msus 中基本病变的定义和表现 (omeract) · sinovitis eg: hs + derrame. ... bursitis:...
TRANSCRIPT
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MSUS 中基本病变的定义和表现 (OMERACT)
Esperanza Naredo西班牙马德里
中国风湿学会香港风湿学会
MSUS初级课程中国,上海
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声明
本人无与此课程相关的利益冲突
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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
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Synovitis
滑膜炎
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Synovitis components滑膜炎的组成
滑膜增生Synovial
hypertrophy
B-mode
(灰阶GS)
滑液
Synovial fluid
B-mode
(灰阶GS)
滑膜充血Synovial
vascularization
多普勒Doppler
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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 intra-articular tissue that is non displaceable and poorly
compressible which may exhibit Doppler signal
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GS Synovitis = SH + effusion滑膜炎(灰阶)=滑膜增生+积液
Sinovitis EG: HS + derrame
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Synovitis, GS 滑膜炎(灰阶)
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What is this?
Sinovitis EG: HS + derrame
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GS & Doppler synovitis 滑膜炎(灰阶&多普勒)
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Synovitis, Doppler滑膜炎(多普勒)
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Synovitis, GS滑膜炎(灰阶)
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Synovitis, Doppler滑膜炎(多普勒)
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Synovitis, GS. Dynamic scanning滑膜炎(灰阶)动态扫描
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Synovitis, Doppler滑膜炎(多普勒)
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Synovitis, GS滑膜炎(灰阶)
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Synovitis. Gout (tophus)滑膜炎,痛风(痛风石)
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Tenosynovitis
腱鞘炎
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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-tendinousDoppler 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
OMERACT definitions 定义
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Where?
Peripheral joints (hand, foot)
PD more sensitive in supeficial joints
Grey-scale synovitis: synovial hypertrophy + effusion
Wrist, 6th extensor compart (ECU)
腕,第6伸肌腔室(尺侧腕伸肌)
Trans横断面Long长轴
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
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Tenosynovitis, GS 腱鞘炎(灰阶)
trans, peroneal, long 腓骨长短肌腱,横断面,长轴
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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
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Paratenonitis
腱周炎
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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)
US definition 超声定义
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Long
Paratenonitis, GS腱周炎(灰阶)
Finger extensor tendon, long
指伸肌腱,长轴
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Long
Finger extensor tendon, long
指伸肌腱,长轴
Paratenonitis, Doppler腱周炎(多普勒)
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Tendinosis
慢性腱炎
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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)
Definition 定义
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Tendinosis (global) 慢性腱炎(全长)
Patellar tendon, long髌腱,长轴
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Tendinosis (focal) 慢性腱炎(局灶)
Patellar tendon, trans髌腱,横轴Jumper´s knee 跳跃膝
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Tendinosis, Doppler 慢性腱炎 (多普勒)
Elbow, common extensor tendon, long肘,伸肌总腱,长轴
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
Active/inactive tendinopathy 活动性/非活动性肌腱病
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Enthesopathy
肌腱端病
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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
OMERACT definitions 定义
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Enthesopathy, GS 肌腱端病(灰阶)
Achilles tendon, long跟腱,长轴
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Enthesopathy, GS 肌腱端病(灰阶)
Achilles tendon, long and trans
跟腱,长轴和横断面
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Tendon crystal
deposition
肌腱内晶体沉积
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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/orhypoechoic 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
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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/orhypoechoic aggregation (which may or may not generate posterior acousticshadow), 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
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Tendon rupture
肌腱断裂
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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
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Partial tendon tear 肌腱部分撕裂
Supraspinatus tendon, long
冈上肌腱,长轴
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Full-thickness tear 全层撕裂
Supraspinatus tendon, trans and long
冈上肌腱,横断面和长轴
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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
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Complete tear 完全撕裂
Achilles tendon, long
跟腱,长轴
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Tendon
damage
肌腱损伤
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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
OMERACT definition 定义
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Finger flexor tendon, trans
指屈肌腱,横断面
Tendon damage 肌腱损伤
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Bursitis
滑囊炎
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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
Definition 定义
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Olecranon bursitis 鹰嘴滑囊炎
Trans , Long
横断面,长轴
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Infrapatellar bursitis髌下滑囊炎
长轴,横断面
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ST calcification
软组织钙化
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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
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Tendon calcification 肌腱钙化
Supraspinatus tendon, long and trans
冈上肌腱,长轴和横断面
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Tendon calcification. Gout肌腱钙化,痛风
Patellar tendon, long
髌腱,长轴
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Tendon calcification 肌腱钙化
Degenerative tendinopathy 退行性肌腱病
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Tendon calcification 肌腱钙化
Osgood-Schlatter
Patellar tendon, long
髌腱,长轴
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Anterior talofibular lig, long
距腓前韧带,长轴
normal
Ligament calcification 韧带钙化
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Bone erosions
骨侵蚀
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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
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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
Grey-scale synovitis: synovial hypertrophy + effusion
Long
MTP, dorsal 背侧
Trans
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Where?
Accessible joints 可探测的关节
Ulnar styloid process 尺骨茎突
Trans横断面
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Bone
proliferation
骨增生
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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
OMERACT definition定义
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Enthesophytes 肌腱端骨赘
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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
OMERACT definition定义
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Osteophytes 骨赘
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Fractures 骨折
Metatarsal occult fracture, long
跗跖关节,隐形骨折,长轴
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Cartilage
abnormalities
软骨病变
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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
OMERACT definition定义
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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
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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
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1st 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
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Femoral condyle, trans and long
股骨髁,横断面和长轴
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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)
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