类风湿关节炎腕关节病变X线表现和MR影像对照分析

目的比较磁共振成像和X线平片在检测类风湿关节炎腕关节骨侵蚀等病变中的作用。方法25例类风湿关节炎患者在一周内行双腕X线平片及MR成像检查。MR成像检查包括自旋回波T1加权像,梯度回波T2加权像及快速自旋回波T2加权像,选择平扫显示病变明显的手腕行Gd-DTPA增强扫描,扫描参数同平扫自旋回波T1加权像。结果25例临床诊断类风湿关节炎的患者的50个腕关节中,X线平片观察到14个腕关节出现骨侵蚀病变,MR影像检出46个腕关节出现骨侵蚀病变。MR影像共检出164个腕骨的骨侵蚀病灶,而X线平片仅检出21个腕骨骨侵蚀病灶。其中三角骨及月骨是最易受累的部位。在类风湿关节炎骨质侵蚀病变的检出上,两种检查方法之间统计学差异显著(P<0.001)。MR影像还可显示滑膜炎性及水肿改变,增强MR影像可鉴别血管翳与关节积液。结论MRI检查可发现类风湿关节炎较早期腕关节的骨质侵蚀等病变。对于临床怀疑类风湿关节炎,且X线平片又不能明确诊断者,建议行双腕MR成像检查,这有助于类风湿关节炎的早期诊断。

Comparison of radiographs and magnetic resonance imaging in the detection of carpal lesions in patients with rheumatoid arthritis

OBJECTIVE: To compare MR imaging with radiographs in detection of the erosions of the wrists in patients with rheumatoid arthritis (RA). METHODS: In 50 wrists of 25 patients with RA, radiographs of AP projection and MR imaging examination were performed within 1 week. The MRI sequences were SE T1-weighted image, FSE T2-weighted image, and GE T2* weighted image in coronal plane. Gd-DTPA enhanced SE T1-weighted image with same parameters of pre-contrast administration SE T1WI was performed in 25 wrists, which showed prominent lesions in each 25 patients. RESULTS: In 50 wrists of 25 patients with RA, bone erosions were found by MR images compared to radiographs in 46 versus 14 wrists, respectively. There were 170 sites of carpal erosions found by MR images, while radiographs found only 23 sites of carpal erosions. Among them triquetrum and lunate were the most frequently involved sites. Significant difference (P < 0.001) was statistically found between conventional radiography and MR imaging in detection of erosions of the wrists of RA. MR imaging also permitted demonstrating synovitis and joint effusion in the wrists. Gd-DTPA-enhanced images allowed distinguishing pannus changes from joint effusion. CONCLUSION: MRI is superior to conventional radiography with respect to detection of bone erosion in wrists. For those whose conventional radiographs show suspected RA, MRI examination should be advised for the early diagnosis.