彩色多普勒肌骨超声、磁共振成像(MRI)在类风湿性关节炎的膝关节炎病变中的诊断价值

Compare the Value of Magnetic Resonance Imaging and Color Doppler Muscle Bone Ultrasound in the Differential Diagnosis of Knee Lesions in

目的探讨彩色多普勒肌骨超声、磁共振成像(MRI)在类风湿性关节炎的膝关节炎病变中的诊断价值。方法选择2018年1月-2022年10月我院查治40例类风湿性关节炎的单侧膝关节病变患者为研究对象。所有患者均行肌骨超声和MRI检查,以关节镜为金标准,分析肌骨超声和MRI在类风湿性关节炎的膝关节软骨损伤分级和其它膝关节病变的诊断符合率。结果关节镜检查股骨内侧髁53处,股骨外侧髁74处,股骨滑车71处;MRI与肌骨超声在软骨Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级及软骨全部损伤诊断符合率差异无统计学意义(76.05%vs70.42%、80.00%vs76.36%、81.40%vs72.09%、82.76%vs79.31%,P<0.05);MRI和肌骨超声总体诊断正确率差异无统计学意义(79.29%vs73.74%,P<0.05);MRI与肌骨超声在关节腔积液、腘窝囊肿差异无统计学意义(95.31%vs89.06%、100%vs93.10%,P>0.05);肌骨超声诊断滑膜增厚正确率95.00%高于MRI的75.00%(P<0.05);MRI在半月板和交叉韧带损伤诊断正确率高于肌骨超声(90.00%vs52.50%、85.71%vs53.06%,P<0.05)。结论MRI和超声在诊断类风湿性膝关节炎病变方面各有优势,肌骨超声在滑膜增厚诊断优于MRI,而MRI在前后交叉韧带损伤和半月板损伤诊断高于肌骨超声,临床医师可根据类风湿性膝关节病变情况,选择相适应的检查方法,对于难以鉴别类风湿性膝关节病变可肌骨超声和MRI联合使用,提高类风湿性膝关节炎病变诊断准确率。

Objective To investigate the diagnostic value of color Doppler muscle bone ultrasound and magnetic resonance imaging(MRI)in knee arthritis of rheumatoid arthritis.Methods 40 patients with knee diseases with rheumatoid arthritis treated in our hospital from January 2018 to June 2020 were selected as the research objects.All patients underwent musculoskeletal ultrasound and MRI.According to the standard of arthroscopy,the diagnostic coincidence rate of musculoskeletal ultrasound and MRI in the grading of knee cartilage injury and other knee diseases of rheumatoid arthritis was analyzed.Results Arthroscopic examination included 53 medial femoral condyles,74 external femoral condyles and 71 femoral trochlea;There was no significant difference between MRI and musculoskeletal ultrasound in the diagnosis of cartilage gradeⅠ,Ⅱ,Ⅲ,Ⅳand all cartilage injuries(76.05%vs 70.42%,80.00%vs 76.36%,81.40%vs 72.09%,82.76%vs 79.31%,P<0.05);There was no significant difference in the overall diagnostic accuracy between MRI and musculoskeletal ultrasound(79.29%vs 73.74%,P<0.05);There was no significant difference between MRI and musculoskeletal ultrasound in joint cavity effusion and popliteal cyst(95.31%vs 89.06%,100%vs 93.10%,P>0.05);The accuracy of muscle bone ultrasound in the diagnosis of synovial thickening was 95.00%,which was higher than 75.00%of MRI(P<0.05);The diagnostic accuracy of MRI in meniscus and cruciate ligament injury was higher than that of muscle bone ultrasound(90.00%vs52.50%,85.71%vs 53.06%,P<0.05).Conclusion MRI and ultrasound have their own advantages in the diagnosis of rheumatoid knee disease.Muscle bone ultrasound is better than MRI in the diagnosis of synovial thickening,while MRI is better than muscle bone ultrasound in the diagnosis of anterior and posterior cruciate ligament injury and meniscus injury.Clinicians can choose appropriate examination methods according to the situation of rheumatoid knee disease,It is difficult to distinguish rheumatoid knee disease.Muscle bone ultrasound and MRI can be used together to improve the diagnostic accuracy of rheumatoid knee disease.