剪切波弹性成像在类风湿关节炎周围神经病变中的诊断价值  

Shear Wave Elastography in Diagnosis of Peripheral Neuropathy in Rheumatoid Arthritis

作　　者：吴慧[1] 盛秋敏 朱剑芳[1] WU Hui;SHENG Qiumin;ZHU Jianfang(Department of Ultrasound,the First Affiliated Hospital of Nanchang University,Nanchang 330000,China)

机构地区：[1]南昌大学第一附属医院超声诊断科,江西南昌330000

出　　处：《中国医学影像学杂志》2020年第6期456-460,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨剪切波弹性成像(SWE)评估类风湿关节炎(RA)患者合并周围神经病变(PN)的可行性,分析RA活动度及腕横纹上方5 cm处正中神经的横切面积(CSAW)与正中神经弹性杨氏模量(E)值的相关性。资料与方法根据神经电生理检查结果纳入RA合并PN组(A组)、RA无PN组(B组)及健康对照组(C组)各50例。在正中神经的腕管入口和腕横纹上方5 cm处,采用二维超声分别测量其左右径(DW1、DF1)、前后径(DW2、DF2)、周长(CW、CF)及横截面积(CSAW、CSAF)。应用SWE测量正中神经前臂中点的E值。比较以上所测量参数的组间差异,并绘制ROC曲线图比较E值、CSAW、CW、DW1在RA合并PN的诊断价值;分析A组RA活动度。结果3组间DW2、DF2差异均无统计学意义(P>0.05);B组与C组DW1、DF1、CW、CF、CSAW、CSAF差异均无统计学意义(P>0.05)。A组与B组、C组相比,DW1、DF1、CW、CF、CSAW、CSAF均显著增大,差异均有统计学意义(P<0.01)。3组间E值差异均有统计学意义(P<0.001)。E值、CSAW、CW、DW1对应的ROC曲线下面积分别为0.827、0.801、0.740、0.747。A组RA活动度与E值呈正相关(rs=0.791,P<0.05)。RA患者的CSAW与E值呈正相关(r=0.651,P<0.001)。结论SWE可通过获取神经的弹性信息有效、可靠地对RA患者周围神经进行无创、定性、定量评估,有利于临床早期发现及诊断PN。Purpose To explore the feasibility of shear wave elastography(SWE)in evaluating patients with rheumatoid arthritis(RA)combined with peripheral neuropathy(PN).The correlation between the RA activity and the cross-sectional area of the median nerve(CSAW)at 5 cm above the wrist stripes and the elastic Young's modulus value(E)of the median nerve are also analyzed.Materials and Methods According to the results of neuro-electrophysiological examination,50 patients were included in RA combined with PN group(group A),RA without PN group(group B)and healthy control group(group C).At the entrance of the carpal tunnel of the median nerve and 5 cm above the carpal horizontal stripes,the left and right diameters(DW1,DF1),anterior and posterior diameters(DW2,DF2),perimeter(CW,CF)and cross-sectional area(CSAW,CSAF)were measured by two-dimensional ultrasound.SWE was used to measure the E value of the midpoint of the forearm of the median nerve.The differences of the above measured parameters among groups were compared,and ROC curve was used to compare the diagnostic value of E value,CSAW,CW and DW1 in RA and PN.RA activity of group A was analyzed.Results There were no statistically significant differences in DW2 and DF2 among the three groups(P>0.05);there were no statistically significant differences in DW1,DF1,CW,CF,CSAW and CSAF between group B and C(P>0.05).Compared with group B and group C,DW1,DF1,CW,CF,CSAW and CSAF increased significantly in group A,the difference were statistically significant(P<0.01).The differences in E values among the three groups were statistically significant(P<0.001).The area under the ROC curve corresponding to the E value,CSAW,CW and DW1 were 0.827,0.801,0.740 and 0.747,respectively.RA activity in group A was positively correlated with E value(rs=0.791,P<0.05).The CSAW of RA patients was positively correlated with E value(r=0.651,P<0.001).Conclusion SWE can effectively and reliably perform non-invasive,qualitative and quantitative assessment of peripheral nerves in RA patients by obtaining elast

关 键 词：关节炎 类风湿 神经病变 超声检查 弹性成像技术 

分 类 号：R445.1[医药卫生—影像医学与核医学] R593.22[医药卫生—诊断学]