PDF â"„®‡∫ ÈÕßμ âπ¢Õß°"√μ√«® §≈ Ëπ·¡ à‡À≈ Á°‰øø Ñ" ¢Õß√-∫∫°√-¥ Ÿ°·≈-¢ âÕ

∫∑§«“¡ª√‘∑—»πå

§«“¡‡¢â“„®‡∫◊ÈÕßμâπ¢Õß°“√μ√«®

§≈◊Ëπ·¡à‡À≈Á°‰øøÑ“ ¢Õß√–∫∫°√–¥Ÿ°·≈–¢âÕ

Õ.πæ.ª“≈π—π∑å »‘√‘«π“√—ß √√§å

ªí®®ÿ∫—π°“√ √â“ß¿“æ∑“ß√—ß ’«‘∑¬“‚¥¬°“√„™â

§≈◊Ëπ·¡à‡À≈Á°‰øøÑ“ (MRI) ‡æ◊ËÕ∑”°“√μ√«®«‘π‘®©—¬·¬°

‚√§„π°≈ÿà¡°√–¥Ÿ°·≈–¢âÕ ¡’∫∑∫“∑∑’Ë ”§—≠Õ¬à“ß¡“°

„π°“√«“ß·ºπμ√«®√—°…“ ‚¥¬‡©æ“–„π°≈ÿà¡‚√§∑’ˇ°‘¥

®“°°“√∫“¥‡®Á∫®“°°“√‡≈àπ°’Ó (Sport medicine) ‚√§

‡π◊ÈÕßÕ°¢Õ߇π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π (Soft tissue tumor) ·≈–

‡π◊ÈÕßÕ°¢Õß°√–¥Ÿ° (Bone tumor) ´÷Ëß°“√ √â“ß¿“æ¥â«¬

§≈◊Ëπ·¡à‡À≈Á°‰øøÑ“„πªí®®ÿ∫—π®–‡ªìπ°“√„™â§≈◊Ëπ·¡à‡À≈Á°

‰øøÑ“„π√–¥—∫§«“¡‡¢â¡¢âπ Ÿß ´÷Ëß¡’¢âÕ¥’‡Àπ◊Õ°“√ àß μ√«®Õ◊Ëπ‚¥¬¿“æ®–¡’§«“¡§¡™—¥ ·≈– “¡“√∂· ¥ß

≈—°…≥–°“¬¿“æ¢Õß‚§√ß √â“ß∑’Ë¡’§«“¡´—∫´âÕπ‰¥â Õ¬à“ß™—¥‡®π ∑”„Àâ “¡“√∂«“ß·ºπ°“√√—°…“ ‰¥âÕ¬à“ß

·¡à𬔠√«¡∑—Èß°“√ àßμ√«®π’ȉ¡à¡’°“√‰¥â√—∫√—ß ’´÷Ë߇æ‘Ë¡

‚Õ°“ „π°“√‡ªìπ¡–‡√Áß∑’Ë¡“°¢÷ÈπÕ’°¥â«¬

°“√ √â“ß¿“æ®–‡√‘Ë¡¥â«¬°“√°√–μÿâπ‡π◊ÈÕ‡¬◊ËÕ¢Õß

√à“ß°“¬¥â«¬§≈◊Ëπ«‘∑¬ÿ·¡à‡À≈Á°‰øøÑ“ (Radiofrequency)

¿“¬„μâ π“¡·¡à‡À≈Á°∑’Ë¡’§«“¡‡¢â¡¢âπ Ÿß ´÷ËßÀ“°°√–μÿâπ

¥â«¬§«“¡∂’Ë∑’ˇÀ¡“– ¡ ®–∑”„Àâ·¡à‡À≈Á°‰øøÑ“√«¡¢Õß

√à“ß°“¬ (Net magnetization) ¡’°“√‡ª≈’ˬπ·°π‰ª

‡π◊ÈÕ‡¬◊ËÕ∑’Ë∂Ÿ°°√–μÿâπ®–§àÕ¬Ê ∂à“¬‡∑æ≈—ßß“π‡æ◊ËÕ°≈—∫

‡¢â“ Ÿà ¿“«– ¡¥ÿ≈ ‚¥¬æ≈—ßß“π¢ÕßÕ«—¬«–·μà≈–Õ¬à“ß

´÷Ëß¡’‚¡‡≈°ÿ≈∑’ˇªìπÕߧåª√–°Õ∫·μ°μà“ß°—π®–∂à“¬‡∑

¥â«¬√–¬–‡«≈“∑’ˉ¡à‡∑à“°—π‚¥¬‡©æ“–‰¢¡—π ·≈–πÈ”¹ ®“°

π—Èπ‡§√◊ËÕß®–π”¢âÕ¡Ÿ≈®“°°“√∂à“¬æ≈—ßß“π°≈—∫¡“ √â“ß

‡ªìπ¿“æ

§à“§«“¡‡¢â¡¢âπ¢Õß π“¡·¡à‡À≈Á°∑’ˇÀ¡“– ¡„π

°“√ √â“ß¿“æ„™â∑“ߧ≈‘π‘°®–Õ¬Ÿà∑’˪√–¡“≥ 0.2-3.0 Tesla

·≈–∂◊Õ«à“¡’§«“¡‡¢â¡¢âπ Ÿß‡¡◊ËÕ§à“¢Õß π“¡·¡à‡À≈Á°¡’

§à“¡“°°«à“ 1.0 Tesla² ‚¥¬°“√¡’§«“¡‡¢â¡¢âπ¢Õß π“¡

·¡à‡À≈Á° Ÿß®–·ª√º—π‚¥¬μ√ß°—∫ª√‘¡“≥ —≠≠“≥∑’ˉ¥â√—∫

‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ —≠≠“≥°«π (signal to noise ratio)

·≈–·ª√º—π‚¥¬μ√ß°—∫§«“¡§¡™—¥‡¡◊ËÕ‡∑’¬∫°—∫ —≠≠“≥

°«π (contrast to noise ratio)

