MRI鉴别诊断膝类风湿性关节炎和骨关节炎的价值及影像特点分析

Analysis of Value and Imaging Features of MRI in the Differential Diagnosis of Knee Rheumatoid Arthritis and Osteoarthritis

目的研究膝类风湿性关节炎和骨关节炎使用MRI鉴别诊断的价值及影像特点分析。方法选取我院2015年3月至2018年3月收治的膝关节类风湿性关节炎(RA)和骨关节炎(OA)86例,分为RA组31例和OA组55例,均进行关节镜、MRI检查,观察MRI检查不同部位软骨损伤分级、软骨下受累情况、半月板损伤情况,分析MRI诊断效能及一致性。结果两组髌骨关节、内侧胫骨关节分级差异无统计学意义(P<0.05),外侧胫骨关节分级差异有统计学意义(P<0.05)。两组患者髌骨关节、股骨内髁差异无统计学意义(P<0.05),外侧胫骨关节差异有统计学意义(P<0.05)。两组内侧半月板、外侧半月板损伤差异有统计学意义(P<0.05)。MRI诊断灵敏度、特异度、准确率、阳性预测值、阴性预测值依次为:90.32%、90.91%、90.70%、84.85%、94.34%,且诊断一致性较好(Kappa>0.7)。结论膝类风湿性关节炎和骨关节炎可通过MRI成像进行鉴别,且鉴别一致性较好,可作为临床无创辅助鉴别方式。

Objective To study the value and imaging features of MRI in the differential diagnosis of knee rheumatoid arthritis and osteoarthritis.Methods 86 cases of knee rheumatoid arthritis (RA) and osteoarthritis (OA) who were treated in our hospital from March 2015 to March 2018 were selected and divided into RA group (31 cases) and OA group (55cases).Arthroscopy and MRI were performed in the two groups.The cartilage injury classification,subchondral involvement and meniscus injury at different parts were observed by MRI.The diagnostic efficacy and consistency of MRI were analyzed.Results There were no significant differences in the classification of patellar joint and medial tibia joint between the two groups (P<0.05),and there was a significant difference in the classification of lateral tibial joint (P<0.05).There were no significant differences in the patellar joint and femoral medial condyle between the two groups (P<0.05),and there was significant difference in the lateral tibial joint (P<0.05).There were significant differences in medial meniscus injury and lateral meniscus injury between the two groups (P<0.05). The sensitivity,specificity,accuracy rate,positive predictive value and negative predictive value of MRI diagnosis were 90.32%,90.91%,90.70%,84.85% and 94.34%,and the diagnostic consistency was good (Kappa>0.7).Conclusion MRI imaging can identify knee rheumatoid arthritis and osteoarthritis,and it has good identification consistency and can be used as a clinical non-invasive auxiliary identification method.