动态增强MRI对于鉴别血清学阴性的手早期类风湿关节炎和骨性关节炎的价值

目的 研究动态增强MRI对于鉴别血清学阴性的手早期类风湿关节炎(RA)和骨性关节炎(OA)的价值.方法 53例疑诊为手RA或OA且X线阴性患者经3～6个月随访直至明确诊断,将其中符合早期RA诊断标准且初诊时血清阴性者18例(RA组)和符合早期OA诊断标准者18例(OA组)纳入研究,另选取18名志愿者(正常对照组);均行全手MR平扫、增强扫描及单层动态增强扫描,测量病变部滑膜强化率、曲线斜率和滑膜厚度,观察RA组和OA组MRI异常征象,滑膜强化率和滑膜强化曲线斜率3组间及3组间两两比较均采用秩和检验;滑膜厚度3组间及3组间两两比较均采用方差分析;RA组与OA组的其他MR征象比较采用秩和检验.结果 RA组、OA组、正常对照组滑膜强化率分别为(100.78±61.96)%、(40.44±15.43)%和(23.56±9.14)%,RA组与OA组比较,u=3.101,P=0.002;RA组与正常对照组比较,u=4.669,P=0.000;OA组与正常对照组比较,u=3.482,P=O.000.滑膜强化曲线斜率值分别为72.50°±13.34°、45.39°±9.94°及14.56°±5.75°,RA组与OA组比较,u=8.002,P=0.000;RA组与正常对照组比较,u=17.102,P=0.000;OA组与正常对照组比较,u=9.100,P=0.000.滑膜厚度分别为(3.3±0.5)、(2.8±0.7)、(1.4±0.6)mm,RA组与OA组比较,q=2.622,P=0.011;RA组与正常对照组比较,q=9.583,P=0.000;OA组与正常对照组比较,q=6.961,P=O.000.滑膜动态强化曲线RA组呈快速上升平台型,OA组呈缓慢上升型,正常对照组呈极慢速上升型.结论 动态增强MR扫描通过滑膜强化率和滑膜厚度等量化指标可以在血清学阴性的早期阶段鉴别RA和OA.RA患者比OA患者的滑膜强化率更高,速度更快,滑膜厚度更大.多种MR征象对于鉴别RA患者与OA患者有价值.     

MRI在早期类风湿关节炎中的应用价值

类风湿关节炎（RA）是以多发性、非特异性关节炎症为主要表现的自身免疫性疾病,呈慢性、进行性发展,是导致劳动力丧失及致残的常见疾病之一,早期诊断及治疗对其预后具有重要影响。MRI具有软组织分辨力高,可多层面、多方位、多序列成像,无电离辐射等优点,能够很好地显示早期RA滑膜炎、骨髓水肿、骨质破坏、软骨变性等病理改变,对于该病的早期诊断、进展预测、预后监测及疗效评价具有重要价值。综述MRI在早期RA中的应用价值,以扩大其应用范围。     

腕关节动态MRI增强在早早期类风湿性关节炎诊断中的价值

目的 探讨动态增强MRI评估腕关节滑膜改变在早早期类风湿性关节炎中的诊断价值.方法 对ACR/EULAR评分小于6分的25例患者腕关节进行MR成像,动态随访观察滑膜的改变,分析腕关节滑膜MRI评分与类风湿性关节炎的相关性.结果 25例患者均进行了MRI检查,所有病例均进行了随访,对12例怀疑有滑膜改变的患者进行了增强检查,滑膜轻度增厚10例,2例未见明显强化.结论 MRI增强扫描在动态随访观察早早期类风湿性关节炎中具有较好的价值,为临床早期干预提供理论依据.     

