膝关节色素沉着绒毛结节性滑膜炎MRI诊断与鉴别诊断

目的 探讨色素沉着绒毛结节性滑膜炎（PVNS）病理表现及磁共振成像（MRI）特点,分析MRI的诊断价值.方法 对16例MRI 检查并经手术病理检查或关节镜活检证实为PVNS患者的临床资料进行分析总结.结果 16例患者均为单发,均为膝关节.MRI 表现为弥散型滑膜增厚12例,局灶型滑膜增厚4例.增厚的滑膜T1WI呈等信号9例,稍高信号3例,低信号 4例;T2WI呈高信号2例,高、低混杂信号 14例,其中 T2W I低信号显示更为明显.8例膝关节增生者滑膜突破关节囊进入腘窝,形成多发大小不等结节状异常信号.髌上囊滑膜边缘呈波浪状改变12例,髌下脂肪囊见结节状、片状异常信号10例,前后交叉韧带区见混杂信号影 4例,出现骨质侵蚀性改变10例.3例增强扫描者均呈中度至明显增强.16例患者膝关节病变均伴关节积液,其中4例积液可见T2低信号结节.结论 PVNS病理及MRI表现具有特征性,MRI在PVNS的诊断与鉴别诊断方面具有重要价值.     

膝关节色素沉着绒毛结节性滑膜炎磁共振成像表现

目的 探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)的磁共振成像(MRI)表现.方法 回顾性分析11例经手术及病理检查证实的膝关节PVNS的MRI影像资料.结果 11例膝关节PVNS均为弥漫型.MRI表现为关节腔内滑膜增生形成绒毛结节或肿块,T1WI呈等或低信号,T2WI呈低信号,其中6例在T2WI上部分病灶呈低、高混杂信号:11例均有不同程度关节积液,关节内脂肪垫受侵10例,软骨或骨质受侵8例,关节韧带受侵6例,关节囊肿胀7例,关节周围软组织受推移7例,累及半月板1例.结论 MRI对膝关节PVNS有特征性表现,并敏感显示关节内、外组织结构的侵犯程度及范围,是诊断PVNS的理想检查方法.     

MR多序列成像在腕关节类风湿性关节炎中的应用价值

目的 探讨MRI多序列成像对类风湿性关节炎腕关节病变的诊断价值.方法 80例类风湿性关节炎患者,行腕部MRI多序列成像,包括冠状位SE T1WI、GE T1WI、GE STIR,轴位TSE T2WI、矢状位 SE T1WI.30例注射GD-DTPA后行SE T1WI、GE T1WI增强扫描.结果 80例患者中,76例显示腕关节有不同程度的滑膜炎,增生滑膜和血管翳在GE T1WI及增强后图像上显示尤为明显.55例骨髓水肿,在T1WI呈低信号,增强后轻度强化,GE STIR上呈斑片状高信号.56例骨侵蚀,表现为关节面边缘不规则小的缺损,T1WI为低信号,STIR为高信号,而GE T1WI稍高信号,强化较SE T1WI明显.58 例关节积液.70例肌腱炎,表现为腱鞘积液、腱鞘增厚、T2WI信号增高,增强扫描后有强化.结论 MRI多序列成像能够反应类风湿性关节炎的病理变化,对其诊断有高度敏感性.     

MRI对膝关节色素沉着绒毛结节性滑膜炎的诊断价值

目的探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)的MRI诊断价值。方法进行回顾性分析11例经手术及病理证实的膝关节PVNS的MRI表现。结果 11例患者均为弥漫型,主要MRI表现为滑膜不规则结节状增厚或弥漫性增生,T1WI呈等/低信号,T2WI呈等/稍高信号,增生的滑膜内可见含铁血黄素沉着(低信号)、邻近半月板和(或)骨侵蚀、关节腔积液等,关节内外结构均可不同程度受侵。结论 PVNS所致的滑膜绒毛结节样增生以及含铁血黄素沉着在MRI上具有特征性的表现和信号,对早期诊断本病具有重要价值。     

