类风湿性关节炎手部非增强磁共振血管成像技术研究

目的:研究基于血流敏感散相的平衡稳态自由进动序列的非增强磁共振技术(FSD-bSSFP NC-MRA,FSD-bSSFP)在类风湿性关节炎手部血管成像的应用价值。方法:20例类风湿性关节炎患者采用FSD-bSSFP序列及增强MRA成像(CE-MRA)进行手部血管成像。由2名5年以上MRI诊断经验的放射科医师测量两种成像方式获得手部动脉血管影像的信噪比(SNR)、对比噪声比(CNR),并对图像质量、静脉污染及手部动脉及分支显示情况进行评分。结果:入组病例17例。FSD-bSSFP序列SNR高于CE-MRA(t=3.707,P<0.05),FSD-bSSFP序列与CE-MRA显示手部血管成像CNR无显著性差异(t=0.600,P>0.05);FSD-bSSFP序列动脉图像质量评分高于CE-MRA(Z=-2.271,P<0.05),静脉污染程度低于CE-MRA(Z=-2.722,P<0.05),动脉分支显示评分无统计学差异(Z=-1.027,P>0.05)。结论:FSD-bSSFP技术应用于类风湿性关节炎患者可获得较好的手部血管成像,避免对比剂对肾脏的潜在损害。     

手关节MRI在早期类风湿关节炎中的临床应用

目的:探讨早期类风湿关节炎(rheumatoid arthritis,RA)手关节MRI表现及其临床价值。方法:回顾性分析40例经临床诊断早期RA的手关节MRI资料,分析主要MRI征象。结果:40例中,腕关节受累18例,掌指关节10例,近节指间关节12例。所有受累关节有不同程度的滑膜炎和血管翳形成,表现为T1WI稍低信号,T2WI稍高信号,压脂T2WI呈高信号,病变范围显示更清晰。骨髓水肿28例,表现为骨质斑片状T1WI稍低信号,T2WI稍高信号,压脂T2WI呈高信号,界限不清。软骨及骨侵蚀20例,软骨侵蚀表现为毛糙或变薄,T1WI呈稍低信号和压脂T2WI上呈稍低和稍高信号,骨侵蚀表现为关节面边缘不规则小的缺损,T1WI呈低信号,T2WI呈稍高信号,压脂T2WI呈高信号,边界清晰。肌腱受累8例,表现为腱鞘积液和腱鞘滑膜增厚,T1WI呈稍低信号,T2WI呈高信号。5例增强扫描增厚滑膜和血管翳明显强化。10例早期RA治疗后复查,8例滑膜炎、骨髓水肿不同程度缓解,2例骨质侵蚀无明显改善。结论:早期RA手关节MRI各序列上的信号特点具有一定特征性。MRI检查成为RA早期诊断、监测进展及治疗后疗效评估的重要方法。     

类风湿关节炎静息态功能磁共振研究

目的:探讨类风湿关节炎(RA)患者静息态下局部脑区的自发神经活动.方法:利用3.0T磁共振扫描仪采集年龄、性别及受教育程度相匹配的35例RA患者(RA组)和35例正常对照者(NC组)静息态功能磁共振(rs-fMRI)数据,应用低频振幅(ALFF)方法分析、比较两组受试者大脑自发活动的差异.结果:与正常对照组相比,RA患者ALFF值增高区位于双侧前扣带膝下部、双内侧眶额皮层以及双侧岛叶,ALFF值降低区主要位于双侧距状回、右舌回、右楔叶、左枕中回(P＜0.05,AlphaSim校正).结论:RA患者静息态下神经活动存在异常,增高区可能反映与疾病相关的运动决策功能改变,功能降低区可能反映视觉功能改变.     

磁共振检查在烟雾病中的应用

目的：评价磁共振检查在诊断烟雾病中的应用价值。方法：回顾分析6例烟雾病患者，每例均有MRI平扫和MRA检查，并跟踪随访。结果：磁共振显示双侧大脑前动脉闭塞2例，双侧大脑前动脉及大脑中动脉均闭塞2例，双侧大脑中动脉闭塞2例，其中3例可显示异常血管网。结论：磁共振检查在烟雾病诊断中独具优势。     

磁共振检查在多发性硬化诊断中的应用进展

多发性硬化是一种炎症性、脱髓鞘痰病，以中枢神经系统多发病灶及病程中缓解一复发为特点。磁共振的新技术如磁化传递成像及磁共振波谱成像可从微观水平对多发性硬化病变做定性、定量分析，从而加深对多发性硬化病理改变及分期的认识。     

