四肢类风湿性关节炎MRI的诊断

目的：探讨四肢类风湿性关节炎的ＭＲＩ诊断价值。方法：回顾分析１６例４２ 个关节类风湿性关节炎ＭＲＩ表现及Ｘ线表现。结果：ＭＲＩ可以清楚显示四肢类风湿性关节炎的滑膜增生、软骨关节面破坏、骨性关节面侵蚀及骨内囊肿形成、韧带及关节囊增厚、腱鞘积液及关节变形等所造成的形态和信号改变。但ＭＲＩ在反映类风湿性关节炎的骨质疏松方面不如Ｘ线照片。结论：ＭＲＩ可较全面反映类风湿性关节炎的病理变化,有利于类风湿性关节炎诊断及鉴别诊断。     

Ⅱ型糖尿病骨关节病的X线和CT表现

目的研究早期Ⅱ型糖尿病骨关节病的x线及CT表现,以提高其诊断水平.材料和方法对临床确诊的28例病史1～5年的Ⅱ型糖尿病骨关节病进行X线、CT检查,其中13例追踪观察2～3年,分析其X线、CT影像表现.结果X线片和CT显示骨质增生20例,表现为骨密度增高、新骨形成、骨肥厚.骨质疏松12例,其中4例与骨质增生并存.骨质破坏2例,表现为局部骨质融解吸收、边缘模糊不清,无骨膜反应.骨折、骨缺血坏死4例,骨性关节炎13例,表现为关节面骨质增生,关节间隙变窄,关节囊积液.局部软组织肿胀16例,伴软组织内钙化2例.结论早期Ⅱ型糖尿病骨关节病的X线片和CT表现主要为骨质增生、骨性关节炎及周围软组织肿胀,但亦可有骨质疏松,无特异性,诊断必须密切结合临床.     

骶髂关节炎性病变及退行性变的诊断和鉴别诊断

骶髂关节炎性病变主要包括骶髂关节的类风湿性关节炎、强直性脊柱炎，它们之间的影像学表现复杂，互有重叠，再加上骶髂关节的退行性骨关节病，使诊断和鉴别诊断更加困难，笔者总结了以下几种疾病的临床症状及影像学表现叙述如下：     

糖尿病足的X线诊断价值

目的：探讨糖尿病足的X线平片表现及其临床价值。方法：回顾分析13例临床确诊为糖尿病足的X线平片特征,加以总结。结果：糖尿病足的X线平片影像学改变为骨质疏松、骨质破坏、骨性关节炎和软组织肿胀为主要影像学改变。结论：X线平片检查简便、经济,可提供糖尿病足的骨质损害征象,能基本反映其病理改变,是指导糖尿病足诊疗的有效影像学方法之一,但诊断必须密切结合临床。     

骶髂关节病变的CT诊断

目的 阐明骶髂关节病变的ＣＴ表现。材料与方法 搜集经临床确诊或病理证实的35例骶髂关节病变者,男22例,女13例。其中强直性脊柱炎（AS）13例,类风湿性关节炎（RA）7例,化脓性骶髂关节炎2例,骶髂关节结核5例,髂骨致密性骨炎6例,创伤性关节炎2例,结果 CT表现：AS常双侧对称发病,自关节下部开始,关节面硬化与破坏,间隙狭窄或消失,骨桥形成,RA常一侧发病,易侵犯关节上壮举剖,关节面密度减低,骨质疏松,关节面下出现周围硬化的小囊状骨缺损;化脓性骶髂关节炎常单发,骨一侧发病,易侵犯关节上半部,关节面密度减低,骨质疏松,关节面下出现周围硬化的小囊状骨缺损;化脓性骶髂关节炎常单发,骨质疏松,破坏,半生,关节间隙增宽或变窄,关节囊肿胀,关节强直,周围软组织肿胀或钙化;骶髂关节结核常单侧发病,多位于关节中下部,关节面模糊,骨质破坏及死骨形成,关节间隙增宽,常伴冷脓肿和窦道形成;髂骨致密性骨炎示髂骨面硬化区,不累及关节;创伤性关节炎骨关节面增生,浓密,关节间隙狭窄,可伴骨性强直。结论 骶髂关节病变的CT表现各不相同,CT能清楚显示骶髂关节及其周围结构,是目前诊断骶髂关节病变最理想的检查手段。     

Value of X-ray Imaging Diagnosis with Foot Disease of Diabetes Mellitus

目的:探讨糖尿病足的X线平片表现及其临床价值.方法:回顾分析13例临床确诊为糖尿病足的X线平片特征,加以总结.结果:糖尿病足的X线平片影像学改变为骨质疏松、骨质破坏、骨性关节炎和软组织肿胀为主要影像学改变.结论:X线平片检查简便、经济,可提供糖尿病足的骨质损害征象,能基本反映其病理改变,是指导糖尿病足诊疗的有效影像学方法之一,但诊断必须密切结合临床.     

