CAJ | 학술논문

目的：探讨动态增强MRI(DCE-MRI)定量评价类风湿性关节炎(RA)炎症活动度的价值。材料与方法20例经临床病理确诊的RA患者行双手腕关节DCE-MRI检查，滑膜病理Krenn评分、临床DAS28评分及血清学检查，运用动态增强专用血流动力学软件测量双腕关节滑膜病变区定量参数：容积转移常数(Ktrans)、速率常数(Kep)、血管外细胞外容积分数(Ve)、血浆容积(Vp)及半定量参数：达峰时间(TTP)、最大浓度(Cmax)、浓度-时间曲线下面积(AUC)、最大斜率(Slopemax)，分析DCE-MRI定量及半定量参数与滑膜病理Krenn评分、临床DAS28评分及血清学检查各指标之间的相关性，采用t检验比较分析滑膜炎症不同活动度组间Ktrans值的差异。结果20例RA腕关节滑膜病变Ktrans值为(1.27±0.59) ml/min， Krenn评分为3.38±1.53，DAS28评分为4.80±0.94。6例滑膜炎症为重度，11例滑膜炎症为轻度。Ktrans与Krenn评分、DAS28具有正相关(r=0.698，P＜0.01；r=0.510， P＜0.05)，Kep、Ve、Vp及TTP、Cmax、AUC、Slopemax与Krenn评分、DAS28及血清学检查各指标之间无相关性(P＞0.05)。滑膜炎症重度组Ktrans值明显高于轻度组(t=4.05，P＜0.01)。结论 DCE-MRI的Ktrans值可用于反映RA患者临床及滑膜病变的炎症活动程度。
목적：탐토동태증강MRI(DCE-MRI)정량평개류풍습성관절염(RA)염증활동도적개치。재료여방법20례경림상병리학진적RA환자행쌍수완관절DCE-MRI검사，활막병리Krenn평분、림상DAS28평분급혈청학검사，운용동태증강전용혈류동역학연건측량쌍완관절활막병변구정량삼수：용적전이상수(Ktrans)、속솔상수(Kep)、혈관외세포외용적분수(Ve)、혈장용적(Vp)급반정량삼수：체봉시간(TTP)、최대농도(Cmax)、농도-시간곡선하면적(AUC)、최대사솔(Slopemax)，분석DCE-MRI정량급반정량삼수여활막병리Krenn평분、림상DAS28평분급혈청학검사각지표지간적상관성，채용t검험비교분석활막염증불동활동도조간Ktrans치적차이。결과20례RA완관절활막병변Ktrans치위(1.27±0.59) ml/min， Krenn평분위3.38±1.53，DAS28평분위4.80±0.94。6례활막염증위중도，11례활막염증위경도。Ktrans여Krenn평분、DAS28구유정상관(r=0.698，P＜0.01；r=0.510， P＜0.05)，Kep、Ve、Vp급TTP、Cmax、AUC、Slopemax여Krenn평분、DAS28급혈청학검사각지표지간무상관성(P＞0.05)。활막염증중도조Ktrans치명현고우경도조(t=4.05，P＜0.01)。결론 DCE-MRI적Ktrans치가용우반영RA환자림상급활막병변적염증활동정도。
Objective: To investigate the value of quantitative evaluation of inflammatory activity by using wrist dynamic contrast-enhanced MRI (DCE-MRI) in rheumatoid arthritis (RA) patients.Materials and Methods: Twenty patients with clinically and pathologically proved RA underwent wrist DCE-MRI examination, Krenn scoring of synovial inflammatory, clinical scoring of DAS28 and serological examination. Quantitative parameters including the volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve), plasma volume (Vp) and semi-quantitative parameters including the time to peak (TTP), maximum concentration(Cmax), the area under concentration-time curve (AUC), maximum slope (Slopemax) of wrist synovial lesions were derived from DCE-MRI data. Relationship between quantitative and semi-quantitative parameters and Krenn scores of synovial inlfammatory, clinical score of DAS28 and serological results were analyzed by using correlation analysis. Ktrans values between different grades of synovitis were analyzed by using Studentt test.Results:The average Ktrans value of 20 patients was (1.27 ± 0.59) ml/min, the average Krenn score was 3.38 ± 1.53, and the average DAS28 score was 4.80 ± 0.94. Pathologically, six patients had high-grade synovitis and eleven patients had low-grade synovitis. Positive correlation was found between Ktrans and Krenn scores,as well as between Ktrans and DAS28 scores (r=0.698,P<0.01;r=0.510,P<0.05 respectively). However, no correlation was found between Kep, Ve, Vp, TTP, Cmax, AUC, Slopemax and Krenn scores, DAS28 scores, serological results (P>0.05). Ktrans values in high-grade synovitis group were higher than these in low-grade synovitis group (t=4.05,P<0.01).Conclusion:Ktrans values derived from DCE-MRI can be used to relfect the clinical and pathological inlfammatory activity of RA.