πÕ°®“°π’È√–¬–‡«≈“„π°“√ √â“ß¿“æ¿“¬„μâ π“¡

·¡à‡À≈Á°§«“¡‡¢â¡¢âπ Ÿß °Á≈¥≈ßÕ¬à“ß¡“° ‡π◊ËÕß®“°‰¥â ª√‘¡“≥ —≠≠“≥μàÕ°“√°√–μÿâπ·μà≈–§√—Èß¡“°μ“¡

§«“¡‡¢â¡¢âπ∑’Ë Ÿß¢÷Èπ‰ª¥â«¬³ Õ¬à“߉√°Áμ“¡°“√¡’ §«“¡

‡¢â¡¢âπ¢Õß π“¡·¡à‡À≈Á°∑’Ë Ÿß¡—°¡’√“§“¢Õ߇§√◊ËÕß·æß

∑”„Àâμâπ∑ÿπ„π°“√ √â“ß¿“æ Ÿß ·≈–¡’§«“¡·ª√ª√«π  ŸßÀ“°¡’«— ¥ÿ∑’ˇªìπ‚≈À–‡¢â“‰ª„π‡§√◊ËÕß (metallic artifact)⁴

*¿“§«‘™“√—ß ’«‘∑¬“ §≥–·æ∑¬»“ μ√廑√‘√“™æ¬“∫“≈

°“√‡≈◊Õ° coil

Coil §◊Õ ‡§√◊ËÕß¡◊Õ∑’Ëπ”¡“μ‘¥∫√‘‡«≥∑’Ë π„®μ√«®‡æ◊ËÕ

‡æ‘Ë¡ —≠≠“≥ ·≈–§«“¡§¡™—¥¢Õß√Ÿª

‚¥¬∑—Ë«‰ª°“√ √â“ß¿“æ∑“ß°√–¥Ÿ°·≈–¢âÕ®–‡≈◊Õ°

„™â coil ∑’Ë¡’¢π“¥„À≠à°«à“∫√‘‡«≥∑’Ë π„®ª√–¡“≥ 1.5

‡∑à“² ®÷ß¡’°“√ÕÕ°·∫∫ coil À≈“°À≈“¬√Ÿª·∫∫ ‡æ◊ËÕ„Àâ

‡À¡“– ¡°—∫∫√‘‡«≥μ”·Àπàß∑’ËμâÕß°“√μ√«® ∑—Èß shoulder, knee, wrist ·≈– ankle coil πÕ°®“°π’Ȭ—ß¡’ coil ∑’Ë„™â‰¥â

„πÀ≈“°À≈“¬«—μ∂ÿª√– ß§å (Multipurpose coil) ´÷Ëß¡’

¢π“¥‡≈Á°ª√–¡“≥Àâ“π‘È« „™â„π°“√ √â“ß¿“æ ∫√‘‡«≥∑’Ë

¡’¢π“¥‡≈Á°‡™àππ‘È«¡◊Õ⁵

´÷Ëß°“√„™â dedicate coil ‡À≈à“π’È ¡’§«“¡ ”§—≠ ”À√—∫

°“√ √â“ß¿“æ¢ÕߢâÕÕ¬à“ß¡“° ‚¥¬‡©æ“–¢âÕ‰À≈à ∑—Èßπ’È

‡π◊ËÕß®“°¢âÕ‰À≈à¡—°Õ¬Ÿà„πμ”·Àπàß∑’ËÕ¬ŸàÀà“ß®“°»Ÿπ¬å°≈“ß

¢ÕßÕÿ‚¡ß§å (off center) ®–∑”„Àâ¿“æ∑’ˉ¥â Ÿ≠‡ ’¬§«“¡

§¡™—¥ (signal to noise ratio) ·≈–Õ“®∑”„Àâ°“√°¥

 —≠≠“≥¢Õ߉¢¡—π∑’ˉ¡à ¡∫Ÿ√≥剥â⁶

°“√ √â“ß¿“æ™π‘¥μà“ßʥ⫬§≈◊Ëπ·¡à‡À≈Á°

‰øøÑ“ (MRI pulse sequence in MSK)

√–¬–‡«≈“√–À«à“ß°“√‡√‘Ë¡°√–μÿâπ‡π◊ÈÕ‡¬◊ËÕ∂÷ß™à«ß∑’Ë¡’

°“√°√–μÿâπ§√—ÈßμàÕ‰ª‡√’¬°«à“ Repetition time(TR) ·≈–

‡«≈“μ—Èß·μà°√–μÿâπ§√—Èß·√°®π∑”°“√°√–μÿâπ¬àÕ¬´È”‡√’¬°

Echo time(TE) ´÷Ëߧÿ≥ ¡∫—μ‘¢Õ߉¢¡—π ·≈–πÈ”„π

√à“ß°“¬®–¡’§«“¡ “¡“√∂„π°“√∂à“¬‡∑æ≈—ßß“π „π

‡«≈“∑’Ëμà“ß°—π °≈à“«§◊Õ ‰¢¡—π®–¡’§ÿ≥ ¡∫—μ‘∂à“¬‡∑

æ≈—ßß“π„π‡«≈“∑’Ë —Èπ°«à“πÈ” ‚¥¬¡—°„™â‡«≈“∑—Èß TR ·≈–

TE ∑’Ë —Èπ ¥—ßπ—Èπ„π™à«ß‡«≈“∑’Ë∑—Èß TR ·≈– TE  —Èπ®–

 “¡“√∂ √â“ß¿“æ∑’ˉ¥âæ≈—ßß“π®“°‰¢¡—π‡ªìπÀ≈—°‰¥â

‡√’¬°¿“æ≈—°…≥–π’È«à“ ¿“æ∂à«ßπÈ”Àπ—° T1 (T1 weighted

√Ÿª∑’Ë 1 (°) · ¥ß ·°π·¡à‡À≈Á°¢Õß protron „π√à“ß°“¬„π ¿“«–ª°μ‘ ®–¡’§à“ net magnetization = 0 ·μà∂â“À“°Õ¬Ÿà¿“¬„μâ  π“¡·¡à‡À≈Á°∑’Ë¡’§«“¡‡¢â¡¢âπ Ÿß °“√‡√’¬ßμ—«¢Õß ·°π·¡à‡À≈Á°¢Õß protron ®–¡“Õ¬Ÿà„π·°π‡¥’¬«°—π ∑”„À⇡◊ËÕ√«¡

