3.0T MRI在血清阴性类风湿关节炎早期诊断中的应用价值

Application of 3.0T MRI in early diagnosis of seronegative rheumatoid arthritis

目的探讨3.0T MRI在血清阴性类风湿关节炎(RA)早期诊断中的应用价值。方法选取活动期血清阴性类风湿关节炎患者60例,根据病程又分为<6个月组、≥6个月<2年组和≥2年组,同时选取年龄、性别相匹配的骨关节炎患者60例,行双手3.0T MRI检查,包括手和腕,观察骨髓水肿、滑膜炎、骨侵蚀、肌腱炎、以及骨赘形成等征象。结果与血清阴性RA组相比,骨关节炎组滑膜炎、骨侵蚀、肌腱炎征象的发生率低,而骨赘形成发生率高,差异有显著性意义,P<0.05;骨髓水肿征象在两组中差异无显著性意义,P>0.05。在血清阴性类风湿关节炎患者中,病程<6个月组可见骨髓水肿、骨侵蚀、滑膜炎征象,其发生率分别为100%、98.0%、96.4%,<6个月组骨髓水肿及骨侵蚀征象与≥2年组比较差异有显著性意义,P<0.05。滑膜炎征象在上述3组中则无明显差异。结论3.0T MRI在血清类风湿关节炎病程早期即可检测出骨髓水肿、滑膜炎和骨侵蚀,这些征象对血清类风湿关节炎的早期诊断和治疗有重要的指导作用。

Objective To study the diagnostic value of 3. 0T MRI in early diagnosis of seronegative rheumatoid arthritis.Methods Sixty patients,28 with very early RA,18 with early RA,and 14 with established RA（ disease duration ﹤ 6months,6 months- 2 years,≥2 years,respectively） were enrolled in the study. The related antibodies were negative in all patients. Sixty age and gender matched patients with osteoarthritis were enrolled in the study as a control group. 3. 0T MRI of hand and wrist was performed to examine signs of bone marrow edema,synovitis,bone erosions,tendonitis and osteophyte formation. Results Incidence of synovitis,bone erosion and tendonitis in osteoarthritis patients was lower than that in seronegative rheumatoid arthritis patients. The difference was statistically significant（ P〈0. 05）. Compared to patients with seronegative rheumatoid arthritis,osteophyte formation was higher in patients with osteoarthritis（ P〈0. 05）. No significant difference was found in bone marrow edema between the two groups. Edema,erosions,and synovitis were present in very early RA,and the prevalence was 100%,98. 0% and 96. 4%,respectively. Significant differences in edema and erosions were found between very early RA and established RA（ P〈0. 05）. No significant difference was found in synovitis. Conclusion Edema,erosions and synovitis are findings of very early RA. MRI,by detecting these lesions,may play an important role in the management of these patients.