比较两种检查方式的诊断效能，同时观察两种检查方式对髋关节病变征像的检出率。

结果 80例患者出院诊断为强直性脊柱炎髋关节病变。

MR检查对强直性脊柱炎髋关节病变的诊断符合率、特异度、灵敏度、阴性预测值以及阳性预测值分别为96.84%、93.33%、97.50%、87.50%、98.73%，较CT检查的81.05%、60.00%、85.00%、42.86%、91.89%高，差异有统计学意义（χ2=12.046、4.658、7.828、7.695、4.097，P< 0.05），MR检查的误诊率、漏诊率分别为6.67%、2.50%，较CT检查的40.00%、15.00%低，差异有统计学意义（P<0.05）。

MR检查对关节强直、关节面侵蚀、关节间隙狭窄、关节软组织肿胀、关节面下骨质囊变、关节面下骨质硬化的检出率分别为88.57%、88.24%、95.38%、94.87%、93.44%、93.75%，高于CT检查的64.29%、64.71%、81.54%、75.64%、75.41%、77.08%，差异有统计学意义（P<0.05）。

结论 MR检查可有效检出强直性脊柱炎髋关节病变，诊断效能高于CT检查，而且，该检查方式对病变征象的检出率较高，因此，可作为临床诊断该疾病的优选方案。

关键词MR；CT；强直性脊柱炎髋关节病变；诊断效能；诊断符合率；病变征象816..8文献标志码A doi10.11966/j.issn.2095-994X.2023.09.04.28中图分类号R816Comparison of Diagnostic Value of MR and CT Examinations in Ankylosing Spondy⁃litis Hip Joint LesionsLIU　Zongcai, DENG　Hongbo, ZENG XianchunDepartment of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, 550001 ChinaAbstract Objective To compare the diagnostic value of nuclear magnetic resonance (MR) and computerized tomography (CT) in ankylosing spondylitis hip joint lesions. Methods　A total of 95 patients with ankylosing spondylitis suspected of hip joint lesions admitted to Guizhou Pro⁃vincial People's Hospital from October 2017 to October 2022 were selected as the research objects. The imaging data of MR and CT examina⁃tions of patients were collected and analyzed, and the diagnostic efficacy of the two examination methods was compared using comprehensive clinical diagnosis as the "gold standard". At the same time, the detection rate of the two inspection methods on the signs of hip joint disease was observed. Results　Eighty patients were discharged and diagnosed as ankylosing spondylitis hip joint lesions. The diagnostic coincidence rate, specificity, sensitivity, negative predictive value, and positive predictive value of MR examination for ankylosing spondylitis hip joint le⁃sions were 96.84%, 93.33%, 97.50%, 87.50%, and 98.73%, respectively, which were higher than those of CT examination 81.05%, 60.00%, 85.00%, 42.86%, 91.89%, the difference was statistically significant (χ2=12.046, 4.658, 7.828, 7.695, 4.097, P<0.05), the misdiagnosis rate and missed diagnosis rate of MR examination were 6.67% and 2.50%, respectively, which were lower than those of CT examination (40.00% and 15.00%), the difference was statistically significant (P<0.05). The detection rates of MR examination for joint ankylosis, articular surface erosion, joint space narrowing, joint soft tissue swelling, subarticular bone cystic degeneration, and subarticular bone sclerosis were 88.57%, 88.24%, 95.38%, 94.87%, 93.44%, 93.75%, higher than CT examination 64.29%, 64.71%, 81.54%, 75.64%, 75.41%, 77.08%, the differ⁃ence was statistically significant (P<0.05). Conclusion　MR examination can effectively detect hip joint lesions in ankylosing spondylitis, with a higher diagnostic efficiency than CT examination. Moreover, this examination method has a higher detection rate of lesion signs, making it a preferred option for clinical diagnosis of the disease.Key words MR; CT; Ankylosing spondylitis hip joint lesion; Diagnostic efficiency; Diagnostic coincidence rate; Lesion signs收稿日期：2023-02-06；修回日期：2023-02-27作者简介：刘宗才（1974-），男，硕士，副主任医师，研究方向为影像学。