 π“¡·¡à‡À≈Á°∑—ÈßÀ¡¥·≈â«®–¡’§à“Õ¬Ÿà„π√–¥—∫Àπ÷Ëß (¢) ‡¡◊ËÕ°√–μÿâπ net magnetization ¥â«¬ radiofrequency pulse ®–

∑”„Àâ·°π¢Õß net magnetization ¡’°“√‡ª≈’ˬπ·ª≈߉ª (§) · ¥ß°“√§◊πμ—«¢Õß net magnetization °≈—∫ Ÿà·°π

‡¥‘¡À≈—ß°“√°√–μÿâπ ´÷Ë߇§√◊ËÕß MRI ®–∑”°“√‡°Á∫¢âÕ¡Ÿ≈°“√§“¬æ≈—ßß“π√–À«à“ß°“√§◊πμ—« ¡“ √â“߇ªìπ¿“æ

° ¢

§

image) „π¢≥–∑’Ë πÈ”¿“¬„π‡π◊ÈÕ‡¬◊ËÕ®–¡’‡«≈“ TR ·≈– TE

∑’ˬ“«ÕÕ°‰ª ¥—ßπ—ÈπÀ“°∑”°“√ √â“ß¿“æ„π‡«≈“∑’Ë TR

·≈– TE ¬“«ÕÕ° ®–‰¥â¿“æ∑’ˉ¥â®“°πÈ”‡ªìπÀ≈—°·≈–

‰¢¡—π‡ªìπ√Õß ∑—Èßπ’ȇπ◊ËÕß®“°‰¢¡—π‰¥â∂à“¬‡∑æ≈—ßß“π‰ª

°àÕπÀπâ“·≈â«

¥—ßπ—Èπ¿“æ∑’Ë √â“ß®“°‡§√◊ËÕß MRI (MRI image)

‡À≈à“π’È¡’§ÿ≥ ¡∫—μ‘„π°“√·ª≈º≈μà“ßÊ °—πÕÕ°‰ª ¬°

μ—«Õ¬à“߇™àπ

- ¿“æ T1 weighted image (T1Wi) ®–‡ªìπ¿“æ

∑’ˇπâπ √â“ß®“° —≠≠“≥¢Õ߉¢¡—π‡ªìπÀ≈—° ∑”„Àâ  “¡“√∂‡ÀÁπ Õ«—¬«–∑’Ë¡’‰¢¡—π‡ªìπ à«πª√–°Õ∫‰¥âÕ¬à“ß

™—¥‡®π ‡™àπ ™—Èπ‰¢¡—π„μ⺑«Àπ—ß °≈â“¡‡π◊ÈÕ∑’Ë¡—°¡’‰¢¡—π

√Ÿª∑’Ë 2 ¿“æ· ¥ß (°) Shoulder coil (¢) Position of shoulder coil (§) Knee coil (ß) Position of knee coil (®) Position of wrist coil (©) Ankle coil (™) Multipurpose coil

° ¢

§ ß

® ©

™

·∑√°μ—«Õ¬Ÿà√–À«à“ß¡—¥ À≈Õ¥‡≈◊Õ¥·≈–‡ âπª√– “∑∑’Ë¡’

‰¢¡—π≈âÕ¡√Õ∫ ´÷Ëß®–∑”„Àâ “¡“√∂‡ÀÁπ≈—°…≥–∑“ß

°“¬«‘¿“§ (anatomy) ‰¥â‡ªìπÕ¬à“ߥ’ √«¡∑—Èߙ૬„π°“√

«‘π‘®©—¬‡π◊ÈÕßÕ°∑’Ë¡’‰¢¡—π – ¡Õ¬Ÿà¿“¬„π‰¥â ‡™àπ Lipoma À√◊Õ Liposarcoma

πÕ°®“°‰¢¡—π·≈â«  “√Õ◊Ëπ∫“ß™π‘¥°Á “¡“√∂„Àâ  —≠≠“≥∑’Ë¢“«¢÷Èπ„π T1W ‰¥â‡™àπ‡¥’¬«°—π ‰¥â·°à ‚ª√μ’π

°âÕπ‡≈◊Õ¥ À√◊Õ “√‡¡≈“π‘π (Melanine) ¥—ßπ—ÈπÀ“°

∑”°“√°¥ —≠≠“≥¢Õ߉¢¡—π≈ß„π¿“æ T1W (T1W fat saturation: T1WFS) ®– “¡“√∂‡ÀÁπ≈—°…≥–¢Õß “√¥—ß

°≈à“«‰¥â¥’¢÷Èπ

- ¿“æ T2 weighted image (T2Wi) ®–‡ªìπ¿“æ

∑’ˇπâπ √â“ß®“° —≠≠“≥¢ÕßπÈ”‡ªìπÀ≈—° ·≈–‰¢¡—π‡ªìπ

√Õß ∑”„Àâ¿“æ∑’ˉ¥â “¡“√∂· ¥ß∂÷ßμ”·Àπàß∑’Ë¡’欓∏‘

 ¿“懰’ˬ«°—∫°“√∫«¡πÈ”‰¥â¥’ ‚¥¬‡©æ“–À“°¡’°“√„™â

‡∑§π‘§°¥ —≠≠“≥¢Õ߉¢¡—π≈ß (fat saturation; T2WFS)