膝关节类风湿性关节炎的MRI诊断

目的探讨磁共振成像(MRI)技术在类风湿性关节炎(RA)患者膝关节病变临床诊断中的应用价值.方法对32例51个膝关节进行磁共振检查,并分析其表现.结果MRI显示了RA患者膝关节的滑膜增生及血管翳形成、关节软骨破坏、骨质受侵、关节囊积液及周围邻近软组织的改变,并可通过血管翳的信号和强化程度判断疾病的时期.结论MRI能直接显示RA患者膝关节的各种改变,与X线及CT比较有明显优势,有助于疾病的早期诊断和临床分期.     

膝关节色素沉着绒毛结节性滑膜炎的临床及影像学表现

目的探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)的临床表现及影像学特征。方法回顾性分析10例经手术(或关节镜)及病理证实的PVNS临床及影像学(X线平片、CT、MRI等)资料并进行总结。结果 10例患者起病缓慢,主要临床表现为膝关节局部包块,关节肿胀疼痛,关节活动时疼痛加剧。X线平片仅能显示不同程度的关节间隙变窄、关节囊的肿胀、关节面下的骨侵犯或骨缺损及其周围硬化;CT可以显示关节囊突向关节腔的软组织结节。MRI对显示关节滑膜增厚和关节积液尤其敏感,滑膜增厚及软组织结节在T1WI呈等低信号,T2W1为低信号3例,等信号或稍高信号7例,8例在增厚的滑膜内可见多发散在含铁血黄素沉着的长T1、短T2低信号影。10例病变关节均有关节积液。8例病变关节有关节软骨及软骨下骨质破坏。结论 PVNS在MRI上有典型特征性的表现,明显优于X线平片及CT,MRI能准确反映PVNS中滑膜的绒毛结节状增生、增生的滑膜对关节软骨的破坏以及其对软骨下骨质及软骨下远部骨质侵蚀的不同时期绒毛结节的影像学特征,并可以准确评价病变对关节内外累及的范围,是诊断PVNS最佳检查方法。     

膝关节色素沉着绒毛结节性滑膜炎的MRI诊断

目的 探讨膝关节色素沉着绒毛结节性滑膜炎的磁共振成像（MRI）表现.方法 回顾性分析11例经手术病理证实的膝关节色素沉着绒毛结节性滑膜炎（pigmental vilionodular synovitis,PVNS）的MRI表现.结果 所有膝关节内均存在滑膜增生及增生的滑膜结节,9例为弥漫型PVNS,2例为局限型PVNS,增生滑膜结节主要位于髌上囊、腘窝内、髌下脂肪垫区、交叉韧带旁.T2WI低信号含铁血黄素结节为特异性表现.结论 膝关节色素沉着绒毛结节性滑膜炎具有特征性MRI表现,MRI能准确反映关节内外受侵组织结构受侵犯的范围和程度,是诊断PVNS的理想检查方法.     

彩色多普勒超声诊断在类风湿性关节炎膝关节病变中的诊断价值

目的探讨高频彩色多普勒超声在类风湿性关节炎膝关节病变诊断中的应用价值。方法应用高频彩色多普勒超声对36例类风湿关节炎患者双侧膝关节进行扫查,观察滑膜、关节囊积液、软骨表面及关节病变区域血流情况。结果68个膝关节出现滑膜增厚（94.44%）,46个关节出现关节囊积液（63.89%）,18个关节显示软骨磨损（25%）,30个关节滑膜内显示低速血流信号（41.67%）。结论高频彩色多普勒超声在诊断类风湿关节炎膝关节病变中有较高的应用价值。     