类风湿关节炎手腕部骨侵蚀的磁共振定量分析

目的：通过类风湿关节炎手腕部骨侵蚀MRI表现及临床指标对照研究,探讨两者在评价类风湿关节炎诊断及预后中的价值。方法：随机选取行手腕部MRI扫描的患者80例,患者均在1周内行相关实验室检查,其中符合类风湿诊断标准的入选为研究对象。采用OMERACT的RA评分系统为类风湿关节炎骨质破坏的评分标准,对磁共振图像进行分析及评分。分别按性别、年龄、病程、晨僵、类风湿因子（RF）、抗环瓜氨酸肽（抗CCP）、抗＂O＂（ASO）、C反应蛋白（CRP）、血沉（ESR）予以分组,使用Mann-Whitney方法分析各组间骨侵蚀的差异。结果：符合RA诊断标准的共54例,共发现238处骨质侵蚀,最多的1例累及13处骨质。腕部骨侵蚀最常累及三角骨（36/54）,其次为头状骨（31/54）;手部最常累及第三掌骨头（7/54）,其次为第二掌骨头（6/54）。早期/中晚期RA组、CRP阳/阴性组、ESR阳/阴性组间骨侵蚀评分差异具有高度统计学意义（P〈0.01）。抗CCP阳/阴性组间的骨侵蚀评分差异具有统计学意义（P〈0.05）。性别、年龄、晨僵、RF、ASO的组间骨侵蚀评分差异无统计学意义（P〉0.05）。结论：MRI可为骨侵蚀的诊断及评估预后提供最直观的依据,抗CCP抗体、CRP、ESR可在一定程度上提示骨侵蚀。     

磁共振检查在多发性硬化诊断中的应用进展

多发性硬化是一种炎症性、脱髓鞘疾病,以中枢神经系统多发病灶及病程中缓解-复发为特点.磁共振的新技术如磁化传递成像及磁共振波谱成像可从微观水平对多发性硬化病变做定性、定量分析,从而加深对多发性硬化病理改变及分期的认识.     

CBASS序列在磁共振成像检查中的应用

目的：分析研究CBASS(Completely Balanced Steady State)序列在MRI检查应用中的优缺点。方法：经Marconi Proview 0．23T开放式磁共振机CBASS序列和常规序列扫描患者及志愿者共65例，受检部位包括脊椎、头颅、骨关节和盆腔等部位，扫描方位有横轴位、矢状位和冠状位。结果：经CBASS序列与常规序列扫描上述各部位对比观察结果表明，CBASS序列可以更清楚地显示受检部位的解剖结构；能够在保持常规T1加权序列所具有的特征的基础上，还能使脑脊液等液体显示高信号；能够清楚显示骨骼内骨小梁及颅神经等微细结构；盆腔扫描可显示前列腺、精囊腺、子宫等结构，尤其对精囊腺囊状结构、间隔及周围静脉丛结构的显示。结论：CBASS具有较高的组织分辨率，能够更精确地显示各组织结构的微细结构，且具有对流体不敏感，扫描时间较短等特点，具有广阔的临床应用前景。     

MRI在银屑病关节炎中的应用研究进展

本文主要阐述近年来对银屑病关节炎(psoriatic arthritis)影像学特点的研究进展.X线对于PsA的发病机理主要提供了骨质有利的依据,但是由于其成像的局限性,对软组织成像不敏感.磁共振的使用和发展克服了X线成像缺点,为PsA的早期诊断和发病机理提供的更加准确的依据和线索.     

磁共振EPI在颅脑急诊检查中的应用

笔者对 5 0例颅脑急诊患者进行了常规ＳＥ序列及平面回波成像 (ｅｃｈｏｐｌａｎａｒｉｍａｇｉｎｇ ,ＥＰＩ)检查 ,这两种方法所产生的图像进行了对照分析。探讨ＥＰＩ在颅脑急诊检查中的应用价值。1　材料与方法1.1　一般资料5 0例颅脑急诊患者 ,男 41例 ,女 9例 ,年龄 43～ 72岁 ,平均 5 3岁。其中急性大面积及多发性脑梗塞 15例、后颅凹及半球出血 5例、基底结出血 11例、脑干出血 5例、脑瘤 13例、脑囊虫 1例 ,全部患者均有不同程度的意识障碍、躁动等表现。1.2　检查方法ＭＲＩ采用Ｐｈｉｌｉｐｓ 1.0Ｔ超导ＭＲ成像仪 ,头线圈、扫描…     

