MRI定性定量分析类风湿关节炎患者手腕部骨关节改变  

MRI qualitative and quantitative anlaysis of wrist and hand changes in patients with rheumatoid arthritis

作　　者：任丽香[1] 吴昆华[1] 张虹[2] 王波[1] 易三莉[3] 陈渝晖[1] 张洁[1] 雷云[1] 张宏江[1] 

机构地区：[1]云南省第一人民医院MRI科,云南昆明650032 [2]云南省第一人民医院风湿免疫科,云南昆明650032 [3]昆明理工大学信息工程与自动化学院,云南昆明650500

出　　处：《中国介入影像与治疗学》2017年第10期632-635,共4页Chinese Journal of Interventional Imaging and Therapy

基　　金：云南省科技计划项目[2017FE468(-127)];昆医联合专项(2014FB095)

摘　　要：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 explore the diagnostic value of qualitative and quantitative analysis for wrist and hand changes of rheumatoid arthritis （RA） patients based on 3.0T MR images. Methods A total of 39 RA patients were enrolled and divided into 2 groups according to the course of the diseases, including 20 cases defined as early stage group （≤24 months） and 19 cases defined as middle-late stage group （〉24 months）. MRI features such as joint synovitis, bone marrow edema, bone erosion, the tenosynovitis in wrists and hands were observed emphatically. Volumes of synovitis and bone marrow edema for all patients were quantified with the software developed by Kunming University of Science and Technology. Results Among the 78 sides of hands and wrists in 39 patients, the incidence rate of synovitis, bone marrow edema, bone erosion, tenosynovitis was 94. 87% （37/39）, 64. 10% （25/39）, 61. 54% （24/39） and 76.92% （30/39）, respectively. The highest incidence rate of synovitis, bone marrow edema and bone erosion was respectively found in the wrist （72/78, 92.31~）, carpus （48/78, 61.54%） and triangular bone （50/78, 64.1 % ）. There was no statistical significance difference of the occurrence of peritendinitis between the flexor tendons （74.36% [58/78]） and extensor tendons （61.54% [48/78]; 2 =2.94, P=0.09）. No statistical difference of the incidence rates of synovitis, bone marrow edema, bone erosion and tenosynovitis was found between the early stage group and middle late stage group （all P〉0.05）. There was no significant difference of synovitis and bone marrow edema volumes between the early stage group and the middle-late stage group （both P〈0.05） with MRI quantitative analysis. Conclusion 3.0T MRI can clearly demonstrate the pathological changes of the wrists and hands in RA patients. The quantitative analysis software can provide more accurate indicators for the assessment of disease severity.

关 键 词：磁共振成像 定性定量分析 关节炎 类风湿 手腕 手 

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]