高频超声及三维血管能量成像在血清阴性类风湿关节炎与手骨关节炎中的鉴别诊断价值

THE VALUE OF HIGH- FREQUENCY ULTRASOUND AND THREE- DIMENSIONAL COLOR POWER ANGIOGRAPHY TO DIFFERENTIAL DIAGNOSIS BETWEEN SERONEGATIVITY RHEUMATOID ARTHRITIS AND HAND OSTEOARTHRITIS

目的探讨高频超声(high-frequency ultrasound,HFUS)及三维血管能量成像(three-dimensionalcolor power angiography,3D-CPA)在老年患者血清阴性类风湿关节炎(rheumatoid arthritis,RA)与手骨关节炎(osteoarthritis,OA)鉴别诊断的价值。方法对临床明确诊断的血清阴性RA患者30例行双手掌指关节、近端指间关节共600个关节进行HFUS及3D-CPA检查,测量滑膜厚度、关节腔积液,观察血流特点、骨面以及肌腱、腱鞘软组织情况,并与30例老年OA患者扫查结果对比。结果 HFUS检测关节腔积液,滑膜增厚、血管翳形成以及肌腱腱鞘炎在血清阴性RA组较OA组检出率更高,差异有统计学意义(P<0.01),骨侵蚀2组差异无统计学意义(P>0.05)。结论 HFUS能显示RA患者手指关节病变的各种病理表现,如滑膜炎症、血管翳形成、软骨下骨侵蚀,对于血清阴性RA与老年手OA患者的诊断以及鉴别诊断具有一定的价值。

Objeetive To evaluate the efficacy of high- frequency ultrasound （HFUS） and three -dimensional color power angiograthy （3D - CPA） in the differential diagnosis between sero - negativity rheumatoid arthritis （RA） and hand osteoarthritis （OA）. Methods A total of 600 joints including metaearpophalangeal joints and proximal interphalangeal joints, together 600 joints in 60 cases were examined by HFUS and 3D -CPA,including 30 cases of sero- negativity RA and 30 cases of OA. The thickness of synovial joints , blood supply, bone face and soft tissue situation were detected. Results Compared with OA group ,the detection rate of joint effusion, synovial thickening, pannus, tendinitis and tenosynovitis by HFUS were higher（ P 〈 0.01 ） but there was no significant difference on bony erosion （ P 〉 0.05）. Conclusion HFUS and 3D - CPA can show various pathological changes of the hand joints, including synovitis lesions, pannus formation and bone erosion RA patients, and are effective in the diagnosis and differential diagnosis between sero- negative RA and OA.