RU2173952C1 - Method for building image of posterior cruciate ligament in making magnetic resonance tomography examination - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves building five reference lines of 4 mm thick slice width with 0 mm gap on sagittal tomogram with partial image of the cruciate ligament. Five tomograms are built in this way in oblique coronary projection. One of the so built oblique coronary projection tomograms is selected that has the picture of the central part of articulation, anterointerior zone of the medial femoral condyle and posterior intercondylar fossa of the tibia that have the posterior cruciate ligament attached to them. Five reference lines of 4 mm thick slice width with 0 mm gap are arranged on this tomogram corresponding to anatomical attachment of the posterior cruciate ligament from the anterointernal edge of the medial femoral condyle to the posterior intercondylar fossa of the tibia. Complete undistorted image of the posterior cruciate ligament is produced on one of these tomograms. EFFECT: high accuracy of image building. 7 dwg

Description

 The invention relates to medicine, namely to magnetic resonance imaging, and can be used to diagnose traumatic damage to the posterior cruciate ligament in orthopedic, trauma and surgical practice.

 The urgency of the problem of identifying complete, partial, and intracircular ruptures of the posterior cruciate ligament is that, despite the small frequency, ligament ruptures are accompanied by small clinical manifestations and the development of early severe post-traumatic dystrophic processes with long-term disability.

 A known method of obtaining images of the posterior cruciate ligament using contrast arthrography. Contrast arthrography of the knee joint is performed under aseptic conditions in an X-ray room. Oxygen and an iodine-containing water-soluble contrast medium are injected into the cavity of the knee joint, then radiographs are made. A contrast agent "smears" the intraarticular ligaments and against the background of oxygen (gas) they become visible (RF patent N 2142738. A method for the diagnosis of intraarticular injuries and diseases of the knee joint. Chizhik - Poleiko AN Bul. N 35, 1999, p. 164-165).

The disadvantages of the method:
- there is no guarantee of obtaining an image of the posterior cruciate ligament,
- Intra-ligamentous lesions, ligament dystrophy are not visible,
- the risk of infection in the joint cavity,
- the possibility of an allergic reaction to the introduction of iodine-containing contrast medium,
- irradiation of the patient with ionizing x-ray radiation.

 A known method of pneumoarthrography of the knee joint. Gas (air, oxygen) is introduced into the cavity of the knee joint, then radiographs are made. Gas fills the joint cavity and intraarticular ligaments become visible against its background (I. Vitiugov. A new modification of the method of arthropneumography for injuries of the meniscus of the knee joint. Abstract of thesis. Candidate of Medical Sciences. L., 1960, 15 pp.).

The disadvantages of the method:
- there is no guarantee of obtaining an image of the contour of the posterior cruciate ligament,
- Intra-ligamentous lesions, ligament dystrophy are not detected,
- the risk of infection in the cavity of the knee joint,
- irradiation of the patient with ionizing x-ray radiation.

 A known method of arthroscopy of the knee joint. Arthroscopy is performed under general anesthesia. An arthoscope is inserted into the cavity of the knee joint, and a posterior cruciate ligament is examined using a special optical device (Levitsky A.F., Lomnitsky O.Ya., Kosyakov A.N., Bebeshko A.V., Krisyuk S.A. Use of arthroscopy for injuries of the knee joint in children and adolescents // Orthopedics, traumatology and prosthetics: Resp. interagency collection - 1989. - Issue 19, - pp. 67-68).

The disadvantages of the method:
- only the shape, dimensions and external contours of the posterior cruciate ligament are visible;
- Intra-ligamentous lesions and dystrophic changes are not visible;
- the danger of introducing infection into the cavity of the knee joint;
- the possibility of complications in the process of conducting general anesthesia.