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。     

膝关节痛风性关节炎的MRI诊断

目的 探讨膝关节痛风性关节炎的MRI特征性表现.资料与方法 回顾性分析7例经手术、病理证实为膝关节痛风性关节炎的MRI表现.所有病例均做SE序列T1WI和FSE序列T2WI.其中4例做了钆喷酸葡胺(Gd-DTPA)增强扫描.结果 膝关节骨质侵蚀破坏5例,股骨髁4例,髌骨下缘1例;股骨髁间窝区域、髌下脂肪区和/或髌韧带周围软组织见团块状病灶6例.全部痛风石病灶T1WI均呈低至中等信号;T2WI有2例呈低信号,3例有低信号病灶和低至稍高混杂信号病灶,另2例则为高信号.4例增强后,病灶无强化1例,轻度不均匀强化1例,病灶边缘强化2例.结论 膝关节痛风性关节炎的MRI特征性表现常是T1WI和T2WI均呈低至中等信号的肿块状病灶,且具边缘强化,其对膝关节痛风性关节炎的诊断很有价值.     

The Development of EERA: Software for Assessing Rheumatic Joint Erosions

Objective

The principal aim of this study was to create a segmentation program, to be used by nonmusculoskeletal or junior fellows, that defines the bones in the metacarpophalangeal joint in a dynamic 3-dimensional image that will lead to higher inter-reader agreement of bone erosion scores.

Methods

The second to fifth metacarpal head and phalangeal bases of 15 participants were rated according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system by one trained and one untrained reader. Two comparisons were made. The first comparison was between the 2 readers using only the traditional 2-dimensional magnetic resonance image set. The second comparison was between the 2 readers, with the untrained reader using a custom segmentation program with traditional 2-dimensional magnetic resonance image set.

Results

The software marginally increased inter-reader reliability with the exception of the second metacarpal head, for which reliability was increased substantially. Future work will concentrate on improving image acquisition, better delineate erosions from surrounding bone oedema, and address methods to directly determine erosion volumes.

Conclusions

Software designed to display dynamic 3-dimensional images enables a relatively untrained user to score the metacarpophalangeal joints in the hand for erosions equivalent to that produced by an expert using the manual methods.     

MR imaging assessment of clinical problems in rheumatoid arthritis

Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, "rice-bodies" bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis.     

Diagnostic performance of three-dimensional MR maximum intensity projection for the assessment of synovitis of the hand and wrist in rheumatoid arthritis: A pilot study

Purpose

To evaluate the diagnostic performance of three-dimensional (3D) MR maximum intensity projection (MIP) in the assessment of synovitis of the hand and wrist in rheumatoid arthritis (RA) compared to 3D contrast-enhanced magnetic resonance imaging (CE-MRI).

Materials and methods

Twenty-five patients with RA underwent MR examinations. 3D MR MIP images were derived from the enhanced images. MR images were reviewed by two radiologists for the presence and location of synovitis of the hand and wrist. The diagnostic sensitivity, specificity and accuracy of 3D MIP were, respectively, calculated with the reference standard 3D CE-MRI.

Results

In all subjects, 3D MIP images yielded directly and clearly the presence and location of synovitis with just one image. Synovitis demonstrated high signal intensity on MIP images. The k-values for the detection of articular synovitis indicated excellent interobserver agreements using 3D MIP images (k = 0.87) and CE-MR images (k = 0.91), respectively. 3D MIP demonstrated a sensitivity, specificity and accuracy of 91.07%, 98.57% and 96.0%, respectively, for the detection of synonitis.

Conclusion

3D MIP can provide a whole overview of lesion locations and a reliable diagnostic performance in the assessment of articular synovitis of the hand and wrist in patients with RA, which has potential value of clinical practice.     

利用 MR全身类 PET 成像加原发部位常规扫描对恶性肿瘤临床分析

目的：探讨在磁共振全身类PET成像（whole body diffusion weighted imaging ,WB‐DWI）基础上于原发部位追加常规扫描对恶性肿瘤局部及全身情况综合分析的意义。方法收集恶性肿瘤病例36例,行磁共振类PET成像及原发部位常规磁共振扫描,并对病变局部侵犯及远处转移情况进行分析。结果类PET成像对所有转移灶的诊断中,假阳性3例,漏诊1例。原发部位手术病理证实病例21例,类PET成像仅对7例原发灶周围侵犯情况作出准确评估,而常规磁共振扫描则对17例作出准确评估。结论在M R全身类PET成像的大范围扫描技术及其发现病变敏感性的基础上,于原发部位追加磁共振常规扫描对恶性肿瘤进行综合性评价具有重要意义。     

