PDF(Pubmed)
Abstract：
OBJECTIVE: Clinical-standard MRI is the imaging modality of choice for the wrist, yet limited to static evaluation, thereby potentially missing dynamic instability patterns. We aimed to investigate the clinical benefit of (dynamic) real-time MRI, complemented by automatic analysis, in patients with complete or partial scapholunate ligament (SLL) tears.
METHODS: Both wrists of ten patients with unilateral SLL tears (six partial, four complete tears) as diagnosed by clinical-standard MRI were imaged during continuous active radioulnar motion using a 1.5-T MRI scanner in combination with a custom-made motion device. Following automatic segmentation of the wrist, the scapholunate and lunotriquetral joint widths were analyzed across the entire range of motion (ROM). Mixed-effects model analysis of variance (ANOVA) followed by Tukey\'s posthoc test and two-way ANOVA were used for statistical analysis.
RESULTS: With the increasing extent of SLL tear, the scapholunate joint widths in injured wrists were significantly larger over the entire ROM compared to those of the contralateral healthy wrists (p<0.001). Differences between partial and complete tears were most pronounced at 5°-15° ulnar abduction (p<0.001). Motion patterns and trajectories were altered. Complete SLL deficiency resulted in complex alterations of the lunotriquetral joint widths.
CONCLUSIONS: Real-time MRI may improve the functional diagnosis of SLL insufficiency and aid therapeutic decision-making by revealing dynamic forms of dissociative instability within the proximal carpus. Static MRI best differentiates SLL-injured wrists at 5°-15° of ulnar abduction.
METHODS: Both wrists of ten patients with unilateral SLL tears (six partial, four complete tears) as diagnosed by clinical-standard MRI were imaged during continuous active radioulnar motion using a 1.5-T MRI scanner in combination with a custom-made motion device. Following automatic segmentation of the wrist, the scapholunate and lunotriquetral joint widths were analyzed across the entire range of motion (ROM). Mixed-effects model analysis of variance (ANOVA) followed by Tukey\'s posthoc test and two-way ANOVA were used for statistical analysis.
RESULTS: With the increasing extent of SLL tear, the scapholunate joint widths in injured wrists were significantly larger over the entire ROM compared to those of the contralateral healthy wrists (p<0.001). Differences between partial and complete tears were most pronounced at 5°-15° ulnar abduction (p<0.001). Motion patterns and trajectories were altered. Complete SLL deficiency resulted in complex alterations of the lunotriquetral joint widths.
CONCLUSIONS: Real-time MRI may improve the functional diagnosis of SLL insufficiency and aid therapeutic decision-making by revealing dynamic forms of dissociative instability within the proximal carpus. Static MRI best differentiates SLL-injured wrists at 5°-15° of ulnar abduction.
摘要：
目的：临床标准MRI是腕部首选的成像方式，但仅限于静态评估，从而可能错过动态不稳定模式。我们旨在研究（动态）实时MRI的临床益处，辅以自动分析，完全或部分肩胛骨韧带（SLL）撕裂的患者。
方法：10例单侧SLL撕裂患者的两个手腕（6例，使用1.5-TMRI扫描仪结合定制的运动装置，在连续活动的径向臂运动过程中对临床标准MRI诊断出的四次完全撕裂）进行成像。在自动分割手腕之后，在整个运动范围(ROM)内分析了肩胛骨和颈肌关节宽度.使用混合效应模型方差分析（ANOVA），然后进行Tukeyposthoc检验和双向ANOVA进行统计分析。
结果：随着SLL撕裂程度的增加，与对侧健康手腕相比，受伤手腕的肩胛骨关节宽度在整个ROM上明显更大（p<0.001）。部分撕裂和完全撕裂之间的差异在5°-15°尺骨外展时最为明显（p<0.001）。运动模式和轨迹被改变。完全的SLL缺乏导致了腔三足关节宽度的复杂改变。
结论：实时MRI可改善SLL功能不全的功能诊断，并通过揭示近端腕骨内分离不稳定的动态形式来辅助治疗决策。静态MRI最好区分尺骨外展5°-15°SLL损伤的手腕。
方法：10例单侧SLL撕裂患者的两个手腕（6例，使用1.5-TMRI扫描仪结合定制的运动装置，在连续活动的径向臂运动过程中对临床标准MRI诊断出的四次完全撕裂）进行成像。在自动分割手腕之后，在整个运动范围(ROM)内分析了肩胛骨和颈肌关节宽度.使用混合效应模型方差分析（ANOVA），然后进行Tukeyposthoc检验和双向ANOVA进行统计分析。
结果：随着SLL撕裂程度的增加，与对侧健康手腕相比，受伤手腕的肩胛骨关节宽度在整个ROM上明显更大（p<0.001）。部分撕裂和完全撕裂之间的差异在5°-15°尺骨外展时最为明显（p<0.001）。运动模式和轨迹被改变。完全的SLL缺乏导致了腔三足关节宽度的复杂改变。
结论：实时MRI可改善SLL功能不全的功能诊断，并通过揭示近端腕骨内分离不稳定的动态形式来辅助治疗决策。静态MRI最好区分尺骨外展5°-15°SLL损伤的手腕。