The closest solution to imaging the posterior cruciate ligament is a standard magnetic resonance imaging of the knee in the coronal, sagittal and axial planes (Crues JV, Ryu RKN Knee // MAGNETIC RESONANCE IMAGING / Ed. By David D. Stark, William G. Bradley, jr., 2 ^nd ed. - St. Lous-Baltimore - Boston - Chicago - London - Philadelphia - Sydney - Toronto: Mosby Year Book, 1992. - P. 2355-2423).

 The method of obtaining the image of the posterior cruciate ligament presented in this monograph in three standard planes: straight (coronal), lateral (sagittal), transverse (axial), does not allow obtaining on the MRI tomograms a complete and undistorted image of the posterior cruciate ligament, since the anatomically posterior cruciate ligament the ligament starts from the front-inner surface of the medial condyle of the femur, goes back and laterally and attaches to the posterior intercondylar fossa of the tibia (Figs. 1 and 2), i.e. goes obliquely in relation to all three planes.

 The objective of the present invention is to improve the accuracy of the image of the posterior cruciate ligament during MR imaging, i.e. obtaining a complete and undistorted image of the posterior cruciate ligament on one tomographic section.

 The task is achieved by the fact that on a sagittal tomogram with a partial image of the posterior cruciate ligament, 5 REF-lines are cut with a thickness of 4 mm, through a gap of 0 mm, 5 tomograms are obtained in an oblique-coronal projection, from the obtained 5 oblique-coronal tomograms one is selected, on which the central part of the joint, the antero-internal part of the medial condyle of the femur and the posterior intercondylar fossa of the tibia, to which the posterior cruciate ligament is attached, are depicted on this tomogram, respectively nical attachment of the posterior cruciate ligament on the anterior inner edge of the medial condyle of the femur to the posterior intercondylar fossa of the tibia Marshall 5 REF-cut lines 4 mm 0 mm through the gap and on one of these tomograms obtained complete undistorted image of the posterior cruciate ligament.

The novelty of the method:
1. The construction of REF lines on sagittal tomograms that pass through the anatomical attachment of the posterior cruciate ligament (from the front-inner surface of the medial condyle of the femur to the posterior intercondylar fossa of the tibia) provides a true image of the posterior cruciate ligament without distortion.

 2. Five sections with a thickness of 4 mm were selected through a gap of 0 mm, because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament is from 1.5 to 3.0 cm. If you take 3 or 4 sections, then You may not get a holistic image of a bunch.

 The invention is illustrated by the attached drawings and MR images, where in FIG. Figures 1-7 show tomographic sections of the knee joint with the image of the posterior cruciate ligament normal, with a complete rupture and a partial rupture. On them anatomical structures are marked with numbers. Under the number 1 is the patella, 2 is the external condyle of the femur, 3 is the anterior cruciate ligament, 4 is the posterior cruciate ligament, 4a is a fragment of the posterior cruciate ligament, 5 is the tibia, 6 is the inner condyle of the femur, 7 is the anterior intercondylar fossa of the tibia bones, 8 - posterior intercondylar fossa of the tibia, 9 - mid REF line.

The method of MRI examination of the posterior cruciate ligament in cases of suspected rupture or dystrophy is as follows:
The study was carried out on a VECTRA2 magnetic resonance imager from GENERAL ELECTRIC with a magnetic field voltage of 0.5 T using a SURE-76 knee coil in standard sagittal and two non-standard oblique-coronal and oblique-sagittal planes using SPIN-EXO and GRE T1 and T2 (see table) weighted images (VI) with a tomograph step of 4 mm through a 1 mm interval with the parameters given in the table (see the end of the description).

 A SURE-76 knee coil is mounted on the table deck of the magnetic resonance imager. The patient is laid on his back on the table deck so that the examined knee joint is placed in the center of the coil. The limb is in a position of slight bending at an angle of not more than 10 degrees.

