MSUS 中基本病变的定义和表现 (OMERACT) 中国风湿学会香港风湿学会 MSUS 初级课程中国, 上海 Esperanza Naredo 西班牙马德里
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大纲 滑膜炎, 滑膜增生, 积液 Synovitis, SH, effusion 腱鞘炎 / 腱周炎 Tenosynovitis/paratenonitis 慢性腱炎 Tendinosis 肌腱端病 / 肌腱端炎 Enthesopathy/enthesitis 肌腱晶体沉积 Tendon crystal deposition 肌腱断裂 / 损伤 Tendon rupture/damage 滑囊炎 Bursitis 软组织钙化 Soft tissue calcification 骨侵蚀 Bone erosion 骨质增生 Bone proliferation 软骨病变 Cartilage abnormalities +
Synovitis 滑膜炎
Synovitis components 滑膜炎的组成 滑膜增生 Synovial hypertrophy 滑液 Synovial fluid 滑膜充血 Synovial vascularization B-mode ( 灰阶 GS) B-mode ( 灰阶 GS) 多普勒 Doppler
OMERACT 定义 definitions 滑液 ( 积液 ): 关节腔内不正常的低或无回声组织, 可移动和压缩, 不显示多普勒信号 Synovial fluid (effusion):abnormal hypoechoic or anechoic intra-articular material that is displaceable and compressible but does not exhibit Doppler signal 滑膜增生 : 关节腔内不正常的低无回声组织, 不可移动, 很难压缩, 可显示多普勒信号 Synovial hypertrophy: abnormal hypoechoic intraarticular tissue that is non displaceable and poorly compressible which may exhibit Doppler signal
GS Synovitis = SH + effusion 滑膜炎 ( 灰阶 )= 滑膜增生 + 积液 Sinovitis EG: HS + derrame
Synovitis, GS 滑膜炎 ( 灰阶 )
What is this? Sinovitis EG: HS + derrame
GS & Doppler synovitis 滑膜炎 ( 灰阶 & 多普勒 )
Synovitis, Doppler 滑膜炎 ( 多普勒 )
Synovitis, GS 滑膜炎 ( 灰阶 )
Synovitis, Doppler 滑膜炎 ( 多普勒 )
Synovitis, GS. Dynamic scanning 滑膜炎 ( 灰阶 ) 动态扫描
Synovitis, Doppler 滑膜炎 ( 多普勒 )
Synovitis, GS 滑膜炎 ( 灰阶 )
Synovitis. Gout (tophus) 滑膜炎, 痛风 ( 痛风石 )
Tenosynovitis 腱鞘炎
OMERACT definitions 定义 腱鞘炎 ( 灰阶 ): 因腱鞘内积液和 / 或增生造成的腱鞘内不正常的无或低回声增宽 Tenosynovitis on B-mode: abnormal anechoic and/or hypoechoic (relative to tendon fibers) tendon sheath widening which can be related both to the presence of tenosynovial abnormal fluid and/or hypertrophy 腱鞘炎 ( 多普勒 ): 在灰阶发现腱鞘增宽的基础上, 两个垂直平面所见的, 腱鞘内或旁的多普勒信号, 需除外腱系膜或系带内正常的滋养血管 Tenosynovitis on Doppler mode: presence of peri-tendinous Doppler signal within the synovial sheath, seen in two perpendicular planes, excluding normal nutrient vessels in mesotenon or vinculae, only if the tendon shows peri-tendinous synovial sheath widening on B-mode
Where? 外周关节 ( 手 足 )Peripheral joints (hand, foot) 多普勒在浅表关节更敏感 Doppler more sensitive in supeficial joints Peripheral joints (hand, foot) PD more sensitive in supeficial joints Long 长轴 Grey-scale synovitis: synovial hypertrophy + effusion Trans 横断面 Wrist, 6th extensor compart (ECU) 腕, 第 6 伸肌腔室 ( 尺侧腕伸肌 )
Tenosynovitis, GS 腱鞘炎 ( 灰阶 ) trans, peroneal, long 腓骨长短肌腱, 横断面, 长轴
Pulley ganglion cysts (overuse, trauma) 滑车的腱鞘囊肿 ( 过度使用, 创伤 ) Long Finger flexor tendon, Long 指屈肌腱, 长轴
Paratenonitis 腱周炎
US definition 超声定义 腱周炎 : 无腱鞘的肌腱旁不正常的低回声晕 ( 横断面 ) 或线状 ( 长轴 ) 回声, 轮廓不规则 Paratenonitis: abnormal hypoechoic halo (transverse) or line (longitudinal) surrounding a tendon without synovial sheath (and contour irregularities)
Paratenonitis, GS 腱周炎 ( 灰阶 ) Finger extensor tendon, long 指伸肌腱, 长轴 Long
