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目的比较Turbo-Spin Echo-WARP(TSE-WARP,Siemens,German)序列同常规Turbo-Spin Echo(TSE)序列对全膝关节置换术(total knee arthroplasty,TKA)术区金属伪影的减除效果;根据TSE-WARP磁共振的影像学征象,结合翻修手术记录及病理报告,阐释TKA术后患者疼痛的可能原因。方法连续选取我院2014年8月至2016年8月,为20例TKA手术且术后伴有慢性疼痛的患者行WARP-TSE序列评价。20例患者年龄60~84岁,平均(69.2±6.0)岁;其中,女18例,年龄60~79岁,平均(68.2±5.1)岁;男2例,年龄分别为73岁、84岁,平均(78.5±7.8)岁。采用Siemens Magnetom Espree syngo 1.5 T成像设备(Siemens Healthcare,Erlangen,Germany)对复查患者进行扫描,序列包括常规磁共振(magnetic resonance,MR)TSE序列及TSE-WARP减伪影序列。收集17例TKA术后患者的膝关节常规及减伪影MR图像(其中3例因不能坚持,未行常规TSE序列检查),由2名经验丰富的高年资主治医师分别于阅片工作站上进行图像清晰度评分,及伪影面积测量;由上述医师阅读20例患者的TSE-WARP MR图像,结合翻修手术记录与病理报告,分析致患者TKA术后慢性疼痛的可能原因。结果 (1)WARP T_1 sag序列伪影面积显著小于T_1WI Sag序列伪影面积,χ~2=15.22,P<0.0001;WARP PDWI STIR cor序列伪影面积显著小于PDWI STIR cor序列伪影面积,χ~2=14.85,P=0.0001。(2)WARP T_1WI Sag序列主观评分显著高于T_1 sag序列主观评分,χ~2=16.57,P<0.0001;WARP PDWI STIR cor序列主观评分显著高于PDWI STIR cor序列主观评分,χ~2=14.61,P=0.0001。(3)20例TKA术后膝关节患者中,经TSE-WARP MR诊断:假体周围骨吸收伴滑膜增生1例,经手术证实;关节腔滑膜/瘢痕纤维增生5例,经手术证实5例,病理确诊2例;另诊断鹅足滑囊炎1例,观察到骨髓水肿(骨应力反应)9例,关节腔积液9例。结论相比于常规序列,TSE-WARP MR可显著减除金属伪影;应用TSE-WARP MR复查膝关节术后慢性关节痛患者,可清晰观察到多种阳性表现。TSE-WARP MR拥有广阔的临床应用前途。
Objective To compare the effects of Turbo-Spin Echo-WARP (TSE-WARP, Siemens, German) sequences with conventional Turbo-Spin Echo (TSE) sequences on metal artifacts in total knee arthroplasty (TKA) According to the imaging features of TSE-WARP magnetic resonance imaging, combined with revision surgery records and pathological reports, to explain the possible causes of pain in patients with TKA. Methods A total of 20 TKA patients with chronic pain after operation were enrolled in this study. The WARP-TSE sequence was evaluated in our hospital from August 2014 to August 2016. Among them, 18 were female, ranging in age from 60 to 79 years, with an average of (68.2 ± 5.1) years. There were 2 males, 73 years of age and 84 years of age respectively, with a mean age of 69.2 ± 6.0 years. Average (78.5 ± 7.8) years old. The patients under review were scanned using a Siemens Magnetom Espree syngo 1.5 T imaging device (Siemens Healthcare, Erlangen, Germany). The sequences included the conventional magnetic resonance (MR) TSE sequence and the TSE-WARP minus artifact sequence. Seventeen knee arthroplasty patients with knee arthroplasty and artifact-less MR imaging were collected (three of them failed to adhere to routine TSE sequence), and two experienced senior physicians were interviewed on the reading workstation The images of TSE-WARP in 20 patients were read by the above physicians. Combined with revision surgery records and pathological reports, the possible causes of chronic pain after TKA were analyzed. Results (1) The artifact area of WARP T_1 sag sequence was significantly smaller than that of T_1WI Sag sequence, χ ~ 2 = 15.22, P <0.0001. The warp area of WARP PDWI STIR cor sequence was significantly smaller than that of PDWI STIR cor sequence, 2 = 14.85, P = 0.0001. (2) The subjective score of WARP T_1WI Sag was significantly higher than that of T_1 sag (χ ~ 2 = 16.57, P <0.0001). The subjective score of WARP PDWI STIR cor was significantly higher than that of PDWI STIR cor (χ ~ 2 = 14.61 , P = 0.0001. (3) TSE-WARP MR diagnosis of 20 cases of knee joint patients with TKA: bone resorption around the prosthesis with synovial hyperplasia in 1 case confirmed by surgery; 5 cases of synovial / scar fibrosis in the joint cavity confirmed by surgery 5 cases were diagnosed pathologically, 2 cases were diagnosed goose foot bursitis in 1 case, bone marrow edema (bone stress response) in 9 cases, 9 cases of joint effusion. Conclusion Compared with the conventional sequence, TSE-WARP MR can significantly reduce metal artifacts; TSE-WARP MR examination of patients with chronic joint pain after knee surgery can clearly observe a variety of positive manifestations. TSE-WARP MR has a broad clinical application.