类风湿性关节炎腕关节滑膜超声造影定性与定量分析及临床应用价值  

Qualitative and quantitative analysis of wrist joint in rheumatoid arthritis by contrast-enhanced ultrasound and its clinical value

作　　者：张玮婧 金志斌[1] 孔文韬[1] 吴敏[1] Zhang Weijing;Jin Zhibin;Kong Wentao;Wu Min(Department of Ultrasound,Nanjing Drum Tower Hospital,Medical College of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属南京鼓楼医院超声诊断科,210008

出　　处：《中华超声影像学杂志》2018年第12期1084-1088,共5页Chinese Journal of Ultrasonography

基　　金：南京市卫生局医学科技发展项目(YKK15076).

摘　　要：目的研究类风湿性关节炎(RA)腕关节滑膜的超声造影特征,并探讨其与临床疾病活动度的相关性。方法对39例腕关节受累的RA患者进行超声造影检查,分析增生滑膜的造影表现特征并使用造影分析软件对数据进行脱机分析,绘制时间-强度(TIC)曲线,获得各造影参数:基础强度(a0)、强度增量(a1)、下降支斜率(a2)、上升支斜率(a3)、达峰时间(TTP)、峰值强度(PI)及实际峰值强度(PI-a0)、造影显影时间(AT)、曲线下面积(AUC),分析其与临床活动度指标的相关性。结果35.9%(14/39)的增生滑膜表现为周边半环状或弧形动脉供血并向中心填充的向心性增强模式,而64.1%(25/39)的滑膜表现为弥漫性整体增强。所有病灶均呈不均匀性增强,其中87.2%(34/39)为高增强,41.0%(16/39)中心存在不增强坏死区域。弥漫性增强组的疾病活动度高于向心性增强组(4.64±1.09对3.69±0.67;P=0.005)。造影定量参数指标中a3、(PI-a0)与血清红细胞细胞沉降率(ESR)呈正相关(r=0.465,P=0.006;r=0.325,P=0.043),而TTP与ESR呈负相关(r=-0.352,P=0.041)。结论滑膜呈弥漫性增强,曲线上升速度越快,TTP越短,PI越高代表疾病活动度越高。超声造影定性或定量参数均能反映RA患者的疾病活动情况,对临床评估有一定的指导意义。Objective To evaluate the value of contrast-enhanced ultrasound(CEUS)in detection of synovial hyperplasia in wrist joint of patients with rheumatoid arthritis(RA)and to explore the correlation with disease activity.Methods Thirty-nine RA patients with their wrist involved were examined by CEUS.The imaging features of synovitis were observed and the analysis of time intensity curve(TIC)was performed by contrast dynamic software.Some quantitative parameters were obtained from these fitting curves including basic intensity(a0),increased intensity(a1),descending slope(a2),ascending slope(a3),time to peak(TTP),peak intensity(PI),actual peak intensity(PI-a0),arrival time(AT),and area under the curve(AUC).And the correlation between these parameters with clinical activity index was analyzed.Results 35.9%(14/39)synovitis showed a centripetal enhancement pattern supplied by ring-like or arc-shaped arterials peripherally while 64.1%(25/39)showed diffusely entire enhancement.All the lesions were heterogeneous enhanced,87.2%(34/39)of which exhibited hyperenhancement.The detection rate of perfusion defects was 41.0%(16/39).The disease activity in the diffuse enhancement group was higher than that in the centripetal enhancement group(4.64±1.09 vs 3.69±0.67,P=0.005).CEUS quantitative parameters a3 and(PI-a0)were positively correlated with erythrocyte sedimentation rate(ESR)(r=0.465,P=0.006;r=0.325,P=0.043),however TTP had a negative relationship(r=-0.352,P=0.041).Conclusions Active synovitis usually represents as a diffuse enhancement pattern.A higher a3 and PI,and a shorter TTP indicate a higher disease activity.CEUS plays a great role in monitoring RA disease activity both from qualitative and quantitative aspect.

关 键 词：超声造影 关节炎 类风湿 滑膜炎 肌骨超声 

分 类 号：R445.1[医药卫生—影像医学与核医学]