 The patient is fixed to the table deck to ensure complete immobility. Then the table with the patient gets into the magnet tunnel. The control panel is gaining technical parameters to obtain an image of the knee joint in the standard sagittal plane in T1 sequences (see table). On a sagittal tomogram with a partial image of the posterior cruciate ligament, five REF-lines are cut with a thickness of 4 mm through a gap of 0 mm, because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament is from 1.5 to 3.0 see. If you take 3 or 4 slices, you can not get a holistic image of a bunch. Five tomograms are obtained in a non-standard oblique-coronal projection. From the five oblique-coronal tomograms obtained, one is selected that shows the central part of the joint, the antero-internal part of the medial condyle of the femur and the posterior intercondylar fossa of the tibia, to which the posterior cruciate ligament is attached. On this tomogram, according to the anatomical attachment of the posterior cruciate ligament (from the anteroposterior margin of the medial condyle of the femur to the posterior intercondylar fossa of the tibia), 5 REF lines are cut with a thickness of 4 mm through a gap of 0 mm, because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament from 1.5 to 3.0 cm. If you take 3 or 4 sections, then you can not get a holistic image of the ligament. Get five tomograms in the oblique sagittal plane in the sequences T1 and T2 weighted images (see table). On one of these tomograms, the posterior cruciate ligament is necessarily visualized in an undistorted form. They study the type, attachment, direction, structure, measure the width, density of the posterior cruciate ligament.

 This made it possible to absolutely accurately diagnose traumatic injuries (complete, partial and intrafocal ruptures), dystrophic lesions of the posterior cruciate ligament and produce surgical treatments adequate to the injury.

CLINICAL EXAMPLES:
1. Patient M., born 1950 aimed at a study at the center for radiation diagnostics of the city clinical hospital N 1 in Novokuznetsk from the trauma department with a diagnosis of damage to the ligamentous ligamentous apparatus of the right knee joint. He had a history of the injury that he received in the mine: he pulled his right leg under the tube with a tape and turned it around, felt a sharp pain in his right knee joint, lost consciousness. Delivered by ambulance to the hospital. Radiographs were made on which the external-rotational subluxation of the lower leg was revealed. On examination, the right leg is sharply swollen, cyanotic-crimson, the knee joint is sharply thickened, deformed, n, and the skin is abrasion, there are no movements. A standard MRI tomographic examination of the joint was performed, external rotational subluxation of the lower leg and patella, intraarticular microfractures of the intercondylar elevation of the tibia, partial rupture of the joint capsule, collateral tibial ligament, partial rupture of the quadriceps femoris, posterior horn of the external inferior meniscus were found post-traumatic hemosynovitis. Intra-articular free-floating small bone fragments. The anterior and posterior cruciate ligaments do not differentiate. On a sagittal tomogram with a partial image of the posterior cruciate ligament, five REF-lines are cut with a thickness of 4 mm through a gap of 0 mm because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament is 2.7 cm. If you take 3 or 4 slices, then you can not get a holistic image of a bunch. Five tomograms are obtained in a non-standard oblique-coronal projection. Of the five oblique-coronal tomograms obtained, a third is chosen, which shows the central part of the joint, the antero-inner part of the medial condyle of the femur and the posterior intercondylar fossa of the tibia, to which the posterior cruciate ligament is attached. On this tomogram, according to the anatomical attachment of the posterior cruciate ligament (from the anteroposterior medial condyle of the femur to the posterior intercondylar fossa of the tibia), five REF lines are cut with a thickness of 4 mm through a gap of 0 mm, because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament is 2.7 cm. If you take 3 or 4 sections, you may not get a complete image of the ligament. Five skew-sagittal tomograms are produced in T1 and T2 weighted images. On the third tomogram, the rupture of the posterior cruciate ligament and the stratification of its fragments were clearly defined. The patient underwent revision of the joint, during which the rupture of the posterior cruciate ligament was confirmed and plastic surgery of the posterior cruciate ligament was performed.

