幼年特发性关节炎膝关节异常的MRI诊断探讨  

MRI in abnormal knees of juvenile idiopathic arthritis

作　　者：王毅[1] 李瑞[1] 宋英儒[1] 黄仲奎[1] 农光民[1] 

机构地区：[1]广西医科大学第一附属医院放射科,南宁530021

出　　处：《磁共振成像》2012年第4期265-269,共5页Chinese Journal of Magnetic Resonance Imaging

基　　金：广西医科大学研究生创新课题(编号:2010105981002M202)

摘　　要：目的探讨幼年特发性关节炎(JIA)患儿膝关节的MRI诊断价值。材料与方法搜集24例临床确诊为JIA并出现膝关节疼痛、肿胀患儿的膝关节X线和MRI,先分析双膝X线平片和MRI表现,再测量膝关节髌上囊滑膜厚度、髌上囊积液量,采用Person法分别分析其与实验室指标的相关性。结果 24例平片均见关节肿胀,但骨质未见异常;24例MRI平扫均见关节囊积液[积液量为(13.19±5.44)ml],伴软骨性关节面损伤、变性4例,前交叉韧带损伤2例,腘窝淋巴结肿大4例,胫骨上段骨髓水肿5例;MRI增强17例均出现髌上囊滑膜增厚[厚度为(3.21±1.27)mm]、血管翳形成及髌上囊积液;髌上囊滑膜厚度与髌上囊积液量呈显著相关性(r=0.837,P<0.05)。24例血类风湿因子(RF)为(4.32±2.92)U/ml,血沉(ESR)为(53.38±19.34)mm/h,C反应蛋白(CRP)为(60.96±45.52)mg/L。髌上囊滑膜厚度与RF和ESR之间均呈弱相关性(r值分别为0.684、0.507,P值均<0.05),与CRP之间无相关性(r=0.213,P>0.05)。髌上囊积液量与RF之间呈显著相关性(r=0.837,P<0.05),与ESR之间呈弱相关性(r=0.452,P<0.05),与CRP之间无相关性(r=0.268,P>0.05)。结论 MRI能清晰显示活动性JIA患儿膝关节髌上囊滑膜厚度、髌上囊积液量、骨髓水肿等病变,可为JIA的早期诊断提供影像学依据。Objective： To evaluate MRI features in abnormal knees of juvenile idiopathic arthritis （JIA）. Materials and Methods： Twenty-four patients diagnosed JIA clinically with knees pain and swelling were taken X-ray and MR images of knees. X-ray and MRI features of knees were read respectively. Thicknesses of suprapatellar bursa synovium and suprapatellar pouch fluid volume were measured. Person＇s correlations between the suprapatellar bursa synovial thickness, fluid volume and the clinical data were analyzed respectively. Results： All 24 X-ray of knees were found swelling, but no bony erosion. MRI of 24 cases showed the suprapatellar bursa efl＇usion [（13.19±5.44） ml] in all, and accompany cartilage articular surface injury in 4, anterior cruciate ligament injury in 2, popliteal lymph nodes enlargement in 4, bone marrow edema in 5. Suprapatellar bursa synovium thickening [（3.21±1.27） mini, pannus formation were showed and enhanced significantly in all 17 cases of MRI- enhancement. The correlation （l±0.837, P〈0.05） were signaficant between synovial thickness and suprapatellar pouch fluid volume. RF was （4.32±2.92） U/ml, ESR was （53.38±19.34） mm/h, CRP was （60.96±45.52） mg/L in all 24 cases. Little correlations （r=0.684, 0.507, P〈0.05） were found between suprapatellar bursa synovial thickness and RF, ESR. No correlations （r=0.213, P〉0.05） were found between suprapatellar bursa synovial thickness and CRP. Large correlations （r=0.837, P±0.05） were found between suprapatellar pouch fluid volume and RF. Little correlations （r=0.452,P〈0.05） were found between suprapatellar pouch fluid volume and ESR. No correlations （r=0.268, P〉0.05） were found between suprapatellar pouch fluid volume and CRP. Conclusion： MRI could show suprapatellar bursa synovial thickness, suprapatellar bursa effusion, bone marrow edema of JIA, which could provide imaging evidence in diagnosis of early active JIA.

关 键 词：关节炎 幼年型类风湿 膝关节 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684.3[医药卫生—诊断学]