膝关节类风湿关节炎与骨关节炎MRI对比研究

目的对比分析晚期膝关节类风湿关节炎(RA)和膝关节骨关节炎(OA)的MRI表现。资料与方法对2010年7月—2012年8月经我院确诊的膝关节RA病人33例(共40个膝关节)和OA病人58例(共60个膝关节)行MRI检查并分组,统计RA组和OA组半月板、关节软骨、软骨下骨、滑膜病变的发病率和发病程度,比较两组间统计学差异。结果 RA组内、外侧半月板各部位损伤程度均重于OA组(均P<0.05);RA组胫股外侧关节软骨病变程度重于OA组(股骨外侧髁和胫骨外侧平台的Z值分别为5.702和7.534,均P<0.05),两组的髌股关节及胫股内侧关节软骨病变程度的差异无统计学意义(P>0.05);RA组的胫股内、外侧关节软骨下骨病变程度重于OA组(股骨内、外侧髁的χ2值分别为6.730和23.938,胫骨内、外侧平台的χ2值分别为12.033和41.017;均P<0.05),两组的髌股关节软骨下骨病变的差异无统计学意义(P>0.05)。RA组膝关节共有97.5%(39/40个膝关节)的滑膜弥漫性增厚,其中半数(20个膝关节)有关节裸区骨质结构破坏;OA组共有21.7%(13/60个膝关节)的滑膜增厚,范围较局限,无一例关节裸区骨质结构破坏。结论膝关节RA可造成滑膜弥漫肥厚,易造成半月板弥漫破坏、关节软骨及骨质广泛受累。膝关节OA可造成滑膜局限增厚,病变易累及内侧半月板后角和体部、胫股内侧关节及髌股关节。     

动态对比增强MRI对前列腺癌的诊断价值

动态对比增强磁共振成像(DCE-MRI)是近年发展起来的一项新技术,能够无创地反映肿瘤的血管生成及毛细血管通透性等血流动力学信息,在前列腺癌的检出、定位、治疗后疗效监测、指导穿刺活检等方面的应用越来越广泛,就DCE-MRI的基本原理及临床应用进行综述。     

类风湿关节炎超微超顺磁性氧化铁颗粒增强MRI研究进展

类风湿性关节炎（rheumatoid arthritis，RA）是一种常见而多发的以关节组织慢性炎症为主要表现的全身性疾病。如果得不到早期诊断与治疗，病情进展迅速，最终将导致关节强直、畸形和功能丧失。长期以来人们一直期望能找到早期诊断RA的方法，关于超微超顺磁性氧化铁（uhrasmall superparamagnetic ironoxide，USPIO）增强MRI是否能用于RA的早期诊断，笔者对近年来在RA发病机制、USPIO的理化特性、摄入机制和USPIO增强MRI用于RA的动物试验研究进展作了简要综述。     

MRI动态增强检查在前列腺癌诊断的价值

目的：分析前列腺癌动态扫描的影像学表现，以提高对本病诊断准确率。资料与方法：回顾性分析手术病理证实的前列腺癌患者20例，患者术前均做MRI平扫十动态增强检查，平扫包括T1W1横断位、冠状位、矢状位成像及横断位T2W1，将动态增强后T1w1分别与平扫T1W1、T2W1进行对照，以比较确定肿瘤位置、大小、形态、及肿瘤穿破包膜及周围脏器侵范的显示情况。结果：MRI动态增强大部分肿瘤组织可见早期强化，与正常前列腺信号差异增大，相对平扫其对肿瘤大小、形态、范围的显示提高、对肿瘤侵犯周围结构显示能力有较明显提高。结论：MRI动态增强扫描对前列腺癌的诊断及周围侵犯情况具有重要意义。     

