磁共振成像在早期类风湿性关节炎诊断中的价值

目的:探讨MRI在早期类风湿性关节炎(RA)诊断中的价值。方法:随访至明确诊断为早期RA患者32例纳入研究。所有病例均进行腕关节X线平片和MRI平扫+增强检查,其中15例行MRI动态增强扫描检查,分析X线平片异常征象及MRI异常征象、时间-信号强度曲线(TIC),测量滑膜厚度,并对X线平片和MRI显示的骨侵蚀病灶分别进行计数。结果:32例早期RA患者,X平片仅发现3例骨侵蚀,1例骨质疏松。MRI异常征象包括:滑膜增厚和滑膜炎32例,关节积液18例,骨髓水肿17例,骨侵蚀15例,腱鞘炎21例,滑膜增厚和滑膜炎、骨髓水肿、骨侵蚀及腱鞘炎均有不同程度强化。15例早期RA动态增强扫描病灶的TIC:2例为快速上升型,12例为上升平台型,1例为延迟上升型。滑膜增厚为(3.5±0.4)mm。MRI对骨质破坏的检出率明显高于X线平片,P<0.01。结论:MRI可反映早期RA的病理改变,对骨侵蚀的检出明显优于传统X线检查,在早期RA诊断中有重要意义;CE及DCE-MRI可评价RA的活动性。

Diagnostic value of magnetic resonance imaging in early rheumatoid arthritis

Objective：To assess the diagnostic value of magnetic resonance imaging（MRI） for rheumatoid arthritis（RA） in its early stage.Methods：Thirty-two cases confirmed as early RA by follow-up were included.The total cases underwent conventional examination of the wrist joint by X-ray plain film and plain MRI,and 15 were given additional dynamic contrast enhanced（DCE-MRI）.The results were determined concerning abnormal X-ray and MRI manifestation,time-intensity curve （TIC） and the thickness of synovial membrane measured on DCE-MRI,on which basis the bone erosion was summed up and calculated.Results：X-ray plain film only exposed respectively the bone erosion in 3 and osteoporosis in 1of 32 patients with early RA. Abnormal MRI findings for the early RA included thickened synovia and synovitis in the total 32 cases,hydrarthrosis in 18,bone marrow edema in 17,bone erosion in 15 and tenosynovitis in 21,respectively.MRI enhancement to a certain extend was observed pertaining to synovial thickening,synovitis,bone marrow edema,bone erosion and tenosynovitis.TIC in DCE-MRI for the 15 cases showed that 2 were I-type curve （ rapid increase ）;12 Ⅱ-type curve （platform type）;and 1,Ⅲ-type curve （delayed elevation）.The synovial membrane thickening was（3.5 ＆#177;0.4）mm on average,and MRI led to higher detection rate in bone destruction than conventional X-ray plain film.Conclusion：MRI examination may reveal pathologic process for early RA ,and is su-perior to conventional X-ray in diagnosis of this entity.In addition,combined use of contrast-enhanced MRI and DEC-MRI may lead to evaluation of RA ac-tivity in its early stage.