临床应用磁共振技术诊断膝关节损伤的价值探讨

目的关于临床应用磁共振扫描技术对膝关节损伤进行诊断的价值探究。方法选择2018年3月至2019年6月我院收治的疑似膝关节损伤的73例患者作为调查对象,对所有患者均选择采用膝关节磁共振扫描技术进行诊断,并评价磁共振诊断和临床病理诊断的符合性。结果本文73例疑似膝关节损伤患者经临床病理最终确诊膝关节损伤患者69例,通过磁共振扫描技术进行诊断,诊断为膝关节损伤的患者66例,占90.41%;评价磁共振对膝关节损伤的具体诊断表现,韧带损伤的磁共振影像学表现患者存在T1WI加权信号为高低混合信号或者表现为低信号,T2WI加权信号则表现为高信号;半月板损伤的磁共振影像学表现患者受伤部位表现为低信号阴影,并且阴影内存在有线状和放射状,同时存在椭圆形或球状的裂隙样阴影,患者的半月板区域当中表现为不规则或者存在线状的高信号;骨质损伤患者的影像学存在有受伤部位异常的网状信号,边界存在模糊不清的表现,T2WI加权信号表现为略高的信号或者等信号,T1WI加权信号则表现为低信号,而且存在有小片状的高信号;关节腔积液患者受伤部位表现为条状低信号,而且存在有边缘模糊不清或表现为波浪形的信号部分可存在分层状况,表现为高信号。T2WI加权信号表现为高信号,T1WI加权信号表现为高低混杂的信号或者表现为低信号。结论临床通过磁共振扫描技术对膝关节损伤进行检查能够发挥理想的诊断效果,具有较高的准确性和影像学特征,可作为有效的辅助诊断策略加以推广应用。     

CT及MRI在大关节痛风性关节炎诊断中的应用

目的 分析大关节痛风性关节炎的CT及MRI表现,提高诊断准确率。方法 回顾性分析两院经临床证实的14例大关节痛风性关节炎的CT及MRI资料。结果 14例中累及膝关节6例,踝关节5例,肘关节2例,髋关节1例;CT及MRI表现为受累关节软组织肿胀、骨质破坏,9例伴有不同程度关节间隙狭窄,3例出现关节畸形及骨质增生或骨质疏松。9例显示数目及大小不等的痛风结节,位于关节滑膜或关节腔,CT呈等或高密度,MRI T1呈低或等信号,T2高或等信号。CT对细微的骨质破坏、软组织肿胀及钙化性痛风结节显示较清晰;MRI对于病变早期的滑膜肿胀、骨髓水肿、关节积液及非钙化痛风结节显示较佳。结论 大关节痛风性关节炎以膝关节和踝关节较多见,CT和MRI对早期的病变显示较清晰,两者联合应用有利于早期诊断。     

Differences in prostanoid production between healthy and rheumatic synovia in vitro

Platelet activating factor (PAF-acether) is a potent pro-inflammatory mediator. The possible involvement of this molecule in the pathogenesis of chronic erosive arthritis has been investigated using an animal model, antigen-induced arthritis in the rabbit, which closely resembles rheumatoid arthritis. The arthritic joint fluids from rabbits with antigen-induced arthritis contained low levels of PAF-acether in the acute stages of the disease. However, PAF-acether was not detectable in the chronic stages of the lesion. The biologically inactive precursor/metabolite of PAF-acether, lyso-PAF-acether, was detectable in both control and arthritic joint washes. However, the levels of lyso-PAF-acether in the arthritic joint fluids were significantly elevated above those of control in the acute stages of the disease, but not in the chronic stages. Intra-articular injection of PAF-acether at doses up to 100 times the levels detected in the acute stages of this model did not induce joint swelling or leucocyte accumulation in normal rabbits. This study suggest that PAF-acether may contribute to the acute phase of antigen-induced arthritis but is less likely to be involved in the chronic processes.     

