皖南医学院学报
皖南醫學院學報
환남의학원학보
ACTA ACADEMIAE MEDICINAE WANNAN
2014年
1期
68-71
,共4页
早期诊断%类风湿关节炎%磁共振成像%动态增强扫描
早期診斷%類風濕關節炎%磁共振成像%動態增彊掃描
조기진단%류풍습관절염%자공진성상%동태증강소묘
early diagnosis%rheumatoid arthritis%magnetic resonance imaging%dynamic contrast-enhanced
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。
目的：探討MRI在早期類風濕性關節炎（ RA）診斷中的價值。方法：隨訪至明確診斷為早期RA患者32例納入研究。所有病例均進行腕關節X線平片和MRI平掃＋增彊檢查，其中15例行MRI動態增彊掃描檢查，分析X線平片異常徵象及MRI異常徵象、時間-信號彊度麯線（ TIC），測量滑膜厚度，併對X線平片和MRI顯示的骨侵蝕病竈分彆進行計數。結果：32例早期RA患者，X平片僅髮現3例骨侵蝕，1例骨質疏鬆。 MRI異常徵象包括：滑膜增厚和滑膜炎32例，關節積液18例，骨髓水腫17例，骨侵蝕15例，腱鞘炎21例，滑膜增厚和滑膜炎、骨髓水腫、骨侵蝕及腱鞘炎均有不同程度彊化。15例早期RA動態增彊掃描病竈的TIC：2例為快速上升型，12例為上升平檯型，1例為延遲上升型。滑膜增厚為（3．5±0．4）mm。 MRI對骨質破壞的檢齣率明顯高于X線平片，P＜0．01。結論：MRI可反映早期RA的病理改變，對骨侵蝕的檢齣明顯優于傳統X線檢查，在早期RA診斷中有重要意義；CE及DCE-MRI可評價RA的活動性。
목적：탐토MRI재조기류풍습성관절염（ RA）진단중적개치。방법：수방지명학진단위조기RA환자32례납입연구。소유병례균진행완관절X선평편화MRI평소＋증강검사，기중15례행MRI동태증강소묘검사，분석X선평편이상정상급MRI이상정상、시간-신호강도곡선（ TIC），측량활막후도，병대X선평편화MRI현시적골침식병조분별진행계수。결과：32례조기RA환자，X평편부발현3례골침식，1례골질소송。 MRI이상정상포괄：활막증후화활막염32례，관절적액18례，골수수종17례，골침식15례，건초염21례，활막증후화활막염、골수수종、골침식급건초염균유불동정도강화。15례조기RA동태증강소묘병조적TIC：2례위쾌속상승형，12례위상승평태형，1례위연지상승형。활막증후위（3．5±0．4）mm。 MRI대골질파배적검출솔명현고우X선평편，P＜0．01。결론：MRI가반영조기RA적병리개변，대골침식적검출명현우우전통X선검사，재조기RA진단중유중요의의；CE급DCE-MRI가평개RA적활동성。
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 ±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.
