磁共振成像在类风湿关节炎早期诊断中的价值

目的探讨双手及腕关节磁共振成像(MRI)在类风湿关节炎(RA)早期诊断中的价值。方法对88例初诊的RA及疑诊为RA的多关节炎/痛患者进行双手和腕关节行MRI扫描检查及临床评价,并对未确诊患者进行1年临床随访,研究MRI在RA早期诊断中的意义。结果在28例初诊RA患者中,27例(96%)在MRI扫描中显示RA异常征象;在60例多关节炎/痛患者中,有24例在随访期间证实为早期RA,其中23例(96%)MRI提示早期诊断,并且15例(62%)的患者已出现MRI骨侵蚀。与已确诊RA患者相比,此24例早期RA患者在病程、关节疼痛数、关节肿胀数、双腕关节受累等指标差异均有统计学意义(P<0.05),而在MRI表现上两组患者差异无统计学意义。结论RA患者的骨侵蚀可以出现在病程早期,双手及腕关节MRI扫描是RA诊断的可靠方法,并可提示早期RA的诊断。

Diagnostic value of magnetic resonance imaging in early rheumatoid arthritis

Objective To investigate the diagnostic value of magnetic resonance imaging(MRI)of the wrist and finger joints in patients with rheumatoid arthritis(RA).Methods The study group comprised twenty-eight patients with newly diagnosed RA and sixty patients with early unclassified polyarthritis in whom erosions were not demonstrated on conventional radiographs.These patients underwent Gd-DTPA-enhanced MRI of wrist and finger joints to detect signs of arthritis at baseline.It was determined the presence of bone erosions,synovitis,joint effusion,tendonitis and bone marrow oedema.In a 1-year follow-up study,the patients with polyarthritis received clinical assessment.Results MRI revealed pathologic findings in the wrist and finger joints in 27 of 28(96%)newly diagnosed RA patients.After 1 year,24 of 60 patients with polyarthritis fulfilled ARA diagnostic standard,their disease duration(P=0.001),the number of swollen joints(P<0.01),the number of tender joints(P<0.01)and symmetry of wrist joints involve(P=0.046)were significantly different compared with 28 newly diagnosed RA patients at baseline,but MRI suggested abnormal in 96%(23/24)patients(synovitis in 22,bone erosions in 15,joint effusion in 8,bone marrow oedema in 6 and tendonitis in 14)already and had no significantly different compared with RA patients.MRI has been shown to be more sensitive than conventional radiography for detecting bone erosions in RA.Conclusion The data suggests that a high proportion of RA patients develop MRI erosions very early in their disease.MRI of the wrist and finger joints is a very valuable tool for assessment of both established and early RA,it contributes an additional method aimed at earlier and more accurate diagnosis and thus might allow an earlier decision to start appropriate medication in patients with early RA.