膝类风湿性关节炎MRI早期诊断价值与关节镜下全滑膜切除术治疗

目的探讨膝类风湿性关节炎(RA)MRI检查的早期诊断价值,观察膝关节镜下全滑膜切除术的临床疗效。方法回顾性分析2008年1月至2012年12月梅州市人民医院收治的68例行膝关节镜下全滑膜切除术RA患者的临床资料,术前行X线片和注射钆对比剂MRI检查,术后常规病理检查。观察X线片、MRI检查诊断早期RA的准确性,记录患者术前,术后3、6、12个月Lysholm评分及类风湿因子(RF)、红细胞沉降率(ESR)、C反应蛋白(CRP)等实验室检查结果的变化。结果根据病理学检查结果,X线片、MRI检查诊断早期RA的准确率分别为66%(29/44)和97%(29/30),两者比较,差异有统计学意义(P0.05)。所有患者获得随访,随访时间12~38个月,平均随访时间18.6个月。术后3、6、12个月Lysholm评分及RF、ESR、CRP等指标明显优于术前,差异有统计学意义(P0.05)。结论 MRI检查诊断早期膝RA较X线片检查准确;全滑膜切除术是治疗膝RA较好的术式选择,术后患者关节功能恢复明显,RF、ESR和CRP等临床指标显著改善,近期效果满意。     

磁共振成像联合血清RANKL、OPG水平诊断早期类风湿关节炎及骨关节损伤的价值

目的探讨磁共振成像(magnetic resonance imaging,MRI)联合血清破骨细胞抑制因子(osteoclastogenesis inhibitory factor,OPG)、核因子κB受体活化因子配体(receptor activator for nuclear factor-κB ligand,RANKL)水平诊断早期类风湿(rheumatoid arthritis,RA)及骨关节损伤的临床价值。方法选择2014年1月-2015年12月我院收治住院的RA患者241例,其中早期RA 118例,非早期RA 123例,另选择100例正常人为对照组;抽取各组晨空腹静脉血并测定血清RANKL、OPG水平;采用GE3.0OHDXT仪器评估滑膜炎、骨髓水肿、骨侵蚀等关节损伤表现,采用RAMRIS系统进行评估。结果 3组RANKL水平逐渐上升,早期RA组OPG明显低于对照组及非早期RA组,而非早期RA组又高于对照组,差异均有统计学差异(P0.05)。MRI肌腱炎与骨髓水肿及滑膜炎均呈正相关(r=0.385,P0.05;r=0.385,P0.05),OPG下降或MRI显示骨侵蚀阳性率为92.87%,骨髓水肿阳性率为73.14%,滑膜炎阳性率为88.36%,肌腱炎阳性率为57.24%,RAMRIS 3项或4项高于0分及OPG下降均为100%。RANKL上升或MRI显示骨侵蚀阳性率为91.25%,骨髓水肿阳性率为73.68%,滑膜炎阳性率为88.42%,肌腱炎阳性率为58.49%,RAMRIS 3项或4项高于0分、OPG上升均为97.48%。结论 MRI联合血清OPG、RANKL水平可明显提高早期RA骨关节损伤诊断水平。     

类风湿关节炎中骨髓水肿研究进展

骨髓水肿在类风湿关节炎(RA)患者的病变关节中普遍存在。骨髓水肿与RA患者的滑膜炎、软骨破坏、关节骨质破坏存在相关性。及时发现并治疗骨髓水肿可减轻RA患者病情、延缓关节破坏。目前,磁共振成像(MRI)检查仍为诊断骨髓水肿的金标准,基于MRI检查的OMERACT-RAMRIS评分系统应用于RA患者的关节病变评估,骨髓水肿可视为RA早期诊断的重要参考指标。该文就RA中骨髓水肿的研究进展进行综述。     

