磁共振成像对类风湿关节炎诊断价值的评估

目的 探讨类风湿关节炎(RA)手关节的磁共振成像(MRI)表现及与临床表现的相关性,从而评价其在RA诊断中的价值.方法 采用对比及相关性分析的方法,分析符合2009年美国风湿病学会/欧洲抗风湿病联盟(ACR/EULAR)诊断标准的25例RA患者双手X线片、MRI及临床特点.结果 25例RA患者在MRI扫描中均显示异常征象,而其中16例患者的X线平片未见异常,18例早期RA患者中有12例未出现X线平片改变.无论患者病程＜1年还是＞1年,MRI骨侵蚀在抗CCP抗体阳性与阴性组之间差异有统计学意义(P＜0.01),RF-IgG阳性组出现滑膜炎的患者明显多于阴性组(P＜0.05).血清RF-IgA浓度与骨髓水肿呈正相关(r=0.561,P＜0.05).在早期患者中,RF-IgM阳性组出现滑膜炎的患者明显多于阴性组(P＜0.01).VAS评分与骨髓水肿评分呈正相关(r=0.562,P＜0.01).C反应蛋白(CRP)水平与MRI积液关节的数目呈正相关(r=0.457,P＜0.05).结论 MRI对于早期RA的诊断价值要远远大于X线平片.早期RA的MRI改变最常见于腕关节.抗CCP抗体阳性时MRI更易出现骨侵蚀,RF-IgG阳性时MRI更易出现滑膜炎.MRI骨髓水肿评分是VAS评分的重要影响因素.CRP水平可反映有关节腔积液的关节数目.

Evaluation of MRI in the diagnosis of rheumatoid arthritis

Objective To study the features of rheumatoid arthritis (RA) on MRI of hands and wrists and compare MRI with clinical manifestations and laboratory tests of RA. Methods A total of 25 patients fulfilling the 2009 ACR/EULAR RA criteria were enrolled. MRI and plain films of hands and wrists and clinical data of swollen joints, tender joints, visual scale (VAS) score, DAS28 score, erythrocyte sedimentation rate ( ESR), C-reactive protein ( CRP), RF classification, anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) were obtained simultaneously. Results MRI revealed pathologic findings on the wrist and hand joints in all diagnosed RA patients. VAS had a positive correlation with bone marrow edema( r=0. 562, P =0. 003). Although the disease duration was less or more than 1 year, the difference of bone erosion had statistical significance between anti-CCP antibody-positive group and anti-CCP antibody negative group ( all P = 0. 000 ). The serum concentration of RF-IgA had a positive correlation with bone marrow edema (r =0. 561, P =0. 041 ). The synovitis score of MRI of RA was higher in the RF-IgG positive group than that in the RF-IgG negative group ( P =0. 035). There was significant difference in MRI synovitis between the RF-IgG or RF-IgM positive and negative groups of patients with a disease course of under 1 year ( P = 0. 015, P = 0. 007 ). The serum CRP level had a positive correlation with arthroedema( r = 0. 457, P =0. 022). Conclusion MRI is proved to be a valuable examination for an early diagnosis and assessment of RA.