The Arthrotropism of Macromolecules in Adjuvant-Induced Arthritis Rat Model: A Preliminary Study

PURPOSE: To study the accumulation of macromolecules into the arthritic joints and the possible applications of such phenomenon. METHODS: The accumulation of plasma albumin in the joints of adjuvant-induced arthritis (AIA) rat model was first visualized with Evans blue injection. A N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer contrast agent was then synthesized and injected into the AIA rats to allow qualitative examination of biodistribution and pharmacokinetics of the injected macromolecule with magnetic resonance imaging (MRI). Vital organs and the diseased joints were isolated and examined histologically to correlate with the MRI findings. RESULTS: Deep blue color developed around the arthritic joints of the AIA rat a few hours after the injection of Evans blue. MR imaging of the AIA rats injected with polymer contrast agent demonstrated a gradual but very strong accumulation of the injected polymer in the arthritic joints, which lasted for 1-2 days. Observed differences in the concentration of the injected polymer in the joints correlated with disease severity as assessed histologically. CONCLUSIONS: Profound arthrotropism of macromolecules in the AIA rat model was demonstrated with various imaging tools. These observations should help in the conceptual and practical design of novel macromolecular delivery systems for the imaging and treatment of rheumatoid arthritis.     

Treatment of Antigen-Induced Arthritis in Rabbits by the Intra-articular Injection of Methylprednisolone, 90Y or Chlorambucil

Abstract— Rabbits with a bilateral antigen-induced arthritis were injected intra-articularly (i.a.) in one joint with methylprednisolone (1 mg), ⁹⁰Y (18·5 MBq) or chlorambucil (1 mg) as a single dose. The severity of arthritis was determined by measuring joint swelling and skin surface temperature, macroscopic and histological changes in the joint being assessed 8 weeks after induction of arthritis when the rabbits were killed. Methylprednisolone injected at the time of antigen challenge or 3 weeks later caused a reduction in joint swelling and temperature (P < 0·05) for 1 to 6 weeks after injection. ⁹⁰Y had an initial proinflammatory effect lasting several days, but later caused a modest reduction in joint swelling for up to 4 weeks (P < 0·05). Eight weeks after induction of arthritis, neither methylprednisolone nor ⁹⁰Y-treated joints showed any significant reduction in erosion or histopathology compared with control arthritic joints. Chlorambucil injected 1 week after antigen challenge caused a rapid reduction in joint swelling which was maintained for the duration of the study. Joint surface temperature was reduced to a lesser extent. Eight weeks after induction of arthritis, chlorambucil-treated joints showed a decrease (P < 0·05) in all of the parameters of disease pathology assessed. Treatment with chlorambucil intra-articularly was clearly more effective than with methylprednisolone or ⁹⁰Y at the doses employed and deserves further study as a potential treatment for chronic synovitis.     

38例膝关节损伤的磁共振诊断分析

目的 分析膝关节损伤的磁共振(MR)诊断价值.方法 收集本院2011至2012年经临床检查有膝关节损伤体征,并行MR检查的38例患者,分析MR影像学表现.结果 MR能够清晰显示膝关节半月板损伤、关节韧带损伤、骨挫伤、骨折、关节积液、周围软组织肿胀等损伤性影像,并有特征性的影像学表现,结合膝关节损伤的病史,诊断可靠率、准确率较高.结论 MRI对膝关节损伤具有很高的诊断价值及临床意义.     

Protective effect of rimexolone on cartilage damage in arthritic mice: a comparative study with triamcinolone hexacetonide

We studied the effect of the local steroid preparation rimexolone on cartilage metabolism in arthritis and normal joints. Prolonged anti-inflammatory action was evident after intraarticular injection of a single dose of 450 micrograms into mice with monoarticular antigen-induced arthritis. Suppression of inflammation lasted for at least 21 days. A single dose of 25 micrograms of the anti-inflammatory steroid triamcinolone hexacetonide (THA) induced comparable suppression in the initial stage of the arthritis, but the suppressive action was of shorter duration. Both drugs significantly prevented osteophyte formation, which is a characteristic feature of this type of experimental arthritis. Although chondrocyte proteoglycan (PG) synthesis in patellar cartilage was significantly suppressed upon injection in normal joints, both steroids counteracted the severe suppression of PG synthesis in arthritic joints. These data indicate that although steroids may have significant side effects on chondrocytes, the overall effect on arthritic chondrocytes is beneficial. An advantage of rimexolone over THA is its prolonged retention, which may explain its sustained anti-inflammatory action, and the lack of systemic effects.     

