高频超声及超声对比增强造影对类风湿性关节炎腕关节早期病变诊断价值及与MR的对比研究

The diagnostic value of high frequency ultrasound and contrast enhanced ultrasound in wrist joints early damage of rheumatoid arthritis and comparison with MR

目的：探讨高频超声（HFUS）及超声造对比增强影（CEUS）对类风湿性关节炎（RA）的早期诊断价值及其与MR检查的对比分析。方法对临床诊断为类风湿性关节炎的患者96例共192个关节行HFUS、CUES检查，结果与MR相比较。结果（1）HFUS检查RA患者关节腔积液、滑膜增厚、肌腱腱鞘炎、软骨破坏及骨侵蚀的显示率分别是83．33％（160／192）7、3．96％（142／192）、60．42％（116／192）、77．08％（148／192），CEUS检出率分别为85．93％（165／192）、84．37％（162／192）、67．71％（130／162）及73．43％（141／192）；MR 检出率分别为82．29％（158／192）、74．48％（143／192）、71．35％（137／192）、100％（192／192）。 HFUS检查测得滑膜厚度分别为（3．07±1．55）mm，造影后CEUS检查测得滑膜厚度为（3．83±1．72）mm，较常规超声测值增大，且造影后滑膜均匀增强，内部微循环显示更为清晰。（2）RA患者HFUS、CEUS检查结果与MR对照分析显示：超声对关节积液及滑膜病变的检出率与MR基本一致（P ＞0．05）；超声对肌腱腱鞘炎、软骨损伤及骨侵蚀的检出率低于MR（χ2＝4．63、4．44、4．44、14．22， P ＜0．05）。结论超声对关节积液及滑膜病变的检测结果与MR检查较为一致，HFUS及CEUS可在一定程度上为诊断早期RA提供依据。

Objective To investigate the early diagnostic value of high frequency ultrasound （ HFUS） and contrast-enhanced ultrasound （ CEUS） in patients with rheumatoid arthritis （ RA） and compared with MR imaging.Methods Ninety-six patients with rheumatoid arthritis with a total of 192 joint were received HFUS, CEUS exam, the results were compared withMRI.Results （1）HFUSexamination,RApatients’jointeffusion,synovitis,tenosynovitis,destructionofcartilage and bone erosion display rates were 83.33% （160/192） and 73.96% （142/192）, 60.42%（116/192）, 77.08%（148/192）.CEUS’s display rates was 85.93% （165/192）, 84.37% （162/192）, 67.71% （130/162） and 73.43% （141/192） respectively;MR detection rate were 82.29%（158/192）, 74.48%（143/192）, 71.35%（137/192）, 100%（192/192） respectively.HFUS measured synovial thickness was （3.07 ±1.55 mm）, after contrast,CEUS measured the synovial thickness was （3.83 ±1.72） mm, compared with the conventional ultrasonic measurement, value was increased and after contrast enhancement, synovium showed homogeneous enhancement, internal microcirculation displayed more clearly.（ 2 ） RA patients’ HFUS and CEUS examination compared with MR showed that ultrasound of joint effusion and synovial lesions de-tection rate are basically the same as MR （ P 〉0.05）; ultrasonic for detection of tenosynovitis and cartilage, bone erosion were lower than MR （χ2 =4.63,χ2 =4.44,χ2 =4.44,χ2 =14.22, P 〈0.05）.Conclusion Ultrasound for joint effusion and synovial lesions detection were consistent with MR examination HFUS and CEUS can provide the basis for diagnosis of ear-ly RA.