MRI对儿童血友病性关节病病情严重程度的评估价值及影像特点分析

目的探讨MRI对儿童血友病性关节病(HA)病情严重程度的评估价值及影像特点。方法选取2013年05月-2014年05月来我院经临床确诊的HA患者30例为观察组,并选取同期入院检查的年龄相仿的正常健康儿童30例作为对照组,采用Denver评分法分别对软组织及骨软骨的影像征象进行评估和量化监测,评价受检关节改变的严重程度,并比较两组受检儿童关节功能Fugl-Meyer评定,并将Denver评分与Fugl-Meyer评定量表做相关分析。结果对照组软骨在常规序列上显示信号均匀一致,无明显异常信号,软骨表面光滑,每层软骨线条显示清晰,表面呈中高信号,中间为等低信号。观察组患儿常规序列显示软骨信号异常,呈明显高信号,软骨分层不清,部分软骨表面毛躁,软骨信号异常可伴有滑膜增生。根据Denver评分结果将关节分为0分组7个关节,1-6分组10个关节和7-10分组13个关节。对照组儿童Fugl-Meyer评分(99.84±0.12)显著高于观察组(70.25±6.81)(P0.05),观察组患儿中随着Denver评分越高,Fugl-Meyer评分逐渐降低,差异具有统计学意义(P0.05)。HA患儿Denver评分与Fugl-Meyer评分呈负相关(r=-0.741,P0.001)。结论 Denver评分能够将MRI图像异常征象量化,且能够从关节软组织及软骨方面评价关节受损严重程度并进行分级,Denver评分和Fugl-Meyer评分能够提示病变发展程度及关节预后情况。

Value and Imaging Characteristics of MRI in Assessing the Severity of Hemophilia Arthropathy in Children

Objective To explore the value and imaging characteristics of MRI in assessing the severity of hemophilia arthropathy(HA) in children. Methods 30 patients diagnosed clinically with HA in our hospital from May 2013 to May 2014 were selected as the observation group, and 30 normal healthy children of the same age hospitalized for the same period were selected as the control group.The imaging signs of soft tissue and bone cartilage were evaluated and quantitatively monitored by the Denver scoring method. The severity of examined joints changes were evaluated and the Fugl-Meyer assessment of joint function in examined children of two groups were compared. And then the Denver scores and Fugl-Meyer rating scales were made correlation analysis. Results Uniform signals without obvious abnormal signals, smooth cartilage surface, clear cartilage lines of each layer,middle-high signal in the surface and low signal in the middle were shown in the conventional sequence in cartilages in the control group. Abnormal cartilage signals with significantly high signals, unclear cartilage layers, rough surface in part of the cartilages, abnormal cartilage signals accompanied by synovial hyperplasia were shown in the conventional sequence of cartilages in the observation group. According to the Denver score, the joints were divided into 0 groups of 7 joints, 1 to 6 groups of 10 joints and 7 to 10 groups of 13 joints.The Fugl-Meyer scores (99.84±0.12) in the control group were significantly higher than those in the observation group(70.25±6.81)(P<0.05). The Fugl-Meyer scores decreased gradually with the higher Denver score in the observation group, therefore the difference was statistically significant (P<0.05). The Denver score was negatively correlated with the Fugl-Meyer score in patients with HA (r = -0.741, P<0.001). Conclusion The Denver scoring method can quantify be abnormal signs in MRI images and evaluate and classify the joint damage severity from soft tissue and cartilage of the joint. The Denver scores and Fugl-Meyer scores can indicate the development degree of lesion and the prognosis of joint.