Paratenonitis, Doppler 腱周炎 ( 多普勒 ) Long Finger extensor tendon, long 指伸肌腱, 长轴
Tendinosis 慢性腱炎
Definition 定义 慢性腱炎 : 肌腱部分或全部的增厚 回声减低, 肌腱内不正常不均匀的低回声, 可伴随彩色 / 能量多普勒信号 ( 新生血管 ) Tendinosis: focal or global thickening and hypoechogenicity of the tendon with abnormal heterogeneous echotexture (hypoechoic areas) which may exhibit a hypervascular pattern at CD/PD (neovascularization)
Tendinosis (global) 慢性腱炎 ( 全长 ) Patellar tendon, long 髌腱, 长轴
Tendinosis (focal) 慢性腱炎 ( 局灶 ) Patellar tendon, trans 髌腱, 横轴 Jumper s knee 跳跃膝
Tendinosis, Doppler 慢性腱炎 ( 多普勒 ) Elbow, common extensor tendon, long 肘, 伸肌总腱, 长轴 Active/inactive tendinopathy 活动性 / 非活动性肌腱病 Zanett M. Radiology 2003; Ohberg L. Knee Surg Sports Tr A 2004; Richards P. Skeletal Radiol 2005; Boensen MI. Scand J Med Sci Sports 2006
Enthesopathy 肌腱端病
OMERACT definitions 定义 肌腱端病 :2 个垂直平面所见, 肌腱或韧带附着于骨端处, 不正常的低回声 ( 失去正常的纤维状结构 ) 和 / 或增厚 ( 偶尔含高回声钙化灶 ), 可伴多普勒信号和 / 或骨改变 ( 肌腱端骨赘 侵蚀或不规则 ) Enthesopathy: abnormally hypoechoic (loss of normal fibrillar architecture) and/or thickened tendon or ligament at its bony attachment (may occasionally contain hyperechoic foci consistent with calcification), seen in 2 perpendicular planes that may exhibit Doppler signal and/or bony changes including enthesophytes, erosions, or irregularity
Enthesopathy, GS 肌腱端病 ( 灰阶 ) Achilles tendon, long 跟腱, 长轴
Enthesopathy, GS 肌腱端病 ( 灰阶 ) Achilles tendon, long and trans 跟腱, 长轴和横断面
Tendon crystal deposition 肌腱内晶体沉积
Tendon crystal deposition 肌腱晶体沉积 OMERACT 定义 : 环形 不均质的高和 / 或低回声聚集物 ( 伴或不伴后方声影 ), 周边可有小的无回声晕 OMERACT definition: a circumscribed, inhomogeneous, hyperechoic and/or hypoechoic aggregation (which may or may not generate posterior acoustic shadow), which may be surrounded by a small anechoic rim Patellar tendon, long 髌腱, 长轴
Tendon crystal deposition 肌腱晶体沉积 OMERACT 定义 : 环形 不均质的高和 / 或低回声聚集物 ( 伴或不伴后方声影 ), 周边可有小的无回声晕 OMERACT definition: a circumscribed, inhomogeneous, hyperechoic and/or hypoechoic aggregation (which may or may not generate posterior acoustic shadow), which may be surrounded by a small anechoic rim Patellar tendon, long 髌腱, 长轴
Tendon rupture 肌腱断裂
Tendon tear 肌腱撕裂 定义 : 肌腱纤维的部分或全层缺失 / 中断 急性 / 近期的撕裂呈低回声 ( 积液 ), 亚急性或慢性撕裂呈等回声 ( 机化的血肿 ), 类似完整的肌腱 进展性的撕裂导致肌腱的轮廓不规则和 / 或变薄 陈旧的完全撕裂表现为在原有的解剖位置肌腱的声像缺失 鉴别部分和完全撕裂最重要的特征是没有肌腱断端的回缩
Partial tendon tear 肌腱部分撕裂 Supraspinatus tendon, long 冈上肌腱, 长轴
Full-thickness tear 全层撕裂 Supraspinatus tendon, trans and long 冈上肌腱, 横断面和长轴
Full-thickness (massive) tear 全层 ( 巨大 ) 撕裂 Supraspinatus tendon, trans and long 冈上肌腱, 横断面和长轴
Complete tear 完全撕裂 Achilles tendon, long 跟腱, 长轴
Tendon damage 肌腱损伤
OMERACT definition 定义 肌腱损伤 :2 个垂直平面发现的, 在被腱鞘包绕的区域里出现的肌腱内部和 / 或周围的局灶的纤维缺失 Tendon damage: internal and/or peripheral focal tendon defect (ie, absence of fibres) in the region enclosed by tendon sheath, seen in two perpendicular planes