Prolonged Anti-Inflammatory Action of DL-Lactide/Glycolide Copolymer Nanospheres Containing Betamethasone Sodium Phosphate for an Intra-Articular Delivery System in Antigen-Induced Arthritic Rabbit

Purpose. The objective of the present study was to develop prolonged anti-inflammatory action of DL-lactide/glycolide copolymer (PLGA) nanosphere incorporating a water-soluble corticosteroid (betamethasone sodium phosphate; BSP). Another aim was to demonstrate the biocompatibility and biologic efficacy of these BSP-loaded nanospheres directly administered into ovalbumin-induced chronic synovitis in the rabbit. Methods. BSP-loaded nanospheres were prepared by an emulsion solvent diffusion method in oil (caprylate and caprate triglyceride). The drug releasing properties of the nanospheres were measured in vitro in phosphate buffer saline (PBS: pH7.4), and in vivo in rat air-pouch (pseudo synovial fluid). The BSP-loaded nanosphere suspensions were administered into the joint cavity in a model of antigen-induced arthritic rabbit and evaluated by measuring the joint swelling, and the biocompatibility was appraised by histologic microscopy. Results. The BSP-nanospheres were a unimodally-dispersed particulate system with a mean diameter ranging from 300 to 490 nm, and BSP was efficiently entrapped in the lipophilic copolymer (PLGA), although its hydrophilic properties. The drug release-rate from the nanospheres in PBS was controlled by the molecular weight and the lactic/glycolic acid (LA/GA) ratio of the polymers. The in vitro releasing study demonstrated that sustained drug release occurred for over three weeks. In the antigen-induced arthritic rabbit, the joint swelling decreased significantly by administering BSP-loaded nanospheres during a 21-day period after intra-articular challenge. With regards to the prolonged anti-inflammatory efficacy, serum antibody to ovalbumin showed a sustained reduction during the period, and the steroidal effect appeared by the degradation of the polymer in the synovium. The BSP-nanosphere administered was phagocytosed by the synovial activated-cells and the cartilage degradation was almost prevented. Conclusions. Direct intra-articular injection of a PLGA nanosphere system with a water-soluble steroid provided a prolonged pharmacological efficacy in the joints of arthritic rabbits. The local anesthetic in the knee-joints was evaluated to be safe and without biologic damage.     

Treatment of Antigen-induced Arthritis in Rabbits with Liposome-entrapped Methotrexate Injected Intra-articularly

Abstract— Rabbits with a bilateral antigen-induced arthritis were injected intra-articularly in one joint with methotrexate as the free drug or entrapped in liposomes. Free methotrexate (1 mg) injected as a single dose at the time of antigen challenge, suppressed the development of joint swelling and the rise in skin surface temperature of treated joints by 20–30% compared with contralateral control arthritic joints. The beneficial effect of methotrexate occurred within 24 h of injection and was maintained for at least 56 days. However, methotrexate was ineffective in suppressing arthritis when injected 7 days after antigen challenge. Liposomal methotrexate suppressed the development of arthritis at a dose one-tenth that of the free drug and it was also effective in suppressing arthritis of 7 days duration, although significant beneficial effects of liposomal methotrexate were delayed for 10 to 14 days after injection. Neither free nor liposomal methotrexate was effective in suppressing an established arthritis, having no significant effect on joint swelling or skin surface temperature when injected 21 and 35 days after antigen challenge. At the end of the study, 8 or 9 weeks after induction of arthritis, the joints were examined morphologically and histologically. Free methotrexate generally had no significant effect on joint pathology. However, liposomal methotrexate suppressed the development of synovial hyperplasia, cellular infiltration and the erosion of cartilage and bone when injected at the time of antigen challenge or 7 days later, but affected none of these parameters in an established arthritis of 3 weeks duration.     

