磁共振压脂序列检查对诊断幼年型关节炎的价值

Values of fat saturation sequence in MRI for juvenile arthritis

目的:探讨磁共振压脂序列在检查幼年型关节炎中的应用价值。方法:选择1 131例幼年型关节炎患者的1 601个有症状关节行磁共振普通T1加权像(T1 weighted imaging,T1WI)及T2加权像(T2 weighted imaging,T2WI)序列与精确频率反转恢复(spectral presaturation attenuated inversion recovery,SPAIR)T2压脂序列检查。所有图像由2名高年资放射科医生及1名小儿风湿免疫科医生独立进行评估,确定关节组织病变的形态和程度,当3名医师意见不一致时,通过讨论达成一致。结果:磁共振异常发现847个,占全部检查的52.9%;普通序列异常发现409个,占异常发现的48.3%;压脂序列异常发现816个,占异常发现96.3%。其中关节积液占异常发现的59.5%,骨髓水肿占异常发现的39.7%。压脂序列对幼年型关节炎的骨髓水肿、关节积液、滑膜增厚、软骨损伤检出率高于普通序列(P<0.05),普通序列的骨侵蚀检出率高于压脂序列(P<0.05),两种序列对关节囊肿的检出率差异无统计学意义(P>0.05)。结论:在幼年型关节炎磁共振检查中加用压脂序列可明显提高影像学阳性检出率;磁共振压脂序列对幼年型关节炎早期病理变化如骨髓水肿和关节积液等检出率高,可为早期诊断幼年型关节炎提供依据。

Objective： To explore the values of fat saturation sequence in MRI for juvenile arthritis. Methods： A total of 1 131 cases with juvenile arthritis and 1 601 with symptomatic arthritis were examined by MRI normal T1 weighted imaging （T1WI） and T2 weighted imaging （T2WI） sequence and spectral presaturation attenuatedinversion recovery （SPAIR） T2 fat saturation sequence. All the images were independently evaluated by two senior doctors from the Department of Radiology and the Department of Pediatric Rheumatology and Immunology respectively to confirm the types and degree of pathological changes of joint tissues. Results： Among the subjects, 847 patients demonstrated positive in MR~, accounting for 52.9%; 409 patients showed positive in normal sequence, accounting for 48.3%; 816 patients showed positive in fat saturation sequence, accounting for 96.3%. Joint hydrops accounted for 59.5%. Bone marrow edema accounted for 39.7%. The relevant ratio of bone marrow edema, joint hydrops, thickening of synovium and cartilage injuries in fat saturation sequence were higher than that in normal sequence （P〈0.05）. The relevant ratio of bone erosion in normal sequence was higher than that in fat saturation sequence （P〈0.05）. However, no significant difference of joint cysts was found between the fat saturation sequence and normal sequence （P〈0.0S）. Conclusion： Application of fat saturation sequence by MRI to check juvenile arthritis could obviously improve the positive MR/relevant ratio. In addition, the relevant ratio of the early pathological changes of juvenile arthritis （such as bone marrow edema and joint hydrops） was high, which might provide references for the early diagnosis of juvenile arthritis.