放射状扫描技术在鼓乳段面神经MRI中的应用

目的：探讨放射状扫描技术在鼓乳段面神经MRI扫描中的应用价值,比较放射状扫描、斜矢状面扫描和3D扫描技术在鼓乳段面神经MRI扫描中的优劣势。方法：使用3．0T磁共振机,对无任何颅内疾病的10例健康成人自愿者（20耳）行鼓乳段面神经MRI扫描,分别采用放射状T2wI、斜矢状面T2wI和3D-FIESTA序列,选取以上3组序列显示该段面神经最完整的层面进行长度测量,同时测量面神经鼓室段、乳突段的信噪比,采用盲法对以上3组序列图像进行综合评分。结果：三组序列图像上面神经长度测量的方差分析结果显示,差异无统计学意义（P=0．234）;三组序列图像上面神经鼓室段、乳突段的信噪比采用Friedman秩和检验,结果显示差异无统计学意义（P=0．196和0．257）;三组序列面神经综合评分比较,差异有统计学意义（P=0．001）,3D-FIESTA序列评分最高。结论：放射状扫描技术在回避扫描倾斜角度问题的同时能够完整显示鼓乳段面神经,放射状序列、斜矢状面序列可作为3D扫描序列的补充,对鼓乳段段面神经疾病的诊断、治疗、手术及预后判断有很大帮助。     

手及腕关节MRI对类风湿性关节炎的早期诊断价值

目的探讨MRI对类风湿性关节炎的早期诊断价值。方法对76例以多关节痛为主诉的患者行双手及腕关节MR扫描(经随访证实，其中54例为类风湿性关节炎，22例为非类风湿性关节炎)，观察其MRI有无滑膜强化或增厚(包括有无对称性)、骨侵蚀、骨髓水肿、肌腱炎及关节积液等征象，及各种征象对诊断的作用。根据不同MRI征象的出现频率，使用Bayes判别分析的方法尝试寻找类风湿性关节炎的MRI诊断标准。结果本组54例类风湿性关节炎患者中12例为MRI早期诊断。以对称性滑膜强化或增厚为诊断标准时，灵敏度85.19％，特异度86．36％。结论MRI是类风湿性关节炎诊断的可靠手段之一，并可应用于早期诊断。当MRI扫描出现对称性滑膜强化时，高度提示早期类风湿性关节炎的诊断；当对称性滑膜强化或增厚与骨侵蚀、骨髓水肿、肌腱炎、关节积液中的至少任何1项并存，或当非对称性滑膜强化或增厚与上述至少任何2项并存时，应该考虑类风湿性关节炎的诊断。     

Advanced imaging in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise that conventional radiographic images show changes of rhuematoid arthritis late after irreversible joint damage has occured. With the advent of powerful disease-modifying drugs there is a need for early demonstration of rheumatoid arthritis and to monitor progress of the disease and response to therapy. Advanced imaging techniques such as ultrasound and MRI have focussed on the demonstration and quanitification of synovitis and erosions and allow early diagnosis of RA. The technology to quantify synovitis and erosions is developing rapidly and now allows change in disease activity to be assessed. However, problems undoubtedly exist in quantification techniques and this review serves to highlight them. Much of the literature on advanced imaging in RA appears in rheumatological journals and may not be familiar to radiologists. This review article aims to increase the awareness of radiologists to this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. This first part addresses synovitis imaging. The second part will look at advanced imaging of erosions in RA. Part 1 of this article (Synovitis) can be found at: . In our previous article we described issues surrounding the advanced imaging of synovitis. This article addresses erosions in a similar manner.     

CISS-3D序列在MR脊髓成像术中的应用价值

目的：探讨ＭＲ脊髓成像ＣＩＳＳ－ ３Ｄ技术的应用价值。方法：对４５ 例（男２７例,女１８例）病人用Ｓｉｅｍ ｅｎｓ Ｖｉｓｉｏｎ １．５ Ｔ磁共振仪用ＣＩＳＳ－ ３Ｄ序列进行脊髓成像术检查,所得原始图像用曲面重建处理。结果：所有病例均获得高质量、高对比的脊髓腔图像,其中阳性３３例,包括脊髓损伤５例,椎管内肿瘤１２例,脊髓先天异常４ 例,脊椎骨病变３例,阴性１２例。结论：ＣＩＳＳ－ ３Ｄ序列ＭＲ脊髓成像是可靠的,减少了对ＭＲ脊髓增强检查的需要。