®–∑”„Àâ “¡“√∂¡Õ߇ÀÁπμ”·Àπàß∑’Ë¡’°“√∫«¡πÈ”‰¥â¥’¬‘Ëß

¢÷Èπ ¬°μ—«Õ¬à“߇™àπ ∫√‘‡«≥∑’ˇ°‘¥°“√∫“¥‡®Á∫¢Õ߇π◊ÈÕ‡¬◊ËÕ μà“ßÊ °“√μ‘¥‡™◊ÈÕ¢Õß√–∫∫°√–¥Ÿ°°≈â“¡‡π◊ÈÕ °“√√–∫ÿ μ”·Àπàß∑’Ë¡’°“√©’°¢“¥¢Õ߇ âπ‡ÕÁπ À√◊Õ∫√‘‡«≥¢Õß

√Ÿª∑’Ë 3 · ¥ßμ—«Õ¬à“ß¿“æ °) Axial T1W ∫√‘‡«≥μâπ¢“ ‡ªìπ¿“æ∑’Ë —߇°μ‡ÀÁπ¢Õ∫‡¢μ¢Õß°≈â“¡‡π◊ÈÕ ·≈– “¡“√∂√–∫ÿμ”·Àπàß

¢Õ߇ âπ‡≈◊Õ¥‰¥âÕ¬à“ß™—¥‡®π ‡π◊ËÕß®“°√–À«à“ßÕ«—¬«–‡À≈à“π’È¡’‰¢¡—π·∑√°Õ¬Ÿà ¢) Axial T2W ∫√‘‡«≥μâπ¢“  —߇°μÿ‰¥â«à“

 ’¢Õß°≈â“¡‡π◊ÈÕ¡’ ’‡¢â¡°«à“„π T1W §) Coronal T2WFS ∫√‘‡«≥¢âÕ‡¢à“´÷Ëß®– “¡“√∂¡Õ߇ÀÁππÈ”„π¢âÕ ·≈–°“√∫«¡

√Õ¬·μ°¢Õß°√–¥Ÿ° femur ‰¥âÕ¬à“ß™—¥‡®π ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫¿“æ x-ray ¢âÕ‡¢à“ (ß)

° ¢

§ ß

‡π◊ÈÕ‡¬◊ËÕ∑’Ë∂Ÿ°¡–‡√Áß≈ÿ°≈“¡ ‡ªìπμâπ

- ¿“æ Proton density (PDWi) ‡ªìπ¿“æ∑’Ë¡’º≈

¢Õß∑—Èß T1W ·≈– T2W §◊Õ∑—Èß —≠≠“≥¢Õ߉¢¡—π·≈–πÈ”

´÷Ë߇ªìπ∑—ÈߢâÕ¥’·≈–¢âÕ‡ ’¬ °≈à“«§◊Õ°“√¡’ —≠≠“≥∑’Ë

¡“°∑—ÈßπÈ”·≈–‰¢¡—π∑”„Àâ “¡“√∂¡Õ߇ÀÁπÕߧåª√–°Õ∫

¬àÕ¬¿“¬„π¢âÕ (microstructure) ‰¥â¥’ √«¡∑—Èß “¡“√∂

· ¥ß欓∏‘ ¿“æ¢Õß ‡π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—πª√–‡¿∑ Fibrocar- tilage ‡™àπ À¡Õπ√Õ߇¢à“ (meniscus) ·≈– À¡Õπ√ÕߢâÕ

‰À≈à (labrum) ‰¥â‡ªìπÕ¬à“ߥ’ ¥—ßπ—Èπ®÷ßπ‘¬¡„™â¿“æ™π‘¥

π’È„π°“√ª√–‡¡‘πºŸâªÉ«¬°≈ÿà¡∑’ˉ¥â√—∫°“√∫“¥‡®Á∫®“°°“√

‡≈àπ°’Ó ·μà‡π◊ËÕß®“°¿“æ∑’Ë„Àâ —≠≠“≥∑—È߉¢¡—π·≈–πÈ”

¥—ßπ—Èπ¿“æ∑’ˉ¥â®÷߉¡à¡’§ÿ≥ ¡∫—μ‘„π°“√·∫àß·¬°™π‘¥

¢ÕßÕߧåª√–°Õ∫¢Õßμ”·Àπàß欓∏‘ ¿“扥â‡≈¬ ®÷߉¡à π‘¬¡∑”„π°√≥’∑’ËμâÕß°“√ª√–‡¡‘π Õߧåª√–°Õ∫¿“¬„π

°âÕπ

- ¿“æ Gradient (GRE) ‡ªìπ°“√ √â“ß¿“æ¥â«¬°“√

„™â π“¡·¡à‡À≈Á°‡ªìπμ—«‡Àπ’ˬ«π” §«“¡‡ª≈’ˬπ·ª≈ß

¢Õß·°π·¡à‡À≈Á°„π√à“ß°“¬ ‡æ◊ËÕ √â“߇ªìπ¿“æ ®÷ß∑”„Àâ

¿“æ∑’ˉ¥â¡’§«“¡‰«μàÕ∫√‘‡«≥∑’Ë π“¡·¡à‡À≈Á°¡’°“√

√∫°«π ‡™àπ∫√‘‡«≥∑’Ë¡’‚≈À– ‡≈◊Õ¥ À√◊Õ·§≈‡´’ˬ¡ – ¡ Õ¬Ÿà ¥—ßπ—Èπ®÷ßπ‘¬¡„™â¿“æ™π‘¥π’È„π°“√ª√–‡¡‘π°“√¡’

‡≈◊Õ¥ÕÕ°¿“¬„π欓∏‘ ¿“æ À√◊Õ°âÕπ‡π◊ÈÕ∑’Ë ß —¬ √«¡

∑—Èß„™âμ√«®À“¿“«–·§≈‡´’¬¡ – ¡„π‡ âπ‡ÕÁπ (Calcific tendinosis)

- °“√©’¥ “√·°¥‚¥≈‘‡π’¬¡ (Gadolinium: Gd)

‡¢â“À≈Õ¥‡≈◊Õ¥ ‚¥¬ “√™π‘¥π’ȇªìπ  “√‚≈À–Àπ—°∑’Ë„Àâ  —≠≠“≥¢“« (high signal) „π T1WFS image ‡¡◊ËÕ„Àâ  “√ºà“π∑“ßÀ≈Õ¥‡≈◊Õ¥¥”  “√‡À≈à“π’È®–ºà“πÀ—«„®·≈–

