MR多序列成像在腕关节类风湿性关节炎中的应用价值

The value of MRI multiple sequences in patients with wrist rheumatoid arthritis

目的探讨MRI多序列成像对类风湿性关节炎腕关节病变的诊断价值。方法 80例类风湿性关节炎患者,行腕部MRI多序列成像,包括冠状位SE T1WI、GE T1WI、GE STIR,轴位TSE T2WI、矢状位SE T1WI。30例注射GD-DTPA后行SE T1WI、GE T1WI增强扫描。结果 80例患者中,76例显示腕关节有不同程度的滑膜炎,增生滑膜和血管翳在GE T1WI及增强后图像上显示尤为明显。55例骨髓水肿,在T1WI呈低信号,增强后轻度强化,GE STIR上呈斑片状高信号。56例骨侵蚀,表现为关节面边缘不规则小的缺损,T1WI为低信号,STIR为高信号,而GE T1WI稍高信号,强化较SE T1WI明显。58例关节积液。70例肌腱炎,表现为腱鞘积液、腱鞘增厚、T2WI信号增高,增强扫描后有强化。结论 MRI多序列成像能够反应类风湿性关节炎的病理变化,对其诊断有高度敏感性。

Objective To investigate the diagnostic value of MRI with multiple sequences in patients with wrist rheumatoid arthritis （RA）. Methods Wrist MR imaging was performed in 80 patients with RA,the sequencesconsisting of coronal SE T1WI, gradient echo （GE） T1WI and GE STIR, transverse TSE T2WI ,and sagittal SE T1WI. Contrast enhanced T1W imaging was obtained after Gd-DTPA injec- ted in 30 patients,with the same parameters to the plain scan sequences. Results In 80 patients,76 patients showed synovitis and pannus in wrists ,which was obviously discerned on GE T1W pre＂ and post-enhanced images. 55 patients had bone marrow edema,which manifested as low signal on TIW images and patchy high signal on GE STIR images,and slight enhancement. Bone erosion was detected in 56 patients,which showed small irregular defect on the articular surface,with low signal on SE T1W images and high signal on STIR images ,while GE T1W images showed slightly high intensity signal and enhanced images were obviously discerned compared to SE T1W images. 58 patients had joint effusion. Myotenositis was found in 70 cases,which manifested as tendon sheath effusion,tendon sheath thickening,high signal on T2W images and en- hancement after contrast media injection. Conehtsions MRI with multiple sequences is high sensitive to wrist RA, and can reveal the patholog- ic changes of RA.