MRI动态增强时间-强度曲线在手未分化性关节炎向类风湿性关节炎转归预测中的价值

目的探讨MRI动态增强时间-强度曲线各指标在手未分化性关节炎(UA)向类风湿性关节炎(RA)转归预测中的价值。方法分析2014年1月—2015年8月于天津市第一中心医院风湿免疫科就诊的61例UA病人动态增强MRI基线资料,其中女53例,男8例,年龄22~68岁,平均(49.93±10.27)岁,中位病程2.7个月(7 d~12个月)。将随访1年后确诊为RA病人25例和确诊为非RA病人22例纳入研究,采用t检验或两独立样本的秩和检验比较2组间时间-强度曲线各指标差异,采用受试者操作特征(ROC)曲线下面积评价各指标的诊断价值。结果RA组相对增强(RELENH)、最大相对增强(MAXRELENH)、最大增强(MAXENH)、最大强化斜率(WASHIN)、曲线下面积(AREACURV)均高于非RA组(均P0.001);RA组达峰时间(TTP)差异无统计学意义(P0.05)。RELENH、MAXRELENH、MAXENH、WASHIN、AREACURV的ROC曲线下面积分别为0.838、0.829、0.855、0.955、0.864,敏感度分别为92.0%、92.0%、88.0%、92.0%、96.0%,特异度分别为77.3%、77.3%、81.8%、86.4%、68.2%。其中,WASHIN的ROC曲线下面积在5项指标中诊断效能最高,AREACURV的敏感度在5项指标中最高。结论 MRI动态增强时间-强度曲线RELENH、MAXRELENH、MAXENH、WASHIN、AREACURV对预测UA向RA转归具有较高的临床价值,对临床早期诊断、早期治疗具有重要指导意义。     

高场强磁共振成像对类风湿关节炎的诊断价值

目的探讨高场强磁共振成像（MRI）在类风湿关节炎（RA）的早期诊断及活动性评估中的优越性。方法对我院2011年6月至2012年5月26例确诊为风湿性关节炎患者的双侧腕关节进行x线、CT、MRI检查,并对检查结果进行分析比较。结果所有26例患者的52个腕关节中具有骨侵蚀病灶,X线、CT、MRI的检出分别为：13、22、50个。在MRI表现中有骨侵蚀改变的50个关节中滑膜的厚度95％的可信区间为1．98～4．10mm,并通过对相关临床指标的统计学分析发现滑膜的厚度与RA患者的活动性有一定的联系。结论MRI在RA早期影像学诊断中具有非常重要的意义。在早期及活动期其敏感性优于x线和CT检查,MRI对RA的活动性评估有一定的价值。     

Changes underlying the dynamic contrast-enhanced MRI response to treatment in rheumatoid arthritis

Objective Dynamic contrast-enhanced MRI of patients with rheumatoid arthritis has shown a decrease in the early enhancement rate (EER) of synovitis after treatment. The purpose of this work was to investigate the underlying changes. Methods 3D dynamic contrast-enhanced images were acquired from 13 patients before and 1–2 weeks after anti-TNFα treatment. The EER of the inflamed synovium was measured. The T₁ relaxation time of the synovitis was calculated from images at different flip angles. The time course of the arrival of gadolinium at the radial artery was determined. The gadolinium enhancement of the inflamed synovium was modeled to calculate the fractional plasma volume (v_p), the fractional extravascular, extracellular fluid volume (v_e), and the volume transfer constant (K^trans). Pre- and post-treatment values were compared and the dependence of the EER on each parameter was assessed. Results There was a decrease in the EER measured over 26 s after treatment (29%, p = 0.002). Reductions in T₁ (12%, p = 0.001), K^trans (31%, p = 0.002), and v_p (43%, p = 0.01) contributed to this; however, the EER was relatively insensitive to changes in v_e. Conclusions The decrease in EER after anti-TNFα treatment is largely caused by reductions in the volume transfer constant K^trans, the fractional plasma volume v_p, and the T₁ relaxation time. Only the contributions from K^trans and v_p directly reflect synovial vascularity.     