掌指关节解剖学因素对早期类风湿性关节炎中滑膜炎和骨侵蚀分布的影响

类风湿性关节炎(RA)是一种以对称性增生性滑膜炎和骨侵蚀为特征的慢性全身性结缔组织疾病。传统认为,RA对关节及其邻近滑膜的损害与免疫因素和细胞破坏机制密切相关。该研究通过MRI成像技术对掌指关节滑膜炎和骨侵蚀的分布特点进行观察,发现掌指关节解剖学和生物力学等因素对早期RA中滑膜炎和骨侵蚀的分布有重要作用。选取33例临床诊断为早期RA伴掌指关节疾病的患者(男13例,女20例,平均年龄54岁)及28名     

血清标志物在类风湿关节炎早期诊断中的临床价值

目的探讨血清中抗环瓜氨酸抗体(CCP)、抗突变型瓜氨酸波形蛋白抗体(MCV)、葡萄糖6磷酸异构酶抗原(GPI)、类风湿因子(RF)、基质金属蛋白酶3(MMP-3)、抗RA33、血清淀粉样蛋白A(SAA)在类风湿关节炎(rheumatoid arthritis,RA)早期诊断中的意义。方法选取早期RA患者160例、非RA风湿病患者100例、健康体检者100例,检测其血清中7种血清标志物的浓度,统计各指标阳性率,对所有数据进行统计学分析。结果早期RA组血清中抗CCP、抗MCV、GPI抗原、RF、MMP-3、抗RA33、SAA平均水平显著高于非RA风湿病组和健康体检组水平(P0.05)。3组间各阳性率比较,差异具有统计学意义(P 0.05)。早期RA组抗MCV的敏感度最高(86.25%),其次为抗CCP (83.50%)、GPI抗原(83.50%)和RF(81.00%);结合特异度、Youden指数、阳性预测值和阴性预测值得出,单项抗CCP、抗MCV、GPI抗原、RF对早期RA的诊断能力较好,MMP-3中等,抗RA33和SAA较差。抗CCP、抗MCV、GPI抗原、RF 4项联合检测特异度最高(99.50%)。结论抗CCP抗体、抗MCV抗体、GPI抗原、RF单项检测对早期RA的诊断能力较好,4项指标联合检测有助于早期RA的诊断和鉴别诊断。     

股骨头坏死的早期诊断

目的探讨各种检查方法对股骨头坏死的早期诊断价值。方法比较23例股骨头缺血坏死(ANFH)患者的各种影像学表现。结果CR、CT对早期诊断敏感性低,ECT虽然对早期的敏感性高,但特异性低。MRI对软组织的分辩率高,对骨髓敏感性高,在对ANFH的诊断方面显示极大优势。结论MRI对早期ANFH的诊断最敏感、最特异。     

X 线片和磁共振及核素扫描在儿童大骨节病早期诊断中的应用研究简

目的初步探讨大骨节病（KBD）儿童早期手部X线、高场强磁共振成像（MRI）及全身核素扫描（SPECT）的表现及分别在儿童KBD早期诊断中的价值。方法对四川省壤塘县KBD疫区筛查出的18例KBD儿童进行双手X线、MRI及SPECT检查,并对比阅片。总结儿童KBD早期手指指间关节的X线、MRI及SEPCT异常表现。结果18例KBD儿童在X线片上显示出的异常表现均能在MRI中清楚呈现,表现为干骺端先期钙化带与骨骺部分穿通、干骺端先期钙化带凹陷、中断以及锥形骺;MRI还观察到如骺线中断、不整、变薄、信号强度改变以及干骺端由骺板伸入指骨的中高信号等X线无法显示的微小形态变化。所有儿童的全身核素骨显像,双手核素摄取率计算都未见确切异常。结论MRI不仅能在形态学方面呈现与X线片一致,且更细微的儿童KBD早期手部异常改变,还能通过观察软骨信号变化提供软骨组织结构变化的病理生理信息,其在儿童KBD早期诊断中具有重要价值,而现有SPECT技术对儿童KBD早期诊断价值不大。     

