早期类风湿性关节炎腕关节磁共振的诊断价值

Diagnostic Value of Wrist MRI in Early Rheumatoid Arthritis

目的:观察早期类风湿性关节炎(RA)手腕关节的滑膜改变、骨质侵蚀及关节腔积液等在MRI上的表现。同时探讨MRI表现与血清学检查指标相关性。方法:将根据临床症状及血清学检查结果确诊为类风湿性关节炎,而其腕关节行X线平片检查未见骨质破坏的28例患者作为研究对象。分析早期RA关节病变MRI影像学表现的特点。对MRI所见滑膜评分与血清学检查结果之间的关系进行相关性分析。结果:MRI发现16例手腕关节有骨质侵蚀或骨髓水肿,其中骨质侵蚀共26处,12例无骨质侵蚀或骨髓水肿。所有病例腕关节均见有不同程度滑膜增厚,增强扫描可见血管翳强化。并发现腕关节滑膜评分分值与临床血清检查结果(RF、IgA、IgG、IgM)相关性有统计学意义(P均<0.05),而与CRP相关性无统计学意义(r=0.26,P>0.05)。此外,MRI还可显示早期RA的骨髓水肿、关节积液等征象。结论:MRI能清楚显示早期RA手腕部小关节病变,且明显优于传统X线平片检查。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滑膜炎的诊断及活跃程度的深入研究提供了新方法。

Objective： To observe the MRI manifestations of wrist joints＇ synovitis changes,bone erosion and articular cavity effusion in rheumatoid arthritis（RA） patients,and to explore the correlation between MRI manifestations and serological testing indices.Methods： RA were diagnosed in 28 patients according to clinical symptoms and serological testing results,but no bone damage in wrist joints was found in X-ray examination.Correlation between synovitis scores in MRI and serological indices were analyzed.Results： Of all the 28 cases,MRI showed 26 lesions from 16 patients as bone erosion or bone marrow edema.The other 12 patients had neither of the problems.All the patients＇ synovium in wrist joint were thickened in varying degrees,and the correlation between synovitis scores in wrist joints and the serological testing results（RF,IgA,IgG,and IgM,P0.05）,except CRP（P0.05）,presented statistical significance.Conclusion： MRI can semi-quantitatively evaluate the early pathological changes of the wrist joints with RA,and it is superior to the traditional X-ray examination in displaying bone erosion,synovitis,and articular cavity effusion.The correlation between synovitis scores in MRI and serological manifestations is valuable for further study in early RA＇s diagnosis and monitoring.