MRI对判断类风湿性关节炎手腕关节活动性的价值

Value of MRI for judging activity of hand and wrist joints in patients with rheumatoid arthritis

目的分析类风湿性关节炎(RA)手腕部磁共振成像(MRI)及磁共振扩散加权成像(DWI)表现,并与临床指标作相关性分析,探讨MRI对评估双手、腕RA炎症的严重程度及临床活动性的价值。方法对2016年1月至2017年12月20例确诊RA患者行双手腕关节MRI检查及DWI扫描,分析MRI表现,参照OMERACT-RAMRIS评分系统进行分级评分。同时记录患者的临床及实验室检查资料,与表观扩散系数(ADC)值进行相关性分析。结果20例患者中,MRI表现滑膜炎20例(100%);骨侵蚀18例(90. 0%);骨髓水肿15例(75. 0%);关节腔积液15例(75. 0%)。MRI上,滑膜炎与骨侵蚀(r=0. 665,P=0. 013)、骨髓水肿(r=0. 769,P=0. 002)、关节腔积液(r=0. 582,P=0. 037)之间,骨侵蚀与骨髓水肿(r=0. 696,P=0. 008)之间,骨髓水肿与关节腔积液(r=0. 557,P=0. 048)之间均有相关性。ADC值与ESR、CRP、疾病活动性评分(DAS28评分)有相关性(P <0. 05)。结论 MRI能清楚显示RA手腕部小关节的病理改变。DWI的ADC值与临床指标有一定相关性,结合常规MRI检查,可更加直接地反映病变关节的活动程度。

Objective To analyze the manifestations of magnetic resonance imaging( MRI) anddiffusion weighted imaging( DWI) in hand and wrist joints of patients with rheumatoid arthritis( RA),and thecorrelation analysis of the MRI manifestations with clinical indicators was performed to explore the value of MRI for assessing the severity of RA inflammation in both hands and wrists and the clinical activity. Methods MRI examination and DWI scan for both hands and wrists were performed in 20 patients diagnosed as RA from January 2016 to December 2017. MRI manifestation was analyzed,and its grading was made according to Outcome Measures in Rheumatoid Arthritis Clinical Trials( OMERACT)-Rheumatoid Arthritis MRI Score( RAMRIS) scoring system. The clinical and laboratory data of the patients were recorded,and the correlation analysis of the data with apparent diffusion coefficient( ADC) value was performed. Results Out of 20 cases of RA,20( 100%) were synovitis,18( 90. 0%) were bone erosion,15( 75. 0%) were bone marrow edema,15( 75. 0%) were arthroedema for MRI,there were significant correlations between synovitis and bone erosion( r = 0. 665,P =0. 013),bone marrow edema( r = 0. 769,P = 0. 002),arthroedema( r = 0. 582,P = 0. 037) and between bone erosion and bone marrow edema( r = 0. 696,P = 0. 008) as well as between bone marrow edema and arthroedema( r = 0. 557,P =0. 048). There were correlations between ADC value and erythrocyte sedimentation rate( ESR),C-reactive protein( CRP),disease activity score( DAS28 score)( all P < 0. 05). Conclusions MRI can clearly display the pathological changes of the hand and wrist joints in RA patients. ADC value for DWI was correlated with clinical indexes,and it combined with routine MRI examination can more directly reflect the range of motion of diseased joints.