°√–®“¬ ŸàÕ«—¬«–μà“ßÊ ¢Õß√à“ß°“¬ºà“πÀ≈Õ¥‡≈◊Õ¥·¥ß

¥—ßπ—ÈπÀ“° “√‡À≈à“π’È„Àâ —≠≠“≥∑’Ëμ”·Àπàß„¥ °Á®–

Õπÿ¡“π«à“μ”·Àπàßπ—Èπ‰¥â√—∫‡≈◊Õ¥®“°√à“ß°“¬ ‡√’¬°Õ’°

Õ¬à“ß«à“°“√¡’ Enhancement

- °“√©’¥ “√·°¥‚¥≈‘‡π’¬¡‡¢â“ Ÿà¢âÕ‚¥¬μ√ß (Di- rect MR arthrogram) π‘¬¡∑”„π¢âÕÀ—«‰À≈à∑—Èßπ’ȇæ◊Ëՙ૬

„π°“√«‘π‘®©—¬¿“«–©’° À√◊Õ·μ°¢ÕßÕ«—¬«–∑’Ë¡’¢π“¥

‡≈Á°‡™àπ °“√©’°¢ÕßÀ¡Õπ√Õ߉À≈à (Labrum) ‚¥¬®–

√Ÿª∑’Ë 4 (°) · ¥ß¿“æ Proton Density image ∫√‘‡«≥¢âÕ‰À≈à ´÷Ëß “¡“√∂· ¥ß√“¬≈–‡Õ’¬¥¿“¬„π‰¥â‡ªìπÕ¬à“ߥ’ (¢) · ¥ß¿“æ GRE ´÷Ëß “¡“√∂· ¥ß∫√‘‡«≥∑’Ë¡’ calcification ‰¥â·¡â®–‰¡à “¡“√∂‡ÀÁπ‰¥â„π PDW ‚¥¬‡ÀÁπ«à“¡’ blooming artifact „π subscapularis tendon

° ¢

√Ÿª∑’Ë 5 (°) T1WFS post Gd administration  “¡“√∂ —߇°μÿ‡ÀÁπ°“√ enhance ¢Õ߇ âπ‡≈◊Õ¥‰¥âÕ¬à“ß™—¥‡®π (¢) · ¥ß¿“æ T1WFS direct arthrogram ¢ÕߢâÕÀ—«‰À≈à ´÷Ëß “¡“√∂· ¥ß√Õ¬·μ°¢Õß Labrum ‰¥âÕ¬à“ß™—¥‡®π ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫°—∫ (§) ¿“æ PDW FS ∑—Èßπ’ȇπ◊ËÕß®“°¢âÕ¡’§«“¡‡μàß¡“°¢÷Èπ®“° Gadolinium ∑’Ë©’¥‡¢â“‰ª∑”„Àâ‡ÀÁπÕ«—¬«–∑’Ë¡’¢π“¥‡≈Á°‰¥â¥’¢÷Èπ ·≈–

contrast ¬—߇§≈◊Õ∫μ“¡√àÕߢÕß√Õ¬·μ°¥â«¬

∑”°“√©’¥ “√·°¥‚¥≈‘‡π’¬¡‡¢â“‰ª¬—ߢâÕ‰À≈à‚¥¬μ√ß

‚¥¬®–¡’¢âÕ¥’§◊ՙ૬„Àâ¢âÕ∑’Ë π„®μ√«®¡’§«“¡μ÷ßμ—«

¡“°¢÷Èπ®“° “√∑’Ë©’¥‡¢â“‰ª∑”„Àâ “¡“√∂‡ÀÁπÕ«—¬«–

¿“¬„π∑’Ë¡’¢π“¥‡≈Á° ‰¥âßà“¬°«à“°“√¡Õß®“°°°“√∑”

conventional MRI⁷ ·μàÕ¬à“߉√°Áμ“¡°“√ àßμ√«®π’È®”‡ªìπ μâÕß∑”°“√„™â‡¢Á¡‡®“–‡¢â“„πª√‘‡«≥¢âÕ‚¥¬μ√ß ‚¥¬

®”‡ªìπ®–μâÕß∑”¿“¬„μâ°“√π”¢Õß Ultrasound À√◊Õ Fluo- roscopic guide ‡æ◊ËÕ≈¥‚Õ°“ ∑’Ë “√·°¥‚¥≈‘‡π’¬¡√—Ë«

‰À≈‰ª¬—ßÕ«—¬«–¢â“߇§’¬ß⁸ ´÷ËßμâÕß„™â§«“¡‡™’ˬ«™“≠¢Õß

·æ∑¬å‡©æ“–¥â“π ®÷߬—߉¡à¡’°“√∑”Õ¬à“ß·æ√àÀ≈“¬·≈–

μâÕß∑”°“√§—¥‡≈◊Õ°ºŸâªÉ«¬‡ªìπÕ¬à“ߥ’·≈⫇∑à“π—Èπ

°“√ª√–‡¡‘π°“√∫“¥‡®Á∫®“°°“√‡≈àπ°’Ó

(Sport medicine)

„πªí®®ÿ∫—π‰¥â¡’°“√æ—≤π“°“√√—°…“∑“߇«™»“ μ√å

°“√°’Ó‰ªÕ¬à“ß¡“° ‚¥¬°“√√—°…“¥â«¬°“√ àÕß°≈âÕß

¿“¬„π¢âÕ (Arthroscope) ‚¥¬°“√∫“¥‡®Á∫¢ÕߺŸâªÉ«¬„π

≈—°…≥–π’È¡—°‡ªìπ°“√∫“¥‡®Á∫∑’ˇπ◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π∑’ËÕ¬Ÿà

