核磁共振与关节镜对类风湿关节炎患者膝关节病变诊断的比较

目的 探讨核磁共振成像（MRI）在膝关节类风湿关节炎中的诊断价值.方法 随机选取我院2008年10月至2012年10月临床及MRI检查均高度疑为类风湿关节炎的患者106例,进一步行关节镜检查确诊,分析MRI诊断类风湿关节炎的敏感性、特异性、阳性预测值、阴性预测值、一致率和Kappa值.结果 与关节镜金标准结果对比,MRI对诊断类风湿关节炎的病变种类包括关节积液、滑膜增厚/血管翳形成、软骨和骨侵蚀、周围软组织病变等的敏感度、特异性、阳性预测值、阴性预测值、一致率和Kappa值分别为90.91％、88.10％、66.67％、97.37％、91.51％和0.712,MRI诊断类风湿关节炎的敏感度、特异性、阳性预测值、阴性预测值、一致率和Kappa值分别为94.74％、83.91％、56.25％、98.48％、85.85％和0.687,膝关节软骨退行性变损害的MRI分级与关节镜分级的符合率为99.06％,Kappa值为0.654,两者具有高度一致性（P＜0.05）.结论 MRI诊断类风湿关节炎有较好的一致性,并可准确判断病变种类和软骨损伤的程度,对类风湿关节炎的早期诊断和指导临床治疗都有重要意义.

MRI diagnosis of rheumatoid arthritis of the knee:correlated with arthroscopy

Objective To evaluate the efficacy of MRI in the diagnosis of rheumatoid arthritis of knee.Methods 106 consecutive patients with symptoms of knee pain were scheduled for arthroscopy in two weeks undergoing MRI examination before operation.The sensitivity,specificity,accuracy and Kappa value of MRI in the diagnosis of rheumatoid arthritis were analyzed.Results Correlated with arthroscopy findings,the sensitivity,specificity,accuracy and Kappa value of MRI in the diagnosis of rheumatoid arthritis of joint fluid,synovium thicken or pannus formation,cartilage and bone erosion,soft tissue affection was 90.91％,88.10％,66.67％,97.37％,91.51％ and 0.712 respectively.The sensitivity,specificity,accuracy and Kappa value of MRI in the diagnosis of rheumatoid arthritis was 94.74％,83.91％,56.25％,98.48％,85.85 ％ and 0.687 respectively.The accuracy of MRI diagnosis of meniscal injury grade was 99.06％,and Kappa value was 0.654 （P ＜ 0.05）.Conclusion MRI has good accordance with arthroscopy in detecting rheumatoid arthritis.The types of rheumatoid arthritis and degree of meniscal injury could also be accurately evaluated.MRI has important significance in early diagnosis of rheumatoid arthritis and benefit to clinical treatment.