膝类风湿关节炎与骨关节炎的MRI及超声表现分析

Analysis of MRI and ultrasonic manifestation in knee rheumatoid arthritis and osteoarthritis patients

目的总结中晚期活动性膝类风湿关节炎(rheumatoid arthritis, RA)及膝骨关节炎(osteoarthritis, OA)的MRI及超声表现。方法选取2015年5月至2018年10月于航天中心医院住院的中晚期活动性膝RA患者30例和症状性膝OA患者20例,所有患者均行膝关节MRI及超声检查,分析两组膝关节滑膜、骨髓水肿、关节软骨及半月板等病变的差异。结果 MRI检查显示,RA组膝关节滑膜炎发生率显著高于OA组(86.7%比25.0%, P <0.05),髌骨、股骨及胫骨骨髓病变程度均显著高于OA组(P <0.05);两组半月板、软骨病变程度的差异无统计学意义。膝关节超声检查显示,RA组滑膜平均厚度显著高于OA组[(5.4±2.3)mm比(2.6±1.3)mm,P <0.05],滑膜增厚及滑膜内血流信号丰富程度均显著高于OA组(P <0.05)。结论膝关节MRI及超声对中晚期活动性膝RA及OA的鉴别诊断有一定价值,尤其是滑膜炎及骨髓水肿程度的判断对RA的诊断有一定帮助。

Objective To summarize MRI and ultrasound(US) manifestations of knee joints in middle-late active knee rheumatoid arthritis(RA) and osteoarthritis(OA). Methods There were 30 cases with knee RA and 20 cases with knee OA in Aerospace Central Hospital from May 2015 to October 2018. All the patients received MRI and US examination. The differences in the synovitis, bone marrow edema(BME), menisci and articular cartilage between the two groups were analyzed. Results Knee MRI showed that the incidence of synovitis in RA group was significantly higher than that in OA group(86.7%vs. 25.0%, P < 0.05);the degree of BME in patella, femora and tibia was more severe in RA group than that in OA group(P <0.05), while the differences in lesions of menisci and articular cartilage between the two groups were not statistically significant. The US results of knee joints showed that the mean synovial thickness in RA group was higher than that in OA group[(5.4±2.3) mm vs.(2.6±1.3)mm, P < 0.05];the degree of synovial thickness and blood flow signal in the synovium was more severe in RA group compared with OA group(P < 0.05). Conclusions MRI and US are valuable to differentiate knee RA and OA.Especially, the degree of synovitis and BME is helpful for diagnosis of knee RA.