创伤性髌前滑囊炎的MRI诊断

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572 •浙江临床医学2020年4月第22卷第4期•检测诊断•创伤性髌前滑囊炎的MRI诊断娄斌奇赵建江*

【摘要】

张梅花余德洪目的探讨创伤性髌前滑囊炎的MRI特征。方法回顾性分析经手术病理确诊为髌前滑囊炎，术前均进行过膝关节MRI检查的

12例患者。MRI图像分析包括：病灶的大小、部位、形态、平扫的信号特征。结果12例患者病灶最长径2〜10cm

(平均5.9cm ); 11例位于

髌前，1例位于髌軔带前，与膝关节腔均不相通。病灶形态：3例表现为单房囊状，4例表现为分房状，5例表现扁平状；MRI信号特点：T,WI

8例呈等、低信号，4例内夹杂斑片状高信号，脂肪抑制T2WI或STIR均呈高信号为主。其中3例边缘可见脂肪滴信号；4例内伴出血样信号；1

例囊底内可见液液平；3例滑囊壁增厚；病变周围均可见不同程度渗出表现。结论创伤性髌前滑囊炎多位于髌前皮下囊，MRI信号可多样，

结合外伤病史，MRI有助于诊断和鉴别诊断。【关键词】髌前滑囊炎磁共振成像创伤【Abstract

】 Objective

To investigate the MRI features of traumatic prepatellar bursitis.

Methods

12 patients with pathologically proven

prepatellar bursitis were retrospectively reviewed. MR examinations of the knee were performed on all these patients before operation. The MR image

analysis of the lesion including the size, location, shape, and signal features in plain scan.

Results

The maximum diameter of

12 lesions in all patients

was 2〜10cm ( average 5.9cm ) .11 lesions were located in front of the patella, and 1 lesion was located in front of the patella of these were

not in communication with the knee joint cavity. Lesion shape

： 3 lesions showed unilocular cystic, 4 lesions showed bilocular and 5 lesions showed flat.

Features of MRI signal

：

8 lesions showed isointense and hypointense on T^1, 4 lesions were mixed with patchy hyperintense, and FS T2WI or STIR

showed hyperintense mainly. Among them, signal of fat drop in 3 lesions were seen at the edge. Blood signal were observed in 4 lesions. In 1 lesion liquid

level was visible in the bottom of the sac. In 3 lesions the wall of the synovial bursa were thickened. All around the lesions, different degrees of exudation

were observed.

Conclusion

Traumatic prepatellar bursitis mostly locates in the subcutaneous prepatellar bursa. MR signs can be diverse. Combined with

the history of trauma, MRI can help diagnose and differential diagnosis.【Keywords】

Prepatellar bursitis MRI Trauma髌前滑囊炎临床较为常见，多由于外伤所致，其

1.2检查方法12例均进行了膝关节MRI平扫，所

以非手术为主，但对于非手术无效，或

用设备MR机型为GE

SIGNA

EXCITE

1.5T磁共振扫描

反复发作，应采用手术或关节镜。MRI现已成为

仪，膝关节线圈，分别行横轴位、冠状A及矢状位扫描。

膝关节疾病诊断的重要手段，但对创伤性髌前滑囊炎

MRI扫描参数：快速自旋回波（FSE)序列T,WI

(TR

的MRI影像学表现国内报道较少，多数为病例报道。

540~56〇ms，TE

10ms

);脂肪抑制快速自旋回波（FSE )

本资料收集12例创伤性髌前滑囊炎的临床及MRI资

序列

T2WI

(TR

2200~3600ms,

TE

66~85ms

);

STIR 序

料，回顾性分析该病的MRI特点，以提高对该病的诊

列（TR

4700ms，TE

50ms )〇

层厚

4mm,层间距

0.5~ 1

mm，

断准确性。视野（FOV

)

200mm x 200mm。1资料与方法1.3资料分析MRI图像分析由两名放射科副主任医

师分析图像，以两人共同确定分析结果，分析包括以

1.1 一般资料收集2011年6月至2016年5月本院

下内容：病灶部位、大小（病灶的最大径）、形态、边

收治的12例创伤性髌前滑囊炎患者，均经手术病理证

界、病灶的信号强度（与周围肌肉作对照)。实，术前均进行过膝关节MRI检查。其中男8例，女4例;

年龄25~73岁，平均49.4岁;位于右膝5例，左膝7例：

2结果病程1周~1年，其中病程>1个月8例。患者膝部前

2.1

MRI表现11例位于髌前，1例位于髌韧带前，

方均见肿胀或肿块，程度不一，部分有波动感，轻度

与膝关节腔均不相通。3例表现为单房囊状肿块（见

压痛或疼痛性屈伸受限。10例有明确膝部跪伤或撞伤

图1 ); 4例表现为分房状或不全分隔肿块，其中1例

史，伤后局部疼痛、肿胀，可行走；2例膝部有长期

横向延伸，1例向外侧延伸，1例向内侧延伸（见图2 );

压迫摩擦史（跪姿工作），膝前部轻度疼痛，逐渐肿胀。

5例表现扁平状肿块（见图3 )。病变大小范围2.0cm

患者保守后未见好转或反复发作。x 1.0cm

x 0.5cm~10.0cm

x 8.0cm

x 2_0cm〇

MRI

f目号特

点：TWI 8例呈等、低信号，4例等信号内夹杂斑片

作者单位：310013杭州市第七人民医院（娄斌奇）状高信号；脂肪抑制T2WI或STIR均以混杂高信号为

311200浙江萧山医院（赵建江张梅花余德洪）主。其中3例边缘可见脂肪滴信号，T/WI小点状高信*通信作者