≈÷°¿“¬„π¢âÕ ∑”„Àâ°“√ª√–‡¡‘π°“√∫“¥‡®Á∫¥â«¬‡§√◊ËÕß

¡◊Õ™π‘¥Õ◊Ëπ¡—°∑”‰¥â¬“° °“√ √â“ß¿“æ¥â«¬ MRI ®–

 “¡“√∂¡Õ߇ÀÁπ‚§√ß √â“ß¿“¬„π (internal structure)

‰¥âÕ¬à“ß™—¥‡®π ·≈–𔉪 Ÿà°“√«‘π‘®©—¬∑’Ë∂Ÿ°μâÕß ∑’Ë¡’

§«“¡π‘¬¡„™â¡“°„πªí®®ÿ∫—π ®–‡ªìπ°“√∑” MRI ∑’Ë

∫√‘‡«≥¢âÕ‡¢à“ ·≈–¢âÕÀ—«‰À≈à ‚¥¬°“√ √â“ß¿“æ  “¡“√∂∑”„Àâ‡ÀÁ𰓬«‘¿“§¢π“¥‡≈Á°¿“¬„π¢âÕ ∑’Ë¡’

§«“¡ ”§—≠„π°“√√—°…“§«“¡‡ ∂’¬√¢ÕߢâÕ² ‡™àπ ‡ âπ

‡ÕÁπ„π¢âÕ‡¢à“ (anterior cruciate ligament, posterior cruci- ate ligament) ·≈–À¡Õπ√ÕߢâÕ‡¢à“ (meniscus) ‡ âπ‡ÕÁπ À—«‰À≈à (supraspinatus tendon) ‡ªìπμâπ ´÷Ëß°“√· ¥ß 欓∏‘ ¿“æ∑’Ë™—¥‡®π ®–¡’ à«π™à«¬„π°“√«“ß·ºπ°àÕπ

°“√ºà“μ—¥‰¥â‡ªìπÕ¬à“ߥ’

°“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õ߇π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π (Soft tissue tumor)

MRI ∂◊Õ‡ªìπ‡§√◊ËÕß¡◊Õ∑’Ë¥’∑’Ë ÿ¥„π°“√ª√–‡¡‘π ‡π◊ÈÕ ßÕ°¢Õ߇π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π ∑—Èß„π¥â“π°“√„Àâ°“√«‘π‘®©—¬

·≈–°“√ª√–‡¡‘π°“√≈ÿ°≈È”¢Õß√Õ¬‚√§ °“√ √â“ß¿“æ¢Õß MRI ®–¡ÿà߇πâπ‰ª∑’Ë°“√ √â“ß¿“æ‡æ◊ËÕ·∫àß·¬°√–À«à“ß

‡π◊ÈÕßÕ°™π‘¥¥’ (Benign) ·≈–‡π◊ÈÕßÕ°™π‘¥√⓬ (Malignant) ÕÕ°®“°°—π ´÷ËߺŸâªÉ«¬ à«π¡“°¡—°¡“√—∫°“√μ√«®

° ¢ §

μ“√“ß∑’Ë 1 Routine shoulder MR protocol

MRI sequence TR/TE Slice thickness/gap Matrix Field of view

(msec) (mm) (cm²)

Axial PDW 2500/30 3 312x256 12-14

Axial GRE 550/12 3 256x233 12-14

Coronal oblique PDW 2500/30 3 280x256 12-14

Coronal oblique T2WFS 3800/70 3 233x233 12-14

Sagittal oblique PDW 2500/30 3 280x256 12-14

Sagittal oblique T2WFS 4200/80 3 233x233 12-14

μ“√“ß∑’Ë 2 Routine MRI knee protocol

MRI sequence TR/TE Slice thickness Matrix Field of view

(msec) (mm) (cm²)

Axial PD SPAIR 2200/10 4 300x280 13-15

Axial T2W 2200/100 4 330x265 13-15

Sagittal PD 3000/10 4 375x320 13-15

Sagittal T2W 3000/120 4 375x320 13-15

Coronal PD SPAIR 2800/30 4 330x270 13-15

Coronal oblique T2W 2500/100 2 332x300 13-15

μ“√“ß∑’Ë 3 Routine Protocol for soft tissue and bone tumor/mass evaluation

MRI sequence TR/TE Slice thickness Matrix Field of view

(msec) (mm) (cm²)

Axial T1W 640/10 5 365x330 20-25

Axial T2W 2500/80 5 365x330 20-25

Axial GRE 350/12 5 330x300 20-25

Coronal T1W 580/10 5 330x330 20-25

Coronal T2W 2500/80 5 330x330 20-25

STIR 3700/220/30 5 365x310 20-25

Sagittal T1W 640/10 5 365x350 20-25

Sagittal T2W 2500/80 5 365x350 20-25

√Ÿª∑’Ë 6 (°) ¿“æ T1W ·≈– (¢) T1WFS post Gd · ¥ß≈—°…≥–

°âÕπ‡π◊ÈÕ‰¢¡—π™π‘¥¥’ ∑’Ë∫√‘‡«≥‰À≈à æ∫«à“¿“¬„π

°âÕπ¡’‡æ’¬ß ‰¢¡—π‡æ’¬ßÕ¬à“߇¥’¬« ´÷Ëß„Àâ —≠≠“≥

¢“« „π T1W ·≈–‚¥π°¥≈ßÕ¬à“ß ¡∫Ÿ√≥å¥â«¬

T1WFS

√Ÿª∑’Ë 7 (°) ¿“æ T1W ·≈– (¢) T1WFS post Gd · ¥ß≈—°…≥–

°âÕπ‡π◊ÈÕ‰¢¡—π™π‘¥√⓬ ∑’Ë∫√‘‡«≥μâπ¢“ æ∫«à“

¿“¬„π°âÕπ¡’ —≠≠“≥∑’˺ ¡°—π (Heterogeneous)

