彩色多普勒超声联合超声造影对类风湿性关节炎腕关节病变的临床价值

Clinical value of color Doppler ultrasound and contrast-enhanced ultrasonography for wrist joint lesions of rheumatoid arthritis

目的探讨彩色多普勒超声（CDUS）联合超声造影（CEUS）对类风湿性关节炎（RA）腕关节病变的临床价值。方法收集2012年1月-2015年9月温州医科大学附属乐清医院和温州医科大学附属第二医院明确诊断RA患者37例，共68个腕关节（RA组），收集同时期对照组20例共40个腕关节。采用彩色多普勒超声分别检测两组腕关节有无滑膜增生及滑膜增生的厚度，并检测增生滑膜内有无血流信号，关节有无骨质侵蚀，关节有无积液。RA组患者经静脉注射超声造影剂后，观察腕关节增牛滑膜强化情况，并测量增生滑膜厚度。结果RA组68个腕关节中，61个腕关节出现滑膜增厚（89．71％），38个腕关节检出关节积液（55．88％），37个腕关节出现骨侵蚀占（54．41％）；对照组40个腕关节中，4个关节出现滑膜增厚（10．00％），3个关节有关节积液（7．50％），1个关节出现骨侵蚀（2．50％）；RA组中各征象出现百分比均较对照组高，差异均有高度统计学意义（P〈0．01）。RA组61个滑膜增厚关节中，39个增厚滑膜内出现血流信号，检出率为63．9％；行CEUS后，59个关节内检出增厚滑膜增强，检出率为96．7％。RA组滑膜厚度为（7．67±4．37）mm；对照组滑膜厚度为（1．29±0．55）mm，两绀差异有高度统计学意义（P〈0．01）。结论CDUS联合CEUS能够明确诊断类风湿性关节炎腕关节病变。CEUS能够更好地显示类风湿性关节炎腕关节病变中的增厚滑膜，在疾病诊断中具有良好的临床价值。

Objective To explore the clinical value of color Doppler ultrasound （CDUS） and contrast-enhances ultra- sonography （CEUS） for wrist joints lesions of rheumatoid arthritis （RA） patients. Methods Thirty-seven patients with RA （68 wrist joints, RA group） and twenty normal controls （40 wrist joints, control group） were enrolled from January 2012 to September 2015 in Yueqing Hospital Affiliated to Wenzhou Medical University and the Second Affiliated Hos- pital of Wcnzhou Medical University. CDUS was used to detect synovial thickness, joint effusion, tendon tenosynovitis, bone erosion and hyperplasia synovium blood flow. In the RA group, after intravenous injection of uhrasound contrast agent, CEUS was used to observe the enhancement of proliferative synovial of the wrist joint, and the thickness of syn- ovial membrane was measured. Results In the RA group, among 68 wrists joints, there were synovial thickening in 61 wrists joints （89.71%）, joint effusion in 38 wrists joints （55.88%）, bone erosion in 37 wrists joints （54.41%）. In the con- trol group, among 40 wrists joints, there were synovial thickening in 4 wrists joints （10.00%）, joint effusion in 3 wrists joints （7.50%）, and bone erosion in 1 wrists joint （2.50%）. All above parameters in the RA group were higher than those in the control group, with statistically significant differences （P 〈 0.01）. In the RA group, among 61 wrists joints of synovial thickening, there were blood flow signal in 39 wrists joints of synovial thickening, the detection rate was about 63.9%. After the CEUS examination, there were enhancement of thickened synovial in 59 wrists joints, the detec- tion rate was about 96.7%. In the RA group, the average thickness of the synovial membrane was （7.67±4.37） mm, and in the control group,it was （1.29±0.55） mm, the difference was statistically significant between the two groups （P 〈 0.01）. Conclusion The wrist joints lesions of RA are accurately diagnosed by CDUS and CEUS. Synovial thickening of IRA in wrist joints can be better displayed by CEUS, which has good clinical value in diagnosis of the disease.