Value of contrast-enhanced ultrasound in rheumatoid arthritis

The purpose of this review is to describe the spectrum of sonographic findings in rheumatic diseases with respect to the diagnostic potential using US contrast media which prove activity or inactivity in synovial tissue where new treatment regimes target. Synovial activity can be found in non-erosive and erosive forms of primary and secondary osteoarthritis, and in inflammatory forms of joint diseases like rheumatoid arthritis and peripheral manifestations of spondyloarthritis including, ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis and enteropathic arthritis. It can also be present in metabolic and endocrine forms of arthritis, in connective tissue arthropathies like systemic lupus erythematosus or scleroderma and in infectious arthritis. Ultrasound should be used as first-line imaging modality in suspected early cases of RA and other forms of arthritis, whereas contrast-enhanced ultrasound (CEUS) can further enable for sensitive assessment of vascularity which correlates with disease activity.     

Tendon involvement in rheumatoid arthritis of the wrist: MRI findings

Objective. To evaluate the distribution and extent of wrist tendon alterations in patients with active rheumatoid arthritis (RA) using magnetic resonance imaging (MRI). Design and patients. Forty-three clinically active RA patients with an illness duration of less than 4 years and no clinical evidence of tendons tears were enrolled in the study. There were 10 men and 33 women, with an average age of 52 years (range 33– 63 years). MRI of both wrists, with one exception, was performed at 1.0 T using T1- and T2-weighted sequences (slice thickness 3 mm). Twelve healthy subjects (8 women, 4 men; mean age 31 years) were also evaluated as a control group. Two radiologists reviewed each of four schematic anatomical regions (volar, dorsal, ulnar, radial) for the degree of tendon and tendon sheath alterations using two progressive scales. Results. In the control group all tendons had homogeneous low signal intensity on all sequences. A small amount of fluid was found in six subjects but the diameter was always less than 1 mm. In the patient group minimal fluid (<2 mm) was found in 35 (41%) wrists, grade 2 fluid (<2>5 mm) in 26 (31%) and grade 3 fluid (>5 mm) in 24 (28%). Fifty-nine (69%) of the grade 1 changes were in the volar compartment but grade 2 involvement was evenly distributed. Grade 3 changes were most common in the dorsal compartment and combined grade 2 and 3 in the dorsal and ulnar compartments were 32 (38%) and 25 (30%) compared with 16 (18%) and 17 (20%) respectively in the volar and radial compartments. The tendons were normal (grade 0) in 47 (46%) wrists. A maximum tendon signal change (grade 1) was demonstrated in 28 wrists (32%). When associated with other individual tendons grades this grade was demonstrated in the dorsal compartment in 30 (35%) wrists, in the volar compartment in 12 (14%), in the radial compartment in 17 (20%) and in the ulnar compartment in 26 (30%). A partial tear (grade 2) was detected in 7 (8%) wrists, all involving the dorsal and ulnar compartments; five underwent surgical repair and one proved to have a complete rupture of extensor digitorum. Three (3%) had a grade 3 complete tendon tear: all of these were in extensor tendons. Surgical repair was successful in one case but two ruptured again within 3 months. Conclusions. Low grades of peritendinous effusion were more common in the volar compartment whereas moderate and high degrees of tendon sheath fluid collection and/or pannus and signs of tendonitis were more frequent in the dorsal and ulnar tendon sheaths. Received: 20 January 2000 Revision requested: 24 February 2000 Revision received: 25 October 2000 Accepted: 19 December 2000     

A computer-aided detection system for rheumatoid arthritis MRI data interpretation and quantification of synovial activity

Rational and objective

Disease assessment and follow-up of rheumatoid arthritis (RA) patients require objective evaluation and quantification. Magnetic resonance imaging (MRI) has a large potential to supplement such information for the clinician, however, time spent on data reading and interpretation slow down development in this area. Existing scoring systems of especially synovitis are too rigid and insensitive to measure early treatment response and quantify inflammation. This study tested a novel automated, computer system for analysis of dynamic MRI data acquired from patients with RA, Dynamika-RA, which incorporates efficient data processing and analysis techniques.

