磁共振成像在早期类风湿性关节炎诊断中的价值  

Value of MR imaging in early rheumatoid arthritis

作　　者：邓霞[1] 许建荣[1] 路青[1] 李磊[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,上海200127

出　　处：《磁共振成像》2011年第2期95-98,共4页Chinese Journal of Magnetic Resonance Imaging

基　　金：上海市重点学科建设项目(编号:S30203)资助

摘　　要：目的探讨MRI在早期类风湿性关节炎(rheumatoid arthritis,RA)诊断中的价值。方法回顾性分析35例临床确诊早期RA患者的手腕关节X线和MRI图像。使用Philips Achieva3.0T磁共振扫描仪。结果在35例初诊RA患者中,MRI表现包括滑膜增生和滑膜炎、腱鞘炎、关节积液、骨质侵蚀和骨髓水肿。33例(94.3%)表现为滑膜增生和滑膜炎,注入对比剂后增厚的滑膜显著强化。28例腱鞘炎中,以尺侧伸肌腱腱鞘炎最多见,约占71.4%(20例),主要表现为受累肌腱腱鞘增厚和腱鞘积液。MRI检出25例患者中共27个骨质破坏灶。MRI对骨质破坏的检出率明显高于平片,P<0.01。15例骨髓水肿均发生于骨质破坏灶边缘,T2W脂肪抑制图像上呈边缘模糊的高信号影。结论骨质破坏可以出现在疾病早期。MRI能够很好地显示早期RA滑膜、腱鞘和骨的病变,是诊断早期RA的有力工具。Objective：To discuss the role of MR imaging in early rheumatoid arthritis （ERA）.Materials and Methods：The study group consisted of 35 patients diagnosed ERA.All the conventional X-ray and MRI images of wrists and fingers were reviewed.All the MRI examinations were performed on a Philips Achieva 3.0 T sacanner.Results：Abnormalities in 35 ERA patients included synovitis,tenosynovitis,joint effusion,bone marrow edema and bone erosions.MRI revealed synovitis in 33 of 35 （94.3%）,showing thickened synovium and obvious enhancement after the administration of gadolinium.Tenosynovitis was shown as thickened synovium around the tendon or effusion under the synovial sheath.The extensor carpi ulnaris was the most involved in 20 of 28 （71.4%）.Twenty-seven bone erosions were revealed in 25 patients on MRI.MRI was statistically more sensitive than conventional radiography for detecting bone erosions in RA,P〈0.01.Bone marrow edema in 15 patients appeared as a lesion with ill-defined margins and high signal,located surrounding the bone erosions.Conclusion Bone erosions may be found in the early process of RA.Abnormalities of synovium,synovial sheath and bone can be well described on MRI.MRI is a useful modality for evaluation of patients with early rheumatoid arthritis.

关 键 词：磁共振成像 类风湿性关节炎 早期诊断 骨质侵蚀 滑膜炎 腱鞘炎 关节积液 骨髓水肿 滑膜增生 

分 类 号：R445.2[医药卫生—影像医学与核医学] R593.22[医药卫生—诊断学]