血友病患者关节病变的X线和核磁共振影像比较

目的对比观察X线和核磁共振影像(MRI)显示血友病患者关节病变的差异。方法对14例血友病患者的41个症状关节在同一天内完成的X线和MRI影像进行分析。影像观察选用软组织肿胀或关节积液、骨质疏松、骨骺增大、关节侵蚀、关节面下囊肿、关节间隙狭窄、骨髓水肿、关节内出血、滑膜增厚及髁间窝增大和前、后十字韧带病变(仅用于膝关节MRI评估)等征象进行X线和MRI影像比较分析。结果41个症状关节中,软组织肿胀或关节积液X线显示33个关节,MRI为34个。关节侵蚀病变MRI检出34个关节,X线检出20个(P<0·05);关节面下囊肿MRI显示21个关节,X线为9个(P<0·05)。在骨骺增大、关节间隙狭窄和髁间窝增大征象显示方面,X线和MRI显示的结果相同。X线所不能显示的病变MRI显示14个关节有骨髓水肿,34个关节有关节内出血,27个关节有滑膜增厚。结论在显示血友病关节炎病变方面MRI优于传统X线检查,可作为评估血友病关节炎病变的首选影像学方法。

Comparison of radiography and magnetic resonance imaging in detecting arthropathies in patients with hemophilia

Objective To compare magnetic resonance imaging (MRI) and radiography in detecting arthropathies in patients with hemophilia. Methods Of 41 symptomatic joint images in the 14 patients with hemophilia, each joint was examined with both radiography and MRI within the same day. Imaging findings with both two modes were compared. Results Soft tissue swelling or joint effusion was observed in 33 joints by radiographs and in 34 joints by MRI. Joint erosions were demonstrated in 34 joints by MRI and in 20 joints by radiographs. Joint cysts were shown in 21 joints by MRI and in 9 joints by radiographs. Significant differences in the detection of erosion and cyst were found between radiography and MRI (P<0.05). MRI showed improvement for detecting more foci of both erosion and cyst than radiography. Bone marrow edema in 14 joints, hemorrhage in 34 joints, and synovial hypertrophy in 27 joints were revealed only by MRI. Conclusion MRI is superior to conventional radiography in detecting the abnormal changes, and should be considered as the imaging mode of choice in evaluating hemophilic arthropathies.