血友病性关节病的MR表现及其诊断价值

MRI features and diagnostic value of hemophilic arthropathy

目的 探讨血友病性关节病的MRI特征及其诊断价值。 方法 报告6个病人12个膝关节血友病性关节病的MR表现。图像采用常规SE序列,未做增强扫描。6个病人均经实验室检查,确诊为血友病A。 结果 12个关节内示不同时期的积血和滑膜增生,血肿在T1WI呈等或略高信号、T2WI为高信号。病变早期关节软骨肿胀增厚,后期不规则地破坏吸收,甚至消失,关节间隙狭窄。骨质囊变或破坏吸收,关节囊、肌肉及韧带于急性期肿胀,慢性期萎缩。血友病性假肿瘤显示为纤维膜包裹的机化血肿,T1WI、T2WI均呈混杂信号。 结论 MRI清楚地显示出关节诸结构的病理改变,对血友病性关节病的早期诊断、疾病分期、急慢性出血的鉴别、假肿瘤的识别有重要价值,可作为本病的主要检查手段和同位素放射治疗效果的观察。

Objective To study the MRI features of hemophilic arthropathy, and to evaluate the value of MRI in diagnosing the disease. Methods MRI study of 12 knee joints was made in 6 patients with hemophilic arthropathy. All the images were performed by means of conventional SE sequence and no contrast medium was administrated. Hemophilia A was confirmed in all the 6 patients with specific inspection in laboratory. Results Blood accumulation in different stages and hyperplasia of the synovium were shown in 12 joints. The hematomas showed iso-signal or slight high signal in T1WI and high signal in T2WI. The articular cartilage was swollen in early stage and resorbbed irregularly or disappeared in late stages,and joint space became narrow. The cystoid changes and the destructions were revealed in bone. The articular sac, the muscles and the ligaments were swollen in acute stage and atrophic in chronic stage. Hemophilic pseudotumor showed a mixed signal in both T1WI and T2WI, which was composed of hematoma surrounded by fibrous membrane. Conclusion To depict the pathologic findings clearly in all the structures of joint, MRI plays an important role in diagnosing hemophilic arthropathy early, defining the disease stage, differentiating acute and chronic hemorrhage, and confirming hemophilic pseudotumor. MRI can be used as main clinic procedure in detection of hemophilic arthropathy and as a follow-up of curative effect to isotopic synovectomy of the disease.