MRI定性定量分析类风湿关节炎患者手腕部骨关节改变

目的探讨3.0T MRI定性定量分析对类风湿性关节炎(RA)患者手腕部骨关节改变的诊断价值。方法将39例RA患者按病程分为早期组(病程≤24个月,20例)及中晚期组(病程24个月,19例),观察两组MRI滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象,并应用昆明理工大学研发的定量分析软件测算滑膜炎、骨髓水肿范围。结果 39例患者(共78侧)的手腕部骨关节中,滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象的出现率分别为94.87%(37/39)、64.10%(25/39)、61.54%(24/39)、76.92%(30/39)。滑膜炎在腕关节发生率最高[92.31%(72/78)],骨髓水肿在腕骨发生率最高[61.54%(48/78)],骨侵蚀最易累及三角骨[64.10%(50/78)]。屈肌键腱鞘炎[74.36%(58/78)]与伸肌腱腱鞘炎[61.54%(48/78)]发生率差异无统计学意义(χ2=2.94,P=0.09)。早期组与中晚期组滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象出现率差异均无统计学意义(P均0.05)。定量分析显示,早期组与中晚期组间滑膜炎范围及骨髓水肿范围差异均无统计学意义(P均0.05)。结论 3.0T MRI可清楚显示RA手腕部骨关节的改变,通过定量分析软件可为评估疾病严重程度提供更加准确的量化信息。     

胰腺导管内乳头状黏液肿瘤的影像学研究现状及进展

目的总结胰腺导管内乳头状黏液肿瘤(IPMN)的影像学研究现状及进展。方法检索PubMed、中国知网、维普、万方等数据库内与胰腺IPMN相关的影像学研究方面的文献并进行分析与总结。结果现在常用于胰腺IPMN检查的影像学方法包括CT、MRI、EUS及PET-CT,其中CT和MRI有较好的诊断及鉴别良恶性胰腺IPMN的能力,并且MRI与新型靶向纳米粒子造影剂一起可以用于早期胰腺IPMN的诊断;EUS对于发现胰腺IPMN的壁结节很有优势,但其对于胰腺IPMN的诊断分级能力是否比得上CT、MRI尚有争论;PET-CT主要是对于胰腺IPMN良恶性诊断有较高的价值。结论目前各种影像学方法在胰腺IPMN诊断及良恶性鉴别方面都有各自的优势,在条件允许情况下首选MRI检查。     

烟雾病的磁共振成像研究进展

烟雾病(MMD)是一种以双侧颈内动脉末端和/或大脑前动脉和/或大脑中动脉进行性狭窄或闭塞,伴颅底或基底节区异常血管网形成为特征的慢性脑血管病。MRI技术在MMD早期诊断、提供个体化治疗、评估患者病情及不良预后、随访病情进展等方面具有巨大潜力。本文对MRI技术在诊断MMD、评估脑血流动力学及脑功能等方面的应用进行综述。     

The accuracy of magnetic resonance imaging of the hands and feet in the diagnosis of early rheumatoid arthritis

ObjectiveTo analyze MRI findings of early RA in the hand and foot joints and to determine any discrepancies between MRI findings in the hands and feet.MethodsTwenty one patients who fulfilled the 1987 American College of Rheumatology (ACR) criteria for the diagnosis of RA at the onset underwent MRI of both hands and feet.ResultsIn 18 out of 21 patients, rheumatoid changes were observed in the hand and foot joints. However, rheumatoid changes were observed only in the hand joints of the three remaining patients. MRI revealed pathologic findings suggested RA in the hands of 21 of 21 patients. In the feet, MRI findings suggested RA in 18 of 21 patients. Bone erosions were seen in the hands of 14 patients (67%). Observers found as many bony changes in the hands as in the foot joints. MRI detected active synovitis in 17 patients (81%) in the hands and in 15 patients (71%) in the feet. MRI findings suggested bone edema in the hand and foot joints in 14 (63%) and 11 patients (52%), respectively. There was no significant difference between the MCP and MTP joints with respect to RA-based changes obtained in the MRI (p > 0.05).ConclusionEvidence of foot involvement is a frequent occurrence in early RA.     

MRI for the assessment and monitoring of RA--what can it tell us?

