关节专用MRI对手、腕关节早期类风湿性关节炎的诊断价值

Diagnostic value of dedicated extremity magnetic resonance imaging for hands and wrists in early stage rheumatoid arthritis

目的评价四肢关节专用MRI对手、腕关节早期类风湿性关节炎的诊断价值。方法选择手指、腕关节疼痛、肿胀、活动受限的患者35例,经随访临床确诊为早期类风湿性关节炎25例,其中男性7例,女性18例;年龄为34～65岁,平均年龄48岁。进行手、腕关节X射线平片和四肢关节专用MRI检查,观察各种异常MRI征象。结果 X射线平片显示骨质疏松5例,关节间隙轻度狭窄3例,关节肿胀6例,所有患者均未见明确关节面骨质侵蚀破坏。MRI扫描显示腕关节或掌指关节或指间关节滑膜增厚25例,骨髓水肿22例,关节面下不规则骨侵蚀或骨内小囊性变20例,关节腔积液24例,关节周围肌腱韧带异常13例。12例加做MRI增强的患者中,全部可见血管翳形成。结论四肢关节专用MRI是诊断手、腕关节早期类风湿性关节炎的较好方法,可为临床鉴别诊断、判断类风湿性关节炎的炎症程度和活动性、评价治疗效果提供依据。

Objective To evaluate diagnostic value of the dedicated extremity magnetic resonance imaging（MRI） for hands and wrists in early stage rheumatoid arthritis（RA）.Methods A total of 35 patients with pain,intumesce and limitation of fingers and wrists motion were enrolled,of which 25 patients with clinical follow-up finally were diagnosed with early stage RA,included 7 males and 18 females,who were 34-65 years old with a mean age of 48.All the patients underwent radiography and MRI examination,and the abnormal MRI appearances were observed.Results Radiography results showed osteoporosis in 5 cases,joint space mild stenosis in 3 cases and arthrocele in 6 cases.Bone erosion of articular surface could not be seen in all the cases.MRI showed synovial hyperplasia of wrists or articulation metacarpophalangeal or articulations interphalangeal in all cases,while bone marrow edema,bone erosion of articular surface or intraosseous cystic,arthroedema,abnormal muscle tendon and ligament around the joint could be seen in 22,20,24 and 13 cases,respectively.And the pannus could be found in 12 cases who underwent MRI enhancement scanning.Conclusion It is demonstrated that dedicated extremity MRI is a reasonable way to diagnose early stage RA of hands and wrists,which could provide the evidence for clinical antidiastole,judgment of inflammatory degree and activeness,and evaluation of therapeutic efficacy.