∑—È߉¢¡—π ·≈–‡π◊ÈÕ¡–‡√Áß ´÷Ëß„Àâ —≠≠“≥∑—Èߢ“«·≈–

¥” „π T1W √«¡∑—Èß¡’∫“ß à«π enhance „π T1WFS post Gd

‡π◊ËÕß®“° “¡“√∂§≈”°âÕπ‰¥âμ“¡®ÿ¥μà“ßÊ¢Õß√à“ß°“¬

‚¥¬®–¡’°“√ √â“ß¿“æ™π‘¥μà“ßÊ ∑—Èß T1W, T2W, T2WFS

·≈– Gradient ·≈–¬—ß¡’‡∑§π‘§„π°“√©’¥ “√·°¥‚¥≈‘‡π’¬¡

(Gadolinium: Gd) ‡¢â“À≈Õ¥‡≈◊Õ¥ „π T1WFS image ‚¥¬

‡©æ“–∂â“À“°‡ªìπ‡π◊ÈÕßÕ°∑’Ë¡’§«“¡√⓬·√ß¡—°¡’°“√

‡®√‘≠‡μ‘∫‚μ‡√Á« ¡’§«“¡μâÕß°“√„™âæ≈—ßß“π Ÿß ®–¡’°“√

√—∫‡≈◊Õ¥∑’Ë¡“°μ“¡‰ª¥â«¬ ‚¥¬≈—°…≥–∑’˙૬„π°“√

·∫àß·¬°√–À«à“߇π◊ÈÕßÕ°™π‘¥¥’ °—∫™π‘¥√⓬‰¥â·°à⁹ 1. °âÕπ‡π◊ÈÕ∑’Ë¡’¢π“¥¢Õßμ—«°âÕπ∑’Ë„À≠à°«à“ 5

‡´π쑇¡μ√ ®–¡’·π«‚π⡇ªìπ ‡π◊ÈÕ√⓬¡“°°«à“‡π◊ÈÕ¥’

2. ¢Õ∫‡¢μ¢Õßμ—«°âÕπ À“°æ∫«à“¢Õ∫‡¢μ¢Õßμ—«

°âÕπ¡’≈—°…≥–¢√ÿ¢√– ‰¡à§¡‡√’¬∫ (Ill-define) À√◊Õ°“√¡’ en- hancement ¢Õ߇π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π‚¥¬√Õ∫¢Õßμ—«°âÕπ

®–· ¥ß∂÷ß°“√∑’Ëμ—«°âÕπ¡’°“√≈ÿ°≈È”·∑√°μ—«‡¢â“‰ª„π

‡π◊ÈÕ‡¬◊ËÕ∫√‘‡«≥¢â“߇§’¬ß ´÷Ë߇ªìπ≈—°…≥–∑’Ëæ∫‰¥â∫àÕ¬„π

‡π◊ÈÕßÕ°™π‘¥√⓬

3. §«“¡ ¡Ë”‡ ¡Õ¢Õß —≠≠“≥‡π◊ÈÕ‡¬◊ËÕ„πμ—«°âÕπ À“°¿“¬„πμ—«°âÕπ¡’§«“¡·μ°μà“ß°—π¢Õß —≠≠“≥

¡“°„π T2W (Heterogeneous T2W signal intensity) ®–

∑”„À⧑¥∂÷߇π◊ÈÕ‡¬◊ËÕ™π‘¥√⓬·√ß¡“°¢÷Èπ ∑—Èßπ’ȇπ◊ËÕß®“°

¿“¬„π‡π◊ÈÕ√⓬ ¡—°¡’∑—Èß ‡≈◊Õ¥ÕÕ° À√◊Õ ∫√‘‡«≥ ∑’Ë¡’

‡π◊ÈÕ‡¬◊ËÕ쓬¿“¬„π°âÕπ º ¡°—∫‡π◊ÈÕ‡¬◊ËÕ∑’¡’™’«‘μ ·≈–¡’

‡≈◊Õ¥‡≈’Ȭߡ“° ´÷Ëß®–∑”„Àâ “¡“√∂æ∫‡ÀÁπ∫√‘‡«≥∑’Ë¡’

 —≠≠“π¡“°·≈–πâÕ¬ ≈—∫°—π‰ª¿“¬„πμ—«°âÕπ∑—Èß„π T1W, T2W ·≈– T1WFS post Gd.

4. °âÕπμ”·Àπàß °âÕπ‡π◊ÈÕ∑’ËÕ¬Ÿà≈÷°≈߉ª¿“¬„μâ™—Èπ

°≈â“¡‡π◊ÈÕ ¡—°‡ªìπ‡π◊ÈÕ√⓬¡“°°«à“‡π◊ÈÕ¥’

°“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õß°√–¥Ÿ° (Bone tu- mor)

‚¥¬æ◊Èπ∞“π¢Õß°“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õß°√–¥Ÿ°·≈â«

®–∑”°“√«‘π‘®©—¬‚¥¬„™â¿“æ∂à“¬∑“ß√—ß ’ ´÷Ëß¡’§«“¡

·¡à𬔠Ÿß°«à“°“√„Àâ°“√«‘π‘®©—¬‚¥¬„™â MRI(10) ·μà Õ¬à“߉√°Áμ“¡°“√∑” MRI ¬—ß¡’§«“¡ ”§—≠Õ¬à“ß¡“°

„π°“√ª√–‡¡‘π °“√≈ÿ°≈È”¢Õ߇π◊ÈÕßÕ°‰ª¬—ßÕ«—¬«–¢â“ß

‡§’¬ß ∑—Èßπ’ȇπ◊ËÕß®“° MRI ¡’ soft tissue contrast ∑’Ë¥’°«à“

°“√ ◊∫§âπ™π‘¥Õ◊ËπÊ ‚¥¬‡©æ“–¿“¬„π‰¢°√–¥Ÿ° (Bone marrow) ´÷Ëß¡—°¡’‰¢¡—πÕ¬Ÿàª√‘¡“≥¡“° ∑”„Àâ “¡“√∂

