类风湿性腕关节炎的MRI表现及临床对比应用研究

A study comparing MRI with clinical examinations on wrists with rheumatoid arthritis

目的 研究类风湿性 (rheumatoidarthritis,RA)腕关节炎MRI表现及临床对比应用的价值。方法 搜集符合 1987年美国风湿病协会 (ARA)诊断标准的RA患者 5 0例 ,男 15例 ,女 35例 ,行双腕关节MR扫描。均采用常规SET1WI、短时反转恢复 (STIR)序列、增强T1WI行冠状面扫描。选取 10例正常志愿者对照。同时搜集患者的临床症状、体征、实验室指标与MRI表现进行对比分析。结果 5 0例患者 ,MRI下均可见滑膜增厚、血管翳增生 ,38例血管翳可见MRI增强表现 ,骨髓水肿 2 1例 ,关节积液 37例 ,骨质破坏 37例。骨髓水肿组、关节积液组、血管翳强化组分别与无相应表现组在红细胞沉降率、健康评估问卷 (HAQ评分 )、患者的整体评估 (AIMS)、肿胀关节数进行对比分析 ,差异均有显著性意义 (P值均 <0 0 0 1)。骨髓水肿组与无骨髓水肿组的骨质破坏、跖趾关节(MTP)压痛、抗核周因子 (APF)间差异均有显著性意义 (P值分别为 0 0 2 4、0 0 2 5、0 0 18)。结论 MRI能够显示类风湿性关节炎的病理改变 ,通过MRI表现与临床对比研究 ,MRI在类风湿性腕关节炎的诊断及预后评价方面有一定应用价值。

Objective To study the appearances of rheumatoid arthritis(RA)on MRI,and compare MRI with clinical examinations on wrists with RA. Methods Fifty patients,fulfilled 1987 American Rheumatism Association(ARA)revised criteria,and 10 age-matched healthy controls entered the study.T 1-weighted spin echo,short time inversion recovery (STIR)of both wrists,gadolinium contrast material-enhanced sequences of dominant wrists were performed in the coronal planes.MRl,plain wrist radiographs,clinical date,including swollen joint,patient global assessment (AIMS),and laboratory examinations including ESR,RF,APF,and AKA were obtained at the same time.Functional disability was assessed using the Health Assessment Questionnaire Disability Score.Results In 50 patients,all had pannus on MRI of wrists,38 patients had enhanced signal intensity for pannus,21 patients had bone marrow edema,37 patients had joint effusion,and 37 patients had bone erosions.There were significant difference in the ESR,HAQ,AIMS as well as swollen joint count between patients with bone marrow edema and patients without bone marrow edema (P<0.001,respectively),which was the same as patients with joint effusion and patients without joint effusion (P<0.001,respectively),and patients with enhanced pannus and patients without enhanced pannus after injection of contrast material (P<0.001,respectively).There were significant difference in the pain of metatarsophalangeal joint and APF between patients with MRI bone marrow edema of wrists and patients without MRI bone marrow edema of wrists (χ2=5.06,P=0.025; χ2=5.59,P=0.018).Number of patients with MRI erosion of wrists was associated with the number of patients without MRI bone marrow edema of wrists (χ2=5.11,P=0.024).Conclusion MRI can find the appearances of wrists with RA.Comparing MRI with clinical examinations on wrists with RA,we can assess and evaluate the role of MRI on RA.