腕关节3D LAVA动态增强在判断类风湿性关节炎疾病进程的价值研究

The value of 3D dynamic contrast enhanced LAVA in evaluating the progression of rheumatoid arthritis of the wrist

目的:探讨3.0T MRI LAVA动态增强检查在判断类风湿性关节炎(RA)疾病进程的价值。方法:收集临床确诊的RA患者35例,其中关节炎活动期20例,缓解期15例,进行碗关节MRI平扫加动态增强扫描,并将采集的动态增强图像进行后处理,每位患者选取碗关节周围滑膜异常强化6个感兴趣区,获得动态增强时间信号曲线,分别计算每个感兴趣区的滑膜强化率并取平均值,同时测量6个感兴趣区的滑膜厚度并取平均值。将活动期和缓解期患者的滑膜强化率、滑膜厚度差异进行统计学比较,将所有患者的滑膜强化率及滑膜厚度与血沉(ESR)、C反应蛋白(CRP)的相关性进行统计学研究。结果:活动期的时间信号曲线为快速上升平台型,缓解期的时间信号曲线为缓慢上升型。活动期患者的平均滑膜强化率(2.27±0.56)与缓解期患者的平均滑膜强化率(1.04±0.42)差别有统计学意义,P<0.01;活动期平均滑膜厚度((5.9±0.4)mm)与缓解期滑膜平均厚度((2.9±0.6)mm)差别具有统计学意义,P<0.01。患者的滑膜强化率分别与ESR及CRP呈正相关(相关系数R值分别为0.778和0.816,P值分别为0.02和0.01),滑膜厚度与ESR及CRP具有一定相关性(相关系数R值分别为0.506和0.402,P值均为0.05)。结论:动态增强MRI时间信号曲线形状、滑膜强化率及滑膜厚度对判断RA的活动性具有较高价值。

Objective：To investigate the value of 3.0T MRI dynamic contrast enhanced LAVA in the evaluation of the progress of rheumatoid arthritis （RA） disease of the wrist.Methods：Thirty-five patients with RA were enrolled into the study,20 cases were in the active stage,15 cases were in the remission stage.Conventional MR and dynamic enhanced scanning of the wrist were performed for these patients,the enhanced images were processed.Six ROIs were put in the enhanced synovial membrane of the wrist joints of the patients,the dynamic enhancement time signal curve was acquired,the synovial enhanced ratio of each ROI were obtained; the mean value was calculated,at the same time,measured the thickness of the synovial membrane in each ROI and calculated the mean value.Compared the enhancement ratio the difference of the synovial thickness at the active and remission stage respectively.The correlation of the enhancement ratio,synovial thickness,erythrocyte sedimentation rate （ESR）,and C reactive protein （CRP） were statistically studied respectively in all the patients.Results：The time signal curve in the active stage was of rapid rise platform type,in the remission stage,the time signal curve was of slowly rise type.The mean synovial enhancement ration in the active stage was 2.27±0.56,compared to the mean enhancement ratio in the remission stage which was 1.04±0.42,it had statistical significance,P＜0.01.The mean synovial thickness in the active stage was （（5.9±0.4） mm）,compared to that of the remission stage which was （（2.9±0.6） mm） had statistical significance,P＜0.01.The patients＇ synovial enhancement ratio positively correlated with ESR and CRP respectively（correlation coefficient R value was 0.778 and 0.816 respectively,P=0.02 and 0.01）.Synovial thickness and ESR and CRP had certain correlation （correlation coefficient R value was 0.506 and 0.402 respectively,P=0.05）.Conclusion：The synovial dynamic enhanced MRI time signal curve type,synovial dynamic enhancement ratio and synovial thickness have important value in evaluating the progress of RA.