msus 中基本病变的定义和表现 (omeract) · sinovitis eg: hs + derrame. ... bursitis:...
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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
声明
本人无与此课程相关的利益冲突
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
B-mode
(灰阶GS)
滑液
Synovial fluid
B-mode
(灰阶GS)
滑膜充血Synovial
vascularization
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 intra-articular 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
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
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
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
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
Long
Paratenonitis, GS腱周炎（灰阶）
Finger extensor tendon, long
指伸肌腱，长轴
Long
Finger extensor tendon, long
指伸肌腱，长轴
Paratenonitis, Doppler腱周炎（多普勒）
Tendinosis
慢性腱炎
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
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
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
Enthesopathy
肌腱端病
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
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/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
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
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
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
Finger flexor tendon, trans
指屈肌腱，横断面
Tendon damage 肌腱损伤
Bursitis
滑囊炎
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
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
Anterior talofibular lig, long
距腓前韧带，长轴
normal
Ligament calcification 韧带钙化
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
Grey-scale synovitis: synovial hypertrophy + effusion
Long
MTP, dorsal 背侧
Trans
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
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
Enthesophytes 肌腱端骨赘
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
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
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
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
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
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）
