MRI对早期类风湿性关节炎手、腕部关节的诊断价值

MRI in the diagnosis of early rheumatoid arthritis on hand and wrist

目的研究早期类风湿性关节炎(RA)手、腕部关节的MRI对早期RA的诊断及临床价值。方法对40例早期RA患者行双手掌指关节及腕关节X线平片检查和MR扫描。对X线和MRI发现的骨侵蚀病灶分别进行计数,并对滑膜炎进行分级评分。同时搜集患者的临床资料包括症状、体征、实验室化验指标。统计并分析X线和MRI征象与临床检查之间的关系。结果MRI见26例49只腕关节有184处明确的骨侵蚀改变,X线平片仅发现11例14只腕关节21处有骨侵蚀征象。21例患者掌指关节有32处MRI骨侵蚀改变,X线仅发现6处骨侵蚀征象。X线和MRI对早期RA患者的骨侵蚀病灶的检出上的差异有统计学意义。MRI所见40例RA患者均出现滑膜炎性改变,其中31例见明显强化,9例未见明显强化。对明显强化的滑膜炎进行分级评分,腕关节得分为2.5,掌指关节为2.8。腕关节滑膜强化组、无强化组与患者的临床检查的差异性有统计学意义,同时腕关节滑膜炎分级与骨侵蚀征象有较高相关性(r=0.91,P<0.01)。另外,MRI还可显示早期RA的骨髓水肿、关节积液、肌腱炎等征象。结论MRI能显示早期RA手腕部关节的病理改变,对骨侵蚀的检出明显优于传统X线检查。MRI可以对早期RA的滑膜炎进行半定量化分级评分,为早期RA滑膜炎的深入研究提供新的平台。早期滑膜炎、骨侵蚀病变对评价RA的活动性及预测疾病进程、预后方面有重要价值。

Objective To observe the appearances of the early rheumatoid arthritis （RA） of the wrist and hand, and to study the value of MRI in diagnosis and prognosis of early rheumatoid arthritis. Methods Forty patients underwent radiography and MR examination on both wrists and the 2nd to 5th metacarpophalangeals （MCP）. Clinical data including swelling and tenderness joints, and laboratory examinations including ESR, CRP and RF were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score （HAQ score）. Calculated the erosions on wrists and MCP, graded and scored synovitis on MRI and post-processed the relationship between erosions, synovitis and clinical data. Results Of the 80 wrists in 40 patients, carpal erosions were observed in 49 wrists of 26 patients by MRI, and the total numbers of erosions accumulated 184. But X radiology only detected 14 wrists of 11 patients had 21 erosions in wrists. Significant differences between X-ray and MRI were found. MRI detected all patients had synovitis which have been proved by Gd-DTPA enhancement. 31 patients had significantly enhanced after Gd-DTPA injection, but 9 patients had not enhanced. Enhanced synovitis or synovial membranes hypertrophy can be graded and scored on wrists and MCP. Wrists scores were 2.5 and MCP were 2.8. A significant positive correlation was found between patients with enhanced synovitis and patients without enhanced synovitis in clinical examinations include swelling and/or tenderness joints, HAQ scores, ESR, CRP. At the same time, synovitis grades or scores had positive correlation with erosion （r=0.91, P〈0.01）. MRI had also found bone marrow edema of wrists, effusion and tendonitis in RA patients. Conclusion MRI scans of wrists and MCP in early rheumatoid arthritis, can provide imaging basis in diagnosis rheumatoid arthritis and can find the pathology of early RA. MRI was more sensitive than traditional X-ray in diagnosis of early RA. Early synovitis and erosion were valuable factors in the assessment of activity and prognosis of RA.