改良斜轴位磁共振成像扫描在距腓前韧带损伤中的应用价值

Reliability and validity of improved oblique-axial plane magnetic resonance imaging (MRI) for detection of anterior talofibular ligament (ATFL) injuries

摘要:

目的  评估改良斜轴位磁共振成像（MRI）检查对慢性踝关节不稳患者距腓前韧带损伤诊断的可靠性及有效性。方法  选取2013年1月-2015年11月从该院预行踝关节镜检查的住院患者中招募研究对象。所有研究对象行踝关节常规轴位及改良斜轴位MRI检查，利用MRI图像评估距腓前韧带损伤，对比上述检查对韧带全长的显示效果，利用ICC指数评估观察者间一致性，以踝关节镜检查结果作为金标准，评估上述检查的敏感性、特异性、阴性预测值，阳性预测值、准确性。结果  招募91例研究对象。其中，男性49例，女性42例,平均（34.6±13.2）岁。常规轴位MRI显示，效果与改良斜轴位MRI的差异有统计学意义（观察者A：Z =-4.987，P =0.000；观察者B：Z =-4.084，P =0.000），斜轴位MRI检查观察者间ICC指数为0.943，95%CI：0.902，0.987。共有60例患者经关节镜检查确诊为距腓前韧带损伤。改良斜轴位MRI检查的敏感性、特异性、阴性预测值、阳性预测值及准确度：观察者A分别为92%、97%、86%、98%和95%；观察者B分别为95%、94%、91%、97%和95%。结论  对于诊断距腓前韧带损伤，改良斜轴位MRI检查具有很好的观察者间一致性以及突出的诊断价值，可以较好地显示韧带全长，值得在临床推广应用。

Abstract:

Objective To analyze the reliability and validity of improved oblique-axial plane magnetic resonance imaging (MRI) for the detection of anterior talofibular ligament (ATFL) injuries in chronic lateral ankle instability. Methods Patients who underwent conventional and improved oblique-axial plane MRI followed by subsequent arthroscopy for their various ankle disorders between January 2013 to November 2015 were enrolled in this diagnostic study. The ATFL on MRI were assessed by two radiologists independently, and the results of MRI assessments were compared with the arthroscopic findings, which were used as the standard of reference. We compared The display effect of ligament length by the methods was compared, and the consistency between the observers with ICC index was evaluated. The sensitivity, specific, negative predictive value, positive predictive value, and accuracy were compared between two kinds of MRI. Results All 91 cases were recruited in our research, including 49 males and 42 females. The average age was (34.6 ± 13.2). The display effect of conventional MRI and improved oblique axis MRI had statistically significant differences (observer A: Z = -4.987, P = 0.000; observer B: Z = -4.084, P = 0.000). The ICC of conventional MRI was 0.915 (0.867, 0.946) while the ICC of improved oblique axis MRI was 0.943 (0.902, 0.987). The sensitivity and negative predictive value, positive predictive value and accuracy of improved oblique-axial plane MRI were 92%, 97%, 86%, 98%, 95% in  observer A and 95%, 94%, 91%, 97% and 95% in the observer B. Conclusions For the diagnosis of anterior talofibular ligament lesion, the improved oblique axis MRI has better consistency between the observer and the higher diagnostic value of outstanding, which can display well ligament length.