‡ÀÁ𧫓¡·μ°μà“ß√–À«à“ß√Õ¬‚√§∑’ˇμÁ¡‰ª¥â«¬‡´≈

¡–‡√Áß´÷Ëß¡’ —≠≠“≥μË” (low signal intensity) °—∫

‰¢°√–¥Ÿ°ª°μ‘´÷Ëß¡’ —≠≠“π Ÿß(high signal intensity) ‰¥â Õ¬à“ß·¡à𬔠·¡â«à“‡π◊ÈÕßÕ°®–¡’§«“¡√ÿπ·√ß Ÿß´÷Ëß¡—°

¡Õ߇ÀÁπ¢Õ∫‡¢μ‰¥â¬“°®“°°“√¥Ÿ¿“æ∂à“¬∑“ß√—ß ’‡æ’¬ß

√Ÿª∑’Ë 8 (°) ¿“æ T1W ·≈– (¢) T1WFS post Gd ¢ÕߺŸâªÉ«¬¡–‡√Áß°√–¥Ÿ° Fibular ´÷Ëß®– “¡“√∂· ¥ß„Àâ‡ÀÁπ°“√≈ÿ°≈È”¢Õß¡–‡√Áß

∑—Èß¿“¬„π°√–¥Ÿ°‡Õß ·≈–°≈â“¡‡π◊ÈÕ∫√‘‡«≥‚¥¬√Õ∫ ‰¥âÕ¬à“ß™—¥‡®π𔉪 Ÿà°“√«“ß·ºπ°àÕπºà“μ—¥‰¥â¥’

Õ¬à“߇¥’¬«¹¹ °“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õß°√–¥Ÿ°®–ª√–°Õ∫

‰ª¥â«¬ °“√ª√–‡¡‘π°“√≈ÿ°≈È”¢Õ߇π◊ÈÕ‡¬◊ËÕ‚¥¬√Õ∫ °“√

≈ÿ°≈È”‰ª¬—ߢâÕ¢â“߇§’¬ß (Articular invasion) °“√≈ÿ°≈È”‰ª

¬—ßÀ≈Õ¥‡≈◊Õ¥·≈–‡ âπª√– “∑¢â“߇§’¬ß (Neurovascular invasion) ·≈–°“√¡’‡π◊ÈÕßÕ°À≈“¬μ”·Àπàß∫π°√–¥Ÿ°™‘Èπ

‡¥’¬«°—π (Synchronous lesion) °“√ª√–‡¡‘π‡À≈à“π’È ®–¡’

º≈„π°“√«“ß·ºπ°“√√—°…“Õ¬à“ß¡“° ∑—Èßπ’ȇπ◊ËÕß®“°

°“√ºà“μ—¥‡π◊ÈÕßÕ°„πªí®®ÿ∫—π¡’·π«‚πâ¡∑’Ë®– “¡“√∂

√—°…“Õ«—¬«–¢ÕߺŸâªÉ«¬‰«â‰¥â¡“°¢÷Èπ¹² °≈à“«§◊Õ °“√√—°…“

‚√§¡–‡√Áß°√–¥Ÿ°„π ¡—¬°àÕππ‘¬¡μ—¥√–¬“ߧå (Limb am- putation)  à«π∑’Ë¡’¡–‡√Áß∑‘È߉ª„Àâ‡√Á«∑’Ë ÿ¥ ´÷Ëߺ≈∑’Ëμ“¡

¡“§◊Õ°“√ Ÿ≠‡ ’¬§ÿ≥¿“æ™’«‘μ¢ÕߺŸâªÉ«¬ ´÷Ëß°≈“¬‡ªìπ

§πæ‘°“√ „πªí®®ÿ∫—πÀ“°ºŸâªÉ«¬‰¥â√—∫°“√∑” MRI ·≈–‰¥â

√—∫°“√ª√–‡¡‘π∑’ˇÀ¡“– ¡ À“°¡–‡√Á߬—߉¡à¡’°“√≈ÿ°≈È”

‰ª¬—ßÀ≈Õ¥‡≈◊Õ¥ ‡ âπª√– “∑ À√◊Õ≈ÿ°≈È”‡¢â“ Ÿà¢âÕ∑’ËÕ¬Ÿà

¢â“߇§’¬ß ®–¬—ß¡’‚Õ°“ ∑’Ë®– “¡“√∂ºà“μ—¥°âÕπ¡–‡√Áß ÕÕ°‚¥¬∑’ˉ¡à®”‡ªìπμâÕßμ—¥√–¬“ߧ剥⠺ŸâªÉ«¬Õ“® “¡“√∂

°≈—∫¡“‡¥‘π À√◊Õ„™â™’«‘쉥âμ“¡ª°μ‘Õ’°§√—Èß

®–‡ÀÁπ‰¥â«à“°“√∑” MRI ‡ªìπ°“√ àßμ√«®∑’Ë¡’

∫∑∫“∑ ”§—≠„π°“√ª√–‡¡‘πºŸâªÉ«¬„π ¿“«–μà“ßÊ ∑—Èß

°“√∫“¥‡®Á∫®“°°“√‡≈àπ°’Ó °“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õß

‡π◊ÈÕ‡¬◊ËÕ‡°’ˬ«æ—π ·≈–°“√ª√–‡¡‘π‡π◊ÈÕßÕ°¢Õß°√–¥Ÿ°

‚¥¬‰¡à®”‡ªìπμâÕ߉¥â√—∫√—ß ’ ·≈–¿“æ∑’ˉ¥â¡’§«“¡§¡™—¥

√«¡∑—Èß¡’§ÿ≥ ¡∫—μ‘摇»…„π°“√·∫àß·¬°™π‘¥‡π◊ÈÕ‡¬◊ËÕ  “¡“√∂ª√–‡¡‘πÕ«—¬«–∑’Ë¡’§«“¡´—∫´âÕπ ‰¥â‡ªìπÕ¬à“ߥ’

®÷߇ªìπ°“√ àßμ√«®∑’Ë®”‡ªìπ ·≈–¡’§ÿ≥§à“μàÕ°“√«“ß

·ºπ°“√√—°…“

‚¥¬¡’·π«‚πâ¡®–¡’°“√æ—≤π“∑“߇∑§π‘§μà“ßÊ

References

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