手腕关节类风湿关节炎影像学诊断及对比分析

Contrastive analysis and diagnosis of rheumatoid arthritis in wrist and hand

目的观察类风湿关节炎(RA)手腕关节的滑膜改变及骨质侵蚀的形态、部位等在核磁共振(MRI)、关节超声(US)及X线上的表现,同时进行对比分析。方法从2010年3月至2014年9月在北京市上地医院就诊的RA患者中选取30例,分别应用MRI、US、X线检查并记录患者手腕关节的受累情况,分析不同检查方法间的差异。结果本组30例RA患者,X线检查示:10例无明显X线平片异常改变;20例手腕关节受累,其中骨质疏松12例,7例合并近指关节肿胀,1例单纯掌指关节肿胀,1例骨侵蚀。US检查示:患者均出现腕关节超声相关软组织病变,其中4例出现骨侵蚀,27例关节出现关节腔内积液,19例合并出现腕关节背侧伸肌腱腱鞘炎,28例合并出现滑膜炎改变。MRI检查示:MRI发现11例患者手腕关节有骨质侵蚀或骨髓水肿,其中骨质侵蚀6例,包括近指关节1例,掌指关节4例,腕关节1例,另5例患者手腕骨在出现骨质侵蚀的同时合并掌骨骨髓水肿。7例患者发现骨囊性改变。所有病例腕关节均见有不同程度滑膜增厚,掌指关节滑膜增厚8例,近指关节滑膜增厚10例,其中掌指关节及近指关节均出现滑膜增厚的有4例。结论 MRI和US能清楚显示早期RA手腕部小关节的病理改变,对滑膜改变及骨质侵蚀等病变的检出明显优于X线平片检查。

Objective To observe the changes of synovial membranes,morphological erosion findings and locations of hands and wrists in rheumatoid arthritis ( RA) patients and analyze those findings found in magnetic resonance imaging ( MRI) , ultrasonography ( US) , and X-ray contrastively.Methods Thirty patients who were diagnosed as RA were selected from Marth 2010 to September 2014 in Beijing Shangdi Hospital.The affected conditions of patients ’ hands and wrists were observed and recorded by MRI, US, and X-ray images, and the differences were analyzed among the three examination methods. Results In X-ray images, eight patients were normal.Hands and wrists were affected in 20 patients;osteoporosis was found in 12 patients;swelling of proximal interphalangeal ( PIP) joint were found in seven patients and simple swelling of metacarpal phalangeal ( MCP) joint was found in one patient, bone erosion was found in one patient.In US examination, all the patients showed affected soft tissue with US signs:four of them were affected with bone erosion, 27 of them were hydrarthrosis,19 patients were peritendinitis of dorsal extensor tendon, 28 patients were synovitis.In MRI images, bone erosion or bone marrow edema was presented in 11 patients:six of them were bone erosion including one PIP joint, four MCP joints, and one wrist;both bone erosion and bone marrow edema were presented in five patients.Thickened synovial membrane was found in all the patients including eight MCP joints, 10 PIP joint;four patients were affected in both MCP and PIP joints.Conclusion MRI and US can display the pathological changes of early RA accurately, and can present abnormal synovial membrane and bone erosion better than X-ray images.