多层螺旋CT在强直性脊柱炎骶髂关节病变中的应用价值

目的:探讨多层螺旋CT在强直性脊柱炎(AS)骶髂关节病变的应用价值。方法:56例临床确诊为强直性脊柱炎患者行骶髂关节多层螺旋CT检查,观察骶髂关节病变的CT表现及影像学特征。结果:强直性脊柱炎骶髂关节病变的多层螺旋CT表现特征为病变主要累及骶髂关节的髂骨侧,表现为关节软骨钙化、关节面毛糙、骨性关节面下多发小囊状骨质吸收、破坏伴不同程度骨质增生硬化,骶髂关节间隙狭窄、消失、关节骨性融合及骶髂韧带钙化等。结论:多层螺旋CT对强直性脊柱炎(AS)骶髂关节病变的诊断与鉴别诊断具有重要的应用价值。     

强直性脊柱炎骶髂关节病变的CT表现

目的：通过对40例强直性脊柱炎（AS）骶髂关节CT扫描，以提高其鉴别诊断水平。方法：分析40例AS患者的骶髂关节CT表现特点。结果：骶髂关节早期CT表现为关节间隙正常，骨性关节面侵蚀破坏，基本呈对称性，关节面骨皮质毛糙不整，局限性微小皮质破坏或局限性硬化：进展期为双侧骶髂关节面广泛骨皮质破坏，呈锯齿状或毛刷状，局部骨质硬化明显，关节间隙不规则变窄或增宽：晚期为关节骨性强直和普遍性骨质疏松。骶髂关节韧带部也可发生骨侵蚀和囊变；结论：AS骶髂关节的CT表现特点，有助于临床的早期诊断，提高诊断准确率。     

类风湿性关节炎和强直性脊柱炎骶髂关节病变的CT诊断

目的:评价CT对类风湿性关节炎与强直性脊柱炎骶髂关节病变的鉴别价值.方法:收集31例类风湿性关节炎及69例强直性脊柱炎病例,分析其骶髂关节的CT征象.结果:类风湿性骶髂关节炎CT表现主要以骨质疏松为主,伴有关节面下小的囊性变,关节间隙早期可增宽或正常,中、晚期变窄;强直性脊柱炎骶髂关节CT表现主要以增生或破坏为主,关节面早期变模糊,关节间隙变窄,进展期可呈虫噬状破坏,也可骨质强直.结论:CT检查是鉴别类风湿性关节炎与强直性脊柱炎骶髂关节病变的一种重要手段.     

寰枢关节类风湿关节炎的CT 评价

目的：探讨C T及三维后处理技术在诊断类风湿性关节炎累及寰枢关节中的临床价值。方法分析15例临床类风湿性关节炎确诊病例的寰枢关节CT图像,并利用工作站分别进行多平面重建（M PR）和容积再现（VR）成像等进行CT图像的三维后处理,分析寰枢关节骨质、关节间隙、是否半脱位及方向等CT表现。结果类风湿性关节炎累及寰枢关节的主要CT表现为骨质稀疏（6／15）,骨质破坏（9／15）,关节间隙的变窄或增宽;半脱位7例,其中前半脱位3例,侧方半脱位2例,前后脱位伴侧方脱位2例;2例出现颅底凹陷伴神经病变和椎动脉供血不足,4例因寰枢关节前半脱位引起椎管狭窄,造成脊髓压迫。结论 CT及三维后处理技术在类风湿性关节炎累及寰枢关节的诊断中发挥着重要的临床作用。     

Cartilage destruction in small joints by rheumatoid arthritis: assessment of fat-suppressed three-dimensional gradient-echo MR pulse sequences in vitro