The past 15 years has seen an exponential rise in the use of MRI for the assessment of rheumatoid arthritis (RA). In this Perspectives article, we review the current and potential future role of MRI in the diagnosis, prognosis and monitoring of RA. We also review the impact of MRI research on the understanding of disease mechanisms. In our view, the pivotal role of synovitis in RA and its predilection for sonographically accessible joints makes it likely that MRI will be used diagnostically in joints that are inaccessible to ultrasonography or where the differential diagnosis is unclear. Additionally, MRI will probably assume an even more prominent role in clinical trials where the aim of therapy is the complete ablation of synovitis. Given the ever-increasing sophistication of MRI, we anticipate that it will continue to be a key research tool in the coming years.     

The value of sonography and power Doppler in the detection of early arthritis

Magnetic resonance imaging (MRI) of small joints of the hands and feetis still "the gold standard" in detecting early inflammatory changes in the patients with rheumatoid arthritis (RA). Radiographic assessment has only limited value in early diagnostic of RA. The limited accessibility of MRI makes both ultrasound (US) and Power Doppler (PD) of small joints of hands and feet equally useful tools as they give the same results as MRI in evaluating some of the pathologies such as: bone erosions, intraarticular effusions and changes of tendons. Power Doppler can detect subclinically synovitis of the small joints in the early phase of RA. Nowdays, in the field of rheumatology we talk about US and PD as "a rheumatologist's prolonged finger" or as " a rheumatological stetoscope", exactly because of their accessibility and possibility of getting quick and useful information about the patient himself. Since US and PD are inexpensive and non-invasive procedures, they can greatly improve diagnostics in RA and especially the assessment of the early phase of the inflammatory diseases, which can serve as a reliable indicator of the overal progression of the disease. Some new data show possibility of monitoring patients with RA and their response on disease modifying antirheumatic drugs (DMARDs) or biologicals by US and PD.     

DAS28 score vs. ultrasound examination for assessment of rheumatoid arthritis disease activity: comparison and discussion of pros and cons

Rheumatoid arthritis (RA) is a chronic systemic connective tissue disease which is characterized by symetrical multiple joints involvement and extra-articular symptoms. Current EULAR diagnostic criteria for RA include disease activity parameters, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are used to calculate disease activity scores, including DAS and DAS28. Recently attempts have been made to assess disease activity using imaging diagnostic modalities, such as magnetic resonance imaging (MRI) and ultrasonography (US). Due to significant progress in therapy effectiveness and early RA diagnosis possibility, imaging modalities become increasingly meaningful and many clinical trials confirm their usefulness. However, there are no consistent criteria for objective assessment of therapy effectiveness based on US. Moreover, it is not US availability that limits its common use, but rather significant variability between operators. This is why US remains only an additional tool to assess therapy efficacy with regard to DAS/DAS28 index.     

Emerging MRI methods in rheumatoid arthritis

New MRI techniques have been developed to assess not only the static anatomy of synovial hyperplasia, bone changes and cartilage degradation in patients with rheumatoid arthritis (RA), but also the activity of the physiological events that cause these changes. This enables an estimation of the rate of change in the synovium, bone and cartilage as a result of disease activity or in response to therapy. Typical MRI signs of RA in the pre-erosive phase include synovitis, bone marrow edema and subchondral cyst formation. Synovitis can be assessed by T2-weighted imaging, dynamic contrast-enhanced MRI or diffusion tensor imaging. Bone marrow edema can be detected on fluid-sensitive sequences such as short-tau inversion recovery or T2-weighted fast-spin echo sequences. Detection of small bone erosions in the early erosive phase using T1-weighted MRI has sensitivity comparable to CT. Numerous MRI techniques have been developed for quantitative assessment of potentially pathologic changes in cartilage composition that occur before frank morphologic changes. In this Review, we summarize the advances and new directions in the field of MRI, with an emphasis on their current state of development and application in RA.     

MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的效能

目的探讨核磁共振成像（MRI）三维容积内插快速扰相梯度回波序列（3D-LAVA）屏气检查动态增强联合快速翻转快速自旋回波序列（FRFSE）对早期前列腺癌的诊断效能。 方法对我院2013年6月至2019年6月210例可疑早期前列腺癌的临床资料进行回顾，均实施MRI 3D-LAVA动态增强、FRFSE序列扫描。总结两种扫描序列的检查结果，分析不同方法诊断早期前列腺癌的效能；另统计多参数磁共振（mpMRI）的诊断结果，绘制受试者工作特征曲线（ROC）评价不同方法诊断早期前列腺癌的效能。 结果早期前列腺癌的构成比为38.10%；早期前列腺癌（+）患者峰值和强化率均高于前列腺癌（-）受检者，且早期前列腺癌（+）患者峰值时间短于后者，强化幅度小于后者，差异均有统计学意义（P<0.05）；MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的灵敏度与MRI 3D-LAVA动态增强、FRFSE序列单独诊断相近，特异度、准确度和曲线下面积（AUC）均高于单独诊断；MRI 3D-LAVA动态增强联合FRFSE序列诊断早期前列腺癌的灵敏度、特异度、准确度均与mpMRI相当，且二者AUC对比差异无统计学意义（P>0.05）。 结论在早期前列腺癌诊断中MRI 3D-LAVA动态增强、FRFSE序列扫描联合检查的效能理想，与病理结果的一致性良好，和mpMRI诊断早期前列腺癌的效能相近。     

Perspectives on rheumatoid arthritis for the orthopedic surgeon: overview of early diagnosis and the tumor necrosis factor antagonists

Rheumatoid arthritis (RA) is the most common inflammatory arthritis in the United States. As part of ongoing efforts to halt joint damage, preserve function, and reduce associated mortality, the current emphasis in RA management is on prompt diagnosis and the early use of disease modifying antirheumatic drug (DMARD) therapy. Improved serologic tests and updated classification criteria are now available to assist in making an earlier diagnosis of RA. As a therapeutic class, tumor necrosis factor antagonists are widely used by rheumatologists and provide significant benefits to patients who have an incomplete response to methotrexate or other DMARDs. With the reported low concordance between orthopedic surgeons and rheumatologists regarding the potential benefits of surgery to treat RA, there is an opportunity for improved collaboration between these specialties in the care of RA patients. Updates on diagnosis and medical therapy of RA may help orthopedic surgeons appreciate the rheumatologist's approach to this disease.     

Rheumatoid arthritis: Nuclear Medicine state-of-the-art imaging

Rheumatoid arthritis (RA) is an autoimmune disease, which is associated with systemic and chronic inflammation of the joints, resulting in synovitis and pannus formation. For several decades, the assessment of RA has been limited to conventional radiography, assisting in the diagnosis and monitoring of disease. Nevertheless, conventional radiography has poor sensitivity in the detection of the inflammatory process that happens in the initial stages of RA. In the past years, new drugs that significantly decrease the progression of RA have allowed a more efficient treatment. Nuclear Medicine provides functional assessment of physiological processes and therefore has significant potential for timely diagnosis and adequate follow-up of RA. Several single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiopharmaceuticals have been developed and applied in this field. The use of hybrid imaging, which permits computed tomography (CT) and nuclear medicine data to be acquired and fused, has increased even more the diagnostic accuracy of Nuclear Medicine by providing anatomical localization in SPECT/CT and PET/CT studies. More recently, fusion of PET with magnetic resonance imaging (PET/MRI) was introduced in some centers and demonstrated great potential. In this article, we will review studies that have been published using Nuclear Medicine for RA and examine key topics in the area.     

膝骨性关节炎早期诊断的研究进展

膝骨性关节炎是常见的关节病之一,临床上典型患者的临床分期属于中晚期,因此提高对早期膝骨性关节炎的诊断尤为重要。目前临床上最常应用于诊断膝骨性关节炎的方法为磁共振检查,且随着磁共振不同序列的发展,针对关节软骨早期病变的序列正应用于临床。在膝骨性关节炎的早期诊断中,超声检查等简单实用的方法正成为一种趋势,而特异性生物标志物将成为一项热门研究。