Tendon damage 肌腱损伤 Finger flexor tendon, trans 指屈肌腱, 横断面
Bursitis 滑囊炎
Definition 定义 滑囊炎 : 滑囊增大, 内有不正常的增生 ( 通常为低回声也可以是高回声 ) Bursitis: abnormal material (usually hypoechoic but may be hyperechoic) inside a bursa which produce bursa enlargement
Olecranon bursitis 鹰嘴滑囊炎 Trans, Long 横断面, 长轴
Infrapatellar bursitis 髌下滑囊炎 长轴, 横断面
ST calcification 软组织钙化
Tendon calcification 肌腱钙化 定义 : 肌腱内的高反射线或灶, 伴或不伴声影 Definition: hyperreflective lines or foci within tendons with or without acoustic shadow 钙化性肌腱病 : 羟磷灰石结晶 ; 尿酸盐结晶 ;CPPD 结晶 Calcific tendinopathy: hydroxyapatite crystals; urate crystals; CPPD crystals
Tendon calcification 肌腱钙化 Supraspinatus tendon, long and trans 冈上肌腱, 长轴和横断面
Tendon calcification. Gout 肌腱钙化, 痛风 Patellar tendon, long 髌腱, 长轴
Tendon calcification 肌腱钙化 Degenerative tendinopathy 退行性肌腱病
Tendon calcification 肌腱钙化 Osgood-Schlatter Patellar tendon, long 髌腱, 长轴
Ligament calcification 韧带钙化 normal Anterior talofibular lig, long 距腓前韧带, 长轴
Bone erosions 骨侵蚀
OMERACT definition 定义 骨侵蚀 :2 个垂直平面所见, 关节内骨表面的中断 Bone erosion: an intraarticular discontinuity of the bone surface that is visible in 2 perpendicular planes
Where? Accessible joints 可探测的关节 2nd and 5th MCP, PIPs, 5th MTP 第 2 和 5 MCP PIPs MTP Dorsal, palmar, radial/ulnar, lateral/medial 背侧 掌侧 桡侧 / 尺侧, 外侧 / 内侧 Long Grey-scale synovitis: synovial hypertrophy + effusion Trans MTP, dorsal 背侧
Where? Accessible joints 可探测的关节 Ulnar styloid process 尺骨茎突 Trans 横断面
Bone proliferation 骨增生
OMERACT definition 定义 肌腱端骨赘 :2 个垂直平面探及的, 骨末端正常轮廓以外的突起, 伴或不伴声影 Enthesophyte: a step up of bony prominence at the end of the normal bone contour, seen in 2 perpendicular planes, with or without acoustic shadow
Enthesophytes 肌腱端骨赘
OMERACT definition 定义 骨赘 : 骨末端或关节缘正常轮廓以外的突起, 伴或不伴骨赘 Osteophyte: a step up of bony prominence at the end of the normal bone contour, or at the margin of the joint, with or without acoustic shadow
Osteophytes 骨赘
Fractures 骨折 Metatarsal occult fracture, long 跗跖关节, 隐形骨折, 长轴
Cartilage abnormalities 软骨病变
OMERACT definition 定义 软骨病变 : 丧失正常的无回声结构, 和 / 或至少一个边缘的锐度, 和 / 或表面不规则, 和 / 或软骨层变薄 Cartilage damage: loss of normal anechoic echostructure, and/or loss of sharpness of at least one margin, and/or irregularity of the superficial margin, and/or thinning of the cartilage layer
Early changes (OA) 早期改变 外缘锐度下降, 内部回声增高且不均质 Loss of margin sharpness and heterogeneous increase of internal echogenicity Femoral AC, trans 骨骼髁表面软骨, 横断面
Late changes OA 晚期改变 软骨层的不对称变薄, 外缘明显不规则 Asymmetric thinning of the cartilaginous layer and marked irregularity of the margins Femoral AC, trans 骨骼髁表面软骨, 横断面
1 st MTP, long 长轴 双轨征 Double contour sign: 软骨上表面不正常的高回声带, 与声波角度无关, 规则或不规则, 连续或间断, 可与软骨界面征区别开
Femoral condyle, trans and long 股骨髁, 横断面和长轴
Wrist triangular fibrocartilage, long 腕三角纤维软骨, 长轴纤维软骨内形状各异的高回声沉积, 位置固定, 动态检查时与纤维软骨一起移动 ( 如关节运动和探头压迫时 )