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手腕部类风湿性关节炎的MRI诊断[J]. 中山大学学报(医学科学版), 2015,36(1).
MRI Diagnosis of Wrists and Hands in Rheumatoid Arthritis Patients[J]. Journal of Sun Yat-sen University (Medical Sciences), 2015, 36(1).
【目的】 分析手腕部类风湿性关节炎的MRI表现,探讨滑膜炎、骨侵蚀、骨髓水肿的分布及发生规律。【方法】 回顾性分析40例确诊为类风湿性关节炎患者的80只手、腕关节的MRI表现。按病程分为早期组(病史≤2年)18例、中晚期组(病史>2年)22例,采用OMERACT评分系统对其滑膜炎、骨侵蚀、骨髓水肿进行评分并比较分析。【结果】 滑膜炎、骨侵蚀、骨髓水肿、腱鞘炎的发生率分别为92.5%(74/80)、90%(72/80)、50%(40/80)、68.8%(55/80)。滑膜炎、骨侵蚀及骨髓水肿在腕关节区的发生率分别为82.5%(66/80)、90.0%(72/80)、47.5%(38/80),较掌指关节发生率51.3%(41/80)、48.8%(39/80)、30.0%(24/80)高(P < 0.05)。骨侵蚀易累及三角骨(60/80)、头状骨(54/80)及尺骨远端(51/80)。骨髓水肿在各腕骨发生率及评分的差异均无统计学意义(P > 0.05)。屈肌腱腱鞘炎(46/80)较伸肌腱腱鞘炎(32/80)更易发生(P=0.027)。早期与中晚期组滑膜炎、骨髓水肿、骨侵蚀发生率的差异均无统计学意义(P > 0.05)。骨侵蚀与骨髓水肿评分有显著相关性(P=0.001),而滑膜炎与骨侵蚀、滑膜炎与骨髓水肿的评分均无相关性(P > 0.05)。 【结论】 滑膜炎、骨侵蚀、骨髓水肿及腱鞘炎是类风湿性关节炎在手腕部主要的MRI表现,了解各征象特点及发生规律对于该病的诊断有重要价值。
【Objective】 To summarize the magnetic resonance imaging (MRI) findings of rheumatoid arthritis (RA) in wrist joint and hand, and to explore the regularity of synovitis, bone erosion and bone marrow edema. 【Methods】 40 patients fulfilling the 2009 ACR/EULAR for RA, 18 with early RA, 22 with late RA(disease duration ≤2 years, and > 2 years, respectively) were enrolled in the study. Retrospective analysis was performed for the MRI findings of 80 wrist joints and hands of the patients. Evaluation of the synovitis, bone erosion, bone marrow edema were performed with the OMERACT RA MRI scoring system. 【Results】 The prevalence of synovitis, bone erosion, bone marrow edema and tenosynovitis were 92.5% (74/80), 90% (72/80), 50% (40/80), and 68.8% (55/80). The prevalence of synovitis, bone erosion, bone marrow edema in wrist joints were 82.5% (66/80), 90.0% (72/80), 47.5% (38/80), which in metacarpophalangeal joints were 51.3% (41/80), 48.8% (39/80), and 30.0% (24/80), statistic differences were found between two groups (P < 0.05). Bone erosion commonly occurs in triangular bone (60/80), capitates (54/80) and distal ulna (51/80).There were no statistic differences in the prevalence and score of bone marrow edema among the eight carpus (P > 0.05). More tenosynovitis occur in flexor tendons (46/80) than extensor tendons (32/80) (P = 0.027). There were no statistic differences in the prevalence of synovitis, bone erosion and bone marrow edema between early RA group and late RA group (P > 0.05). Significant correlation was found between bone erosion score and bone edema score (P = 0.001). No correlation was found between synovitis score and bone erosion score, synovitis score and bone edema score, either. (P > 0.05). 【Conclusion】 The most common MRI findings of RA in wrist and joint are synovitis, bone erosion, bone marrow edema and enosynovitis, understanding of characteristics and regularity of each finding exerts an important impact on the diagnosis of this disease.
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