 2. Patient B., 53 years old, was sent for a study at the center for radiation diagnostics of the city clinical hospital No. 1 of Novokuznetsk from the traumatology department of the city hospital No. 11 of Novokuznetsk with a diagnosis of rupture of the anterior cruciate ligament, inner-lateral ligament, internal meniscus, hemarthrosis left knee joint. A history of the injury that the patient received 3 weeks ago. In the mine, he received a direct hit with a wooden stance on his left leg. He felt a sharp pain, could not walk, his workmates were taken to the mountain and an ambulance to the hospital. On radiographs of the left knee joint, bone traumatic injuries were not detected. There was an increase in the volume of paraarticular soft tissues, a darkening of the rhomboid space and a shift of the patella up and anterior, indicating a large amount of fluid in the joint cavity. On examination, the left knee joint is sharply swollen, the skin is cyanotic, and there are no movements in the joint. A dense, sharply painful tumor is palpated in the internal part of the joint. A standard MR tomographic examination of the joint was performed, edge fractures of the external condyle of the left femur, patella, micro fractures of the external condyle of the femur and internal condyle of the tibia, ruptures of the joint capsule of the anterior cruciate ligament, collateral inner-lateral ligament, post-traumatic synovitis were found. The posterior cruciate ligament is sharply edematous, fuzzy, very heterogeneous signals emanating from it. On a sagittal tomogram with a partial image of the posterior cruciate ligament, five REF lines are cut with a thickness of 4 mm through a gap of 0 mm, because the places of the upper and lower attachments of the ligament are located in different sagittal and frontal planes, and the width of the ligament is from 2.3 cm. If you take 3 or 4 slices, then you can not get a holistic image of a bunch. Five tomograms are obtained in a non-standard oblique-coronal projection. From the five oblique-coronal tomograms obtained, a second one is selected, in which the central part of the joint, the anterior-internal part of the medial condyle of the femur and the posterior intercondylar fossa of the tibia are visible, to which the posterior cruciate ligament is attached. On this tomogram, according to the anatomical attachment of the posterior cruciate ligament (from the anteroposterior margin of the medial condyle of the femur to the posterior intercondylar fossa of the tibia), five REF lines are constructed with a section thickness of 4 mm through a gap of 0 mm, because the places of the upper and lower attachments are located in different sagittal and frontal planes, and a width of 2.3 cm. If you take 3 or 4 sections, you can not get a holistic image of the ligament.

 Five skew-sagittal tomograms are produced in T1 and T2 weighted images. The second tomogram clearly defined the tear of the posterior cruciate ligament, capturing most of the ligament. The ligament intensity was heterogeneous, and the thickness was uneven. The patient underwent arthroscopy, during which the diagnosis of rupture of the posterior cruciate ligament was confirmed. Arthroscopic plastic surgery of both cruciate ligaments with a transplant from the patellar ligament was produced, and the joint capsule was sutured.

 Thus, the method for examining the posterior cruciate ligament is highly informative and non-invasive. Allows the doctor to timely determine the tactics of treatment in trauma and surgical patients. The method is used in clinical practice of the city clinical hospital N 1, Novokuznetsk.

Claims (1)

 A method of obtaining an image of the posterior cruciate ligament of the knee joint with magnetic resonance imaging in the sagittal plane, characterized in that on the sagittal tomogram with a partial image of the posterior cruciate ligament, 5 REF-lines are cut with a thickness of 4 mm through a gap of 0 mm, 5 tomograms are obtained in a coronal projection , from the 5 oblique tomograms obtained, one is selected, which shows the central part of the joint, the antero-inner part of the medial condyle of the femur and the posterior intercondylar the fossa of the tibia, to which the posterior cruciate ligament is attached, on this tomogram, respectively, the anatomical attachment of the posterior cruciate ligament from the anteroposterior margin of the medial condyle of the femur to the posterior intercondylar fossa of the tibia is built 5 REF-lines with a section thickness of 4 mm through a gap of 0 mm and on one of these tomograms obtain a complete undistorted image of the posterior cruciate ligament.

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