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目的探讨3.0T MRI定性定量分析对类风湿性关节炎(RA)患者手腕部骨关节改变的诊断价值。方法将39例RA患者按病程分为早期组(病程≤24个月,20例)及中晚期组(病程>24个月,19例),观察两组MRI滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象,并应用昆明理工大学研发的定量分析软件测算滑膜炎、骨髓水肿范围。结果 39例患者(共78侧)的手腕部骨关节中,滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象的出现率分别为94.87%(37/39)、64.10%(25/39)、61.54%(24/39)、76.92%(30/39)。滑膜炎在腕关节发生率最高[92.31%(72/78)],骨髓水肿在腕骨发生率最高[61.54%(48/78)],骨侵蚀最易累及三角骨[64.10%(50/78)]。屈肌键腱鞘炎[74.36%(58/78)]与伸肌腱腱鞘炎[61.54%(48/78)]发生率差异无统计学意义(χ2=2.94,P=0.09)。早期组与中晚期组滑膜炎、骨髓水肿、骨侵蚀、腱鞘炎征象出现率差异均无统计学意义(P均>0.05)。定量分析显示,早期组与中晚期组间滑膜炎范围及骨髓水肿范围差异均无统计学意义(P均>0.05)。结论 3.0T MRI可清楚显示RA手腕部骨关节的改变,通过定量分析软件可为评估疾病严重程度提供更加准确的量化信息。
Objective To investigate the diagnostic value of 3.0T MRI qualitative and quantitative analysis on the changes of wrist joint in patients with rheumatoid arthritis (RA). Methods Thirty-nine RA patients were divided into two groups according to their duration of disease: early stage (duration≤24 months, 20 cases) and middle and late stage (duration> 24 months, 19 cases). MRI synovitis, bone marrow edema, , Tenosynovitis signs, and Kunming University of Science and Technology developed quantitative analysis software to measure synovitis, bone marrow edema range. Results The incidence rates of synovitis, bone marrow edema, bone erosion and tenosynovitis in 39 patients (78 sides) were 94.87% (37/39), 64.10% (25/39), 61.54 % (24/39), 76.92% (30/39). The incidence of synovitis was the highest in wrist joint [92.31% (72/78)], the incidence of bone marrow edema was the highest in carpal bones [61.54% (48/78)], and the most likely involvement of bone erosion was in triangular bones [64.10% (50/78) )]. There was no significant difference in the incidence of flexion tenosynovitis (74.36% (58/78) vs extensor tenosynovitis [61.54% (48/78)] (χ2 = 2.94, P = 0.09). There was no significant difference in the incidence of signs of synovitis, bone marrow edema, bone erosion and tenosynovitis between the early group and the late group (all P> 0.05). Quantitative analysis showed that there was no significant difference in the range of synovitis and bone marrow edema between the early group and the late group (P> 0.05). Conclusions 3.0T MRI can clearly show the changes of the joints of the RA wrist. Quantitative analysis software can provide more accurate quantitative information for evaluating the severity of the disease.