Purpose. To assess the accuracy of different MR sequences for the detection of articular cartilage abnormalities in rheumatoid arthritis. Design and patients. Ten metacarpophalangeal joints and 10 metatarsophalangeal joints (specimens from arthritis patients undergoing ablative joint surgery) were examined with a fat-suppressed (FS) 3D FLASH, a FS 3D FISP, a FS 2D fast spin-echo T2-weighted, and a 2D FS spin-echo T1-weighted sequence. Each cartilage lesion and each cortical lesion was graded from 0 to 4 (modified Outerbridge staging system). Subsequently, the results of each sequence were compared with the macroscopic findings and statistically tested against each other. Results. The study shows that 3D gradient-echo sequences with fat suppression were best for imaging and grading of cartilage lesions in arthritis of the small joints of the hands and feet. Using 3D techniques, all grade 2, grade 3, and grade 4 lesions of cartilage or cortical bone were detected. Conclusion. FS 3D gradient-echo techniques were best for the detection and grading of hyaline cartilage and subchondral bone lesions in rheumatoid arthritis. MRI has a great potential as an objective method of evaluating cartilage damage and bone erosions in rheumatoid arthritis.     

Ultrasonography in the study of synovial disorders and tendon lesions in rheumatoid arthritis

Conventional radiology is the main diagnostic tool for the visualization of osteoarticular lesions in rheumatoid arthritis. Articular effusions and popliteal cysts were examined with US. This paper is aimed at proving US capabilities in yielding important information about articular and peri-articular soft tissues in the early phases of rheumatoid arthritis. Over the last 30 months, the shoulder, wrist, hand, knee, and hip of 73 rheumatoid patients were studied by means of US and conventional and microfocal radiography. The patients were divided into 2 groups according to the time of onset of the disease. In group A, US demonstrated early synovial exudative inflammation, whereas conventional and microfocal radiography mainly demonstrated soft tissue swelling. In group B (where the first onset dated back to over 1 year), US demonstrated exudative and proliferative changes, together with recurrences. The authors believe US to be able to recognize the early changes of rheumatoid arthritis: as a matter of fact, US shows articular and periarticular soft tissues abnormalities and allows a differential diagnosis to be made between exudative and proliferative forms.     

Knee in early juvenile rheumatoid arthritis: MR imaging findings

PURPOSE: To determine the magnetic resonance (MR) imaging findings in the knee in early juvenile rheumatoid arthritis. MATERIALS AND METHODS: MR imaging (1.5 T) was performed in the more symptomatic knee in 30 children with juvenile rheumatoid arthritis with a symptom duration 1 year or less. Conventional, fast spin-echo, three-dimensional gradient-echo, and gadolinium-enhanced T1-weighted images were assessed. Two radiologists independently read the images, and a third resolved disagreements. These images were compared with knee radiographs in 27 children. RESULTS: Mean maximal synovial thickness was 4.8 mm +/- 2.4 (SD). Mean synovial volume was 15.4 mL +/- 10.8. Suprapatellar joint effusions were seen in 26 (87%) of 30 knees, meniscal hypoplasia in 11 (37%) of 30 knees, and abnormal epiphyseal marrow in eight (27%) of 30 knees. Three knees had articular cartilage contour irregularity, fissures, and/or thinning. One knee had a bone erosion. Knee radiographs showed suprapatellar fullness in 78% of the knees, joint space narrowing in one knee, and no bone abnormalities. CONCLUSION: Synovial hypertrophy and joint effusions are the most frequent MR imaging findings of knees in early juvenile rheumatoid arthritis. Early in the disease, radiographically occult cartilage and bone erosions are uncommonly seen at MR imaging. The potential relationship of synovitis to cartilage abnormalities deserves further study.     

Septic arthritis

Infectious arthritis is a commonly encountered clinical problem which may result from articular contamination by a wide variety of organisms. Involvement of an articulation may occur by one of four mechanisms: hematogenous spread, spread from a contiguous source of infection, direct implantation, or postoperative contamination. Distribution is typically monoarticular with a swollen, erythematous, and painful joint. The radiographic differential diagnosis includes limited rheumatoid arthritis, gout, synovial osteochondromatosis, and pigmented villonodular synovitis. In order to prevent complications, including growth disturbances, articular destruction with ankylosis, osteomyelitis, or soft tissue extension, early diagnostic arthrocentesis is important. Radiographic abnormalities, which include soft tissue swelling, joint space loss, periarticular osteopenia, and central or marginal osseous erosions, may be delayed following clinical onset of infection. Advanced imaging techniques such as scintigraphy, CT, or MRI may allow accurate diagnosis of the infectious process at an earlier stage.     