Materials and methods

140 MRI scans from hands and wrists of 135 active RA patients and 5 healthy controls were processed using Dynamika-RA and evaluated with RAMRIS. To reduce patient motion artefacts, MRI data were processed using Dynamika-RA, which removed motion in 2D and 3D planes. Then synovial enhancement was visualised and qualified using a novel fully automated voxel-by-voxel analysis based algorithm. This algorithm was used to replace traditional region-of-interest (ROI) and subtraction methods, yielding observer independent quantitative results.

Results

Conventional scoring performed by an observer took 30-45 min per dataset. Dynamika-RA reduced motion artefacts, visualised inflammation and quantified disease activity in less than 3 min. Data processing allowed increasing signal to noise ratio by a factor 3. Due to fully automated procedure of data processing, there was no intertest variation in the results.

Conclusions

Algorithms incorporated into Dynamika-RA allow for the significant enhancement of data quality through eliminating motion artefacts and reduction of time for evaluation of synovial inflammation.     

MRI of the hand in psoriatic and rheumatical arthritis

Magnetic resonance imaging (MRI) of the hand in patients with psoriatic arthritis (PA) was evaluated and compared with MRI of the hand in patients with rheumatoid arthritis (RA). Both MRI and X-ray examinations of the hands were performed in 28 PA patients and 18 RA patients.The MRI showed a PA pattern characterized by a more pronounced soft tissue swelling as compared with RA patients. Diffuse and pronounced periarticular oedema that spread to the subcutis was evident in 24 (85.7 %) PA patients. Subchondral changes were characteristic of PA patients, and were observed in 12 of 28 PA patients (42.8 %). In these cases, conventional X-ray examination failed to show any bone change. These two changes were not seen in RA patients. Our preliminary results indicate that MRI might play a role in differential diagnosis between PA and RA especially in the early phase of the disease in which conventional radiological examination is negative.     

MRI quantification of rheumatoid arthritis: Current knowledge and future perspectives

The international consensus on treatment of rheumatoid arthritis (RA) involves early initiation of disease modifying anti-rheumatic drugs (DMARDs) for which a reliable identification of early disease is mandatory. Conventional radiography of the joints is considered the standard method for detecting and quantifying joint damage in RA. However, radiographs only show late disease manifestations as joint space narrowing and bone erosions, whereas it cannot detect synovitis and bone marrow oedema, i.e., inflammation in the synovium or the bone, which may be visualized by magnetic resonance imaging (MRI) months to years before erosions develop. Furthermore, MRI allows earlier visualization of bone erosions than radiography. In order to allow early treatment initiation and optimal guidance of the therapeutic strategy, there is a need for methods which are capable of early detection of inflammatory joint changes. In this review, we will discuss available data, advantages, limitations and potential future of MRI in RA.     

Pharmacokinetic modeling of dynamic contrast-enhanced MRI of the hand and wrist in rheumatoid arthritis and the response to anti-tumor necrosis factor-alpha therapy.

Dynamic contrast-enhanced MRI (DCE-MRI) of the hand and wrist was performed in 11 patients with rheumatoid arthritis twice before and once 2 weeks after treatment with anti-tumor necrosis factor (TNF)-alpha therapy. A rapid, T1-weighted 3D spoiled gradient echo (SPGR) sequence was used for the dynamic imaging. T1 estimation was performed using similar images obtained at different flip angles. The relative radiofrequency field was estimated from the known T1 of the periarticular fatty marrow. The arterial input function (AIF) was measured at each examination, and normalized to the expected plasma concentration to reduce partial volume effects. Synovial enhancement was modeled to yield values for Ktrans, ve, and vp. Ktrans and ve showed good reproducibility. There was a significant decrease of about 20% in Ktrans after 2 weeks of treatment. This study demonstrates the potential of DCE-MRI and pharmacokinetic modeling to study early changes in inflammatory activity in rheumatoid arthritis following treatment.