DA-7911,<Superscript>188</Superscript>rhenium-tin colloid,as a new therapeutic agent of rheumatoid arthritis

Radiation synovectomy is one of the most useful methods for treating patients with refractory synovitis because of its convenience, long-term effects, repeatability and the avoidance of surgery. In this study, we investigated the toxicity, stability and biodistribution of a rhenium-188 (188Re)-tin colloid to evaluate its suitability as a synovectomy agent. Twenty four hours after injecting the 188Re-tin colloids (74 KBq/0.1 mL) into the tail vein of ICR mice, most of the 188Retin colloidal particles was found in the lungs. In addition, there were no particle size changes at either room temperature or at 37 degrees C after injecting the 188Re-tin colloids in human plasma and synovial fluid. In vitro stability tests showed that the 188Re-tin colloid remained in a colloidal form without a critical size variation over a 2-day period. We investigated the leakage of 188Retin colloids from the intraarticular injection site with gamma counting in New Zealand white rabbits. The 188Re-tin colloids (55.5 MBq/0.15 mL) were injected at the cavum articular and the mean retention percentage of the 188Re-tin colloid was 98.7% for 1 day at the injection site, which suggests that there was neither change in the particle size nor leakage at the injection sites. In the biodistribution study with the SD rats, the liver showed the highest radioactivity (0.0427% ID/organ) except for the injected knees (99.49%). In the SD rats, mild toxicities including the skin or a synovium inflammation were observed as a result of a radioactivity of 15 mCi/kg at the intraarticular injection site. However, there was no systemic toxicity. In the Ovalbumin (OVA)-induced arthritic rabbits, the 188Re-tin colloid improved the macroscopic, the histological score and reduced the knee joint diameter when compared to the arthritic control. In conclusion, a 188Re-tin-colloid is considered as a strong candidate for radiation synovectomy with a superior efficacy and safety.     

X线与MRI对色素沉着绒毛结节性滑膜炎的诊断价值

目的探讨X线与MRI对色素沉着绒毛结节性滑膜炎（PVNS）的诊断价值。方法回顾性分析11例经手术病理证实的PVNS患者资料,7例发生于膝关节,4例发生于髋关节,分析其X线及MRI表现。结果 11例患者的X线表现为关节囊肿胀、关节周围软组织肿块、关节边缘骨质缺损、关节面下囊性透亮区。MRI表现：弥漫型9例,结节型2例,表现为滑膜不同程度增厚、关节内软组织结节,T1WI及T2WI均呈低信号,FFE序列呈极低信号,并有不同程度的关节腔积液,5例发生骨或软骨的侵蚀。结论 PVNS的X线表现无特征性,对本病的诊断仅能起到提示作用;MRI表现则有一定的特征性,对PVNS有定性诊断价值。     

Proteoglycan biosynthesis as a determinant of patella damage in the murine antigen-induced arthritis model

The incorporation of 35SO4 into cartilage proteoglycan has been employed as a measure of patella damage in the murine antigen-induced arthritis model. In a preliminary set of experiments, where both the proteoglycan concentration and 35SO4 incorporation were determined in control and arthritic patella over a 2 day to 6 day week period, the arthritic joint contained significantly higher levels of radioactivity compared with the controls. A subsequent study over an extended period of 10 weeks confirmed the earlier results, and indicated that the 6 week samples showed the greatest difference (71%) in 35SO4 incorporation between the arthritic and control patella.