Multi-modality imaging findings of methotrexate-related Epstein–Barr virus-associated hepatic tumor

Methotrexate (MTX)-associated lymphoproliferative disorders (MTX-LPDs) that occur in rheumatoid arthritis patients who were administered MTX for long periods are well known. However, studies on their pathology in forming hepatic tumors are rare. An approach using diagnostic imaging modalities, mainly computed tomography (CT), is considered a very useful tool for the differential diagnosis of various hepatic tumors. In the present study, detailed findings of dynamic CT, magnetic resonance (MR) imaging, and contrast-enhanced ultrasonography of a hepatic tumor that was confirmed as infected by Epstein–Barr virus, in a rheumatoid arthritis patient administered MTX are presented.     

Juvenile rheumatoid arthritis: assessment with MR imaging

Thirty-three joints of the appendicular skeleton in 15 children with juvenile rheumatoid arthritis were examined with magnetic resonance (MR) imaging to determine if it could demonstrate synovial hypertrophy and status of the articular cartilage. Presumed synovial hypertrophy was seen in 13 joints as masses of varying sizes of low to intermediate signal intensity on T1- and T2-weighted images; sometimes foci of increased signal intensity, most likely due to fluid or inflammation, were seen on T2-weighted images. Probable abnormal articular cartilage was detected in ten joints, and MR imaging also demonstrated epiphyseal overgrowth, bone erosions, joint effusions, and joint space narrowing. Because MR imaging appears to provide an objective method of evaluating both synovial hypertrophy and status of articular cartilage, it may prove to be useful in monitoring progression of juvenile rheumatoid arthritis and response to therapy.     

Temporomandibular joint diagnostics using CBCT

The present review will give an update on temporomandibular joint (TMJ) imaging using CBCT. It will focus on diagnostic accuracy and the value of CBCT compared with other imaging modalities for the evaluation of TMJs in different categories of patients; osteoarthritis (OA), juvenile OA, rheumatoid arthritis and related joint diseases, juvenile idiopathic arthritis and other intra-articular conditions. Finally, sections on other aspects of CBCT research related to the TMJ, clinical decision-making and concluding remarks are added. CBCT has emerged as a cost- and dose-effective imaging modality for the diagnostic assessment of a variety of TMJ conditions. The imaging modality has been found to be superior to conventional radiographical examinations as well as MRI in assessment of the TMJ. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bone destruction/production. For evaluation of soft-tissue abnormalities, MRI is mandatory. There is an obvious need for research on the impact of CBCT examinations on patient outcome.     

类风湿关节炎的MR表现

类风湿关节炎是一种常见的以关节组织慢性炎症性病变为主要表现的全身性疾病。它可侵犯多个关节，并常以手足小关节起病，多呈对称性，伴晨僵。病变反复发作，最终导致不同程度的关节功能障碍。MR由于其软组织分辨率高、成像切面和序列丰富，在类风湿关节炎的影像诊断方面具有很大的优势。MR能直接显示关节积液、滑膜炎和滑膜增生、血管翳形成、关节软骨和骨质的侵蚀破坏及肌腱、韧带异常等类风湿关节炎主要的病理改变，敏感性远高于普通X线检查。MR能早期发现病变，判定病变的活动度，明确病变累及的程度和范围，为疾病的临床早期诊断和早期治疗提供更多的信息。     

Carpal alterations in adult-onset Still disease, juvenile chronic arthritis, and adult-onset rheumatoid arthritis: comparative study

A specific pattern of pericapitate involvement of the wrist has been described in the rheumatologic literature as characteristic of adult-onset Still disease (AOSD), a relatively rare disorder that is often diagnosed by exclusion after extensive and frequently invasive tests. To evaluate the potential diagnostic value of carpal radiography in suspected cases of AOSD, a retrospective blinded analysis of 48 patients (16 each with AOSD, juvenile chronic arthritis, and adult-onset rheumatoid arthritis) was performed. Pericapitate articular alterations without radiocarpal involvement were found to be distinctly unusual among patients with rheumatoid arthritis but frequent in the setting of AOSD. In juvenile chronic arthritis severe pericapitate involvement also occurs frequently but is more likely to be associated with interosseous fusion and severe pancompartmental disease.