目的:探讨3.0T MRI三维-多回波恢复梯度回波（3 dimensional-multiple-echo recalled gradient echo, 3D-MERGE）序列在评价冈上肌肌腱损伤程度中的应用价值。方法:回顾性分析经关节镜证实的52例肩痛患者的3.0T MRI 3D-MERGE序列和常规序列[包括斜冠状位T1加权成像（T1 weighted image,T1WI）、T2WI-脂肪抑制（fat suppress,FS）、轴位T2WI-FS和斜矢状位质子密度加权成像（proton density weighted imaging,PDWI）-FS]影像资料,以关节镜检查结果为标准,分为Ⅰ组（冈上肌肌腱无损伤,含变性）、Ⅱ组（冈上肌肌腱轻度损伤,即撕裂<50%）、Ⅲ组（冈上肌肌腱中重度损伤,撕裂≥50%,但未完全撕裂）和Ⅳ组（冈上肌肌腱重度损伤,完全撕裂）,观察各组间的3D-MERGE序列、常规序列及联合以上2种序列的扫描结果,并比较3种MRI检查方法诊断冈上肌肌腱损伤程度的灵敏度、特异度、阳性预测值、阴性预测值。结果:3D-MERGE序列、常规序列及2种序列联合检查判别冈上肌肌腱轻度及以下损伤(Ⅰ组+Ⅱ组）的诊断效能间差异无统计学意义（P均>0.05）。判别冈上肌肌腱中重度及以上损伤(Ⅲ组+Ⅳ组)时,3D-MERGE序列、常规序列及2种序列联合检查的灵敏度、特异度、阳性预测值、阴性预测值分别为100%、80.00%、88.90%、100%,65.60%、100%、100%、64.50%,100%、90.00%、94.10%、100%。3D-MERGE序列检查及2种序列联合检查的诊断效能均优于常规序列（P均<0.05）,而3D-MERGE序列与2种序列联合检查的诊断效能间差异无统计学意义（P=0.38）。结论:与常规序列相比,MRI 3D-MERGE序列检查在诊断冈上肌肌腱中重度及以上损伤时效能较高,可作为评价冈上肌肌腱损伤程度的补充序列。

Objective: To study the application value of 3.0T MRI 3D-MERGE sequence in evaluating the degree of supraspinatus tendon injury. Methods: A total of 52 patients with shoulder pain diagnosed with arthroscopy were enrolled. The 3.0T MRI 3D-MERGE sequence and conventional sequences (including T1WI, T2WI-FS, T2WI-FS on axial plane and PDWI-FS on oblique sagittal plane) were performed, and the results were retrospectively analyzed. According to the arthroscopic findings, the patients were divided into 4 groups: group Ⅰ(without supraspinatus tendon injury), group Ⅱ(mild tear of supraspinatus tendon, <50%), group Ⅲ (moderate to severe tear of supraspinatus tendon, ≥50% but not completely) and group Ⅳ(supraspinatus tendon tear completely). The diagnostic efficacy of 3D-MERGE sequence, conventional sequences alone and combination for supraspinatus tendon injury were compared. Results: The diagnostic efficacy between 3D-MERGE sequence, conventional sequences alone and combination for differentiating supraspinatus tendon with tear from without tear were similar (all P values>0.05). The sensitivity,specificity,positive predictive value,negative predictive value of the 3D-MERGE sequence, the conventional sequences and the combined two sequences were 100%, 80.00%, 88.90%, 100%, and 65.60%, 100%, 100%, 64.50%, and 100%, 90.00%, 94.10%, 100%, respectively. However, for evaluating supraspinatus tendon tear≥50% and above, the diagnostic efficacies of the 3D-MERGE sequence and the combined two sequences were better than that of conventional sequences (both P values<0.05). There was no significant difference between the 3D-MERGE sequence and the combined two sequences (P=0.38). Conclusions: Compared with conventional sequences, 3D-MERGE sequence has a higher performance for diagnosing supraspinatus tendon injury from moderate to severe degree or above, and it could be used as a supplementary sequence for evaluating the degree of supraspinatus tendon injury.