超声与多排螺旋CT对类风湿性关节炎手腕关节病变的诊断价值对比研究

Comparison of diagnostic value of ultrasound and multi-slice spiral CT in wrist joint lesions of rheumatoid arthritis

目的探讨超声与多排螺旋CT对类风湿性关节炎(RA)手腕关节病变的诊断价值及影像学特点。方法选取南通大学附属建湖医院2018年12月至2020年4月诊治的54例RA手腕关节病变患者作为研究对象,入组患者均行超声、多排螺旋CT检查。计算超声、CT检查对手腕关节滑膜炎、关节积液、腱鞘炎、骨侵蚀检出率,以及对腕关节病变检出率,并分析超声、CT检查的影像学特点。结果54例RA患者共检查1188个关节,其中108个腕关节,540个掌指关节,540个近侧指间关节。超声检查对手腕关节滑膜炎、关节积液、腱鞘炎的检出率与CT检查检出率比较差异无统计学意义(P>0.05)。超声检查对手腕关节病变的检出率高于CT检查,差异有统计学意义[97.2%(105/108)比46.3%(50/108),χ^(2)=36.52,P<0.05]。超声影像特点:滑膜炎超声图像表现为关节腔内低回声,不受关节移位或压缩的影响,彩色多普勒血流显像(CDFI)可见血流信号;关节积液超声图像中关节积液呈带状、条状无回声区,不均匀分布,图像受关节移位或压缩影响,CDFI未见血流信号;骨侵蚀超声图像表现为骨皮质连续性中断或呈"火山口""虫蚀"样缺损。CT影像特点:手腕关节间隙狭窄,骨质疏松,部分患者舟骨、桡骨远端可见明显骨侵蚀。结论采用超声与多排螺旋CT应用于RA手腕关节病变的诊断,两者在手腕关节滑膜炎、关节积液、腱鞘炎检出率方面相当,CT检查在评估患者关节间隙及骨质变化方面略有优势,而超声在诊断手腕关节骨侵蚀及手腕关节病变方面灵敏度高于多排螺旋CT。

Objective To investigate the diagnostic value and imaging characteristics of ultrasound and multi-slice spiral CT in rheumatoid arthritis(RA)wrist joint lesions.Methods The clinical data of 54 cases of RA wrist arthropathy in Jianhu Hospital Affiliated to Nantong University from December 2018 to April 2020 were analyzed.All the patients were examined by ultrasound and multi-slice spiral CT.The imaging characteristics of ultrasound and multi-slice spiral CT were analyzed,and the detection rates of synovitis,joint effusion,tenosynovitis,bone erosion and wrist joint lesions were calculated.Results A total of 1188 joints were examined in 54 patients with RA,including 108 wrist joints,540 metacarpophalangeal joints and 540 proximal interphalangeal joints.There was no significant difference in the detection rate of wrist joint synovitis,joint effusion and tenosynovitis between ultrasound and CT(P>0.05).The wrist joint lesions detection rates of ultrasound and CT were 97.2%(105/108)and 46.3%(50/108),the difference was statistically significant(χ^(2)=36.52,P<0.05).Ultrasound image features:synovitis ultrasound image showed hypoechoic joint cavity,not by joint displacement or compression image,color Doppler flow imaging(CDFI)examination could see blood flow signal;joint effusion in ultrasound image of joint effusion was strip,strip-shaped,non-uniform distribution,image was affected by joint displacement or compression,CDFI examination had no blood flow signal;bone erosion ultrasound image showed bone cortical continuous interruption or"crater""insect erosion"like defects.CT imaging features:wrist joint space narrow,osteoporosis,some patients with scaphoid,distal radius visible bone erosion.Conclusions The detection rate of wrist synovitis,joint effusion and tenosynovitis by ultrasound and multi-row spiral CT are similar.The multi-row spiral CT examination have a slight advantage in evaluating the joint space and bone changes.The sensitivity of wrist bone erosion and wrist joint lesions are higher than those of multi-row spiral CT,which can guide the early clinical diagnosis and treatment of RA.