MRI量化评分在腕关节类风湿关节炎治疗中的应用价值  

The value of MRI quantification score in the treatment of rheumatoid arthritis of wrist joint

作　　者：袁文昭[1] 邓德茂[1] 段高雄[1] 万荣超[1] 陈延强[2] 梁继军[1] 莫夏萍 武莹莹[1] YUAN Wenzhao;DENG Demao;DUAN Gaoxiong;WAN Rongchao;CHEN Yanqiang;LIANG Jijun;MO Xiaping;WU Yingying(Department of Radiology;Department of Rheumatology,the First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China)

机构地区：[1]广西中医药大学第一附属医院放射科,广西南宁530023 [2]广西中医药大学第一附属医院风湿病科,广西南宁530023

出　　处：《实用放射学杂志》2018年第9期1410-1413,1457,共5页Journal of Practical Radiology

基　　金：广西壮族自治区自然科学基金项目（2014GXNSFBA118169，2014GXNSFAA118257）。

摘　　要：目的 探讨3.0T MRI量化评分在腕关节类风湿关节炎（RA）治疗过程中的临床应用价值。方法 对27例病史＜2年的RA患者在治疗前后各行1次同侧腕关节MRI扫描，共54只腕关节完成扫描，观察各腕关节滑膜炎、骨髓水肿、骨侵蚀及关节间隙情况，并进行定量评分，分别比较治疗前及治疗后滑膜炎、骨髓水肿、骨侵蚀及关节间隙狭窄的评分。结果 所有患者2次MRI扫描均见不同程度滑膜炎及骨髓水肿；15例患者治疗前后均有骨侵蚀，12例患者治疗前扫描无骨侵蚀，其中4例患者治疗后出现骨侵蚀；25例患者2次扫描均见不同程度关节间隙变窄，2例患者治疗前无关节间隙变窄，其中1例患者治疗后出现关节间隙变窄。滑膜炎、骨髓水肿在治疗后评分较治疗前降低，但治疗前后差异均无统计学意义（Z=-1.428，P=0.153及Z=-1.120，P=0.263），骨侵蚀及关节间隙狭窄评分在治疗后均不同程度升高，且与治疗前相比差异有统计学意义（Z=-2.913，P=0.004及Z=-4.059，P=0.000）。结论 3.0T MRI能清晰显示RA治疗前后腕关节滑膜炎、骨髓水肿、关节间隙狭窄及骨侵蚀改变，MRI量化评分可以作为监测RA治疗过程中病变变化的有效手段。Objective To investigate the clinical value of 3.0T MRI quantification score in the treatment of rheumatoid arthritis （RA） of the wrist.Methods 27 patients of RA with the case history less than 2 years underwent wrist MRI scan both before and after the treatment in each one ipsilateral, which involved 54 wrists to observe their status in terms of synovitis, bone marrow edema, bone erosion and joint space narrowing with quantification score on each of them. Comparison of scores before and after treatment were then implemented.Results All patients were found to be of different degrees of synovitis and bone marrow edema in the two examinations. 15 patients were found with bone erosion both before and after the treatment, while 4 out of 12 patients bearing no bone erosion before treatment were found with bone erosion after treatment. 25 patients had different degrees of joint space narro- wing in two scans,2 patients had no narrowing of joint space before treatment and 1 of them had narrowing of the joint space after treatment. Synovitis and bone marrow edema scores were lower after the treatment, but there were no significant differences between before and after the treatment （ Z = -1.428, P= 0.153 and Z =- 1.120, P = 0.263 ）. The scores of bone erosion and joint space narrowing increased in different degrees after treatment, and the differences were statistically significant compared with that before treatment, respectively（Z=-2.913,P=0.004 and Z=-4.059,P=0.000）. Conclusion 3.0T MRI can clearly display wrist synovitis, bone marrow edema, joint space narrowing and bone erosion changes before and after RA treatment, and MRI quantification score can be used as an effective method to monitor the change of RA during treatment.

关 键 词：类风湿关节炎 腕关节 磁共振成像 

分 类 号：R593.22[医药卫生—内科学] R445.2[医药卫生—临床医学]