幼年特发性关节炎累及踝部MRI表现  

MRI manifestations of juvenile idiopathic arthritis involving ankle

作　　者：杨洋[1] 白凤森[1] 闫淯淳 辛海燕[1] 赖建铭[2] 王新宁[2] 袁新宇[1] YANG Yang;BAI Fengsen;YAN Yuchun;XIN Haiyan;LAI Jianming;WANG Xinning;YUAN Xinyu(Department of Radiology,the Affiliated Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Rheumatology and Immunology,the Affiliated Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院放射科,北京100020 [2]首都儿科研究所附属儿童医院风湿免疫科,北京100020

出　　处：《中国介入影像与治疗学》2022年第5期300-303,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察幼年特发性关节炎(JIA)累及踝部的MRI表现。方法回顾性观察42例JIA患儿受累踝部的MRI资料,分析其特点。结果JIA共累及46侧踝部,38例单侧、4例双侧踝部受累。①37侧(37/46,80.43%)踝见关节滑膜炎,累及28个(28/43,65.12%)胫距关节、10个(10/43,23.26%)距舟关节及5个(5/43,11.63%)跟距关节;②26侧(26/46,56.52%)踝见关节积液,多累及胫距关节(19/26,73.08%),且均合并同部位滑膜炎;③26侧踝可见腱鞘炎(26/46,56.52%),多累及内踝组(15/30,50.00%)或外踝组(11/30,36.67%),前踝组较少见(4/30,13.33%),其中22侧(22/26,84.62%)合并滑膜炎、4侧(4/26,15.38%)表现为单一腱鞘炎;④15侧(15/46,32.61%)踝见骨髓水肿样改变,均累及多骨骼,常见受累部位依次为距骨(13/31,41.94%)、跟骨(10/31,32.26%)、胫骨远端(8/31,25.81%);其中11侧(11/15,73.33%)病变位于关节面下,以宽基底与关节面相连,且均合并邻近关节滑膜炎,4侧(4/15,26.67%)未伴发滑膜炎或腱鞘炎病变均远离关节面;⑤13侧踝见软组织肿胀(13/46,28.26%),分别见于内踝(7/13,53.85%)、外踝(5/13,38.46%)或内外踝同时受累(3/13,23.08%)。结论JIA累及踝部的最主要MRI表现包括滑膜炎、关节积液和腱鞘炎,且腱鞘炎可作为唯一受累征象出现;骨髓水肿样改变常见,需与生理性表现相鉴别。Objective To observe MRI manifestations of juvenile idiopathic arthritis(JIA)involving ankle in children.Methods MRI data of 42 children with JIA were retrospectively observed,and the imaging characteristics were analyzed.Results There were 46 involved ankles among 42 cases,including unilateral ankle involvement occurred in 38 cases and bilateral ankle involvement developed in 4 cases.①Synovitis was observed in 37(37/46,80.43%)ankles,and the affected sites included the tibiotalar joint(28/43,65.12%),the talonavicular joint(10/43,23.26%)and the talar joint(5/43,11.63%).②Joint effusion was noticed in 26(26/46,56.52%)ankles most affected the tibial talar joint(19/26,73.08%),all complicated with synovitis at the same site.③Tenosynovitis was found in 26(26/46,56.52%)ankles,including medial malleolus group(15/30,50.00%),lateral malleolus group(11/30,36.67%)and the anterior malleolus group(4/30,13.33%).The proportion of tenosynovitis complicated with synovitis was 84.62%(22/26),while single tenosynovitis was found in 4(4/26,15.38%)ankles.④Bone marrow edematous changes were observed in 15(15/46,32.61%)ankles,all were multi-bone involved,and the common affected sites were talus(13/31,41.94%),calcaneus(10/31,32.26%)and distal tibia(8/31,25.81%).The lesions located below the articular surface,connected to the articular surface with a broad base,and all were associated with synovitis of adjacent joints in 11(11/15,73.33%)ankles,while 4(4/15,26.67%)ankles were found without synovitis or with tenosynovitis far away from the articular surface.⑤Soft tissue swelling occurred in 13(13/46,28.26%)ankles,affected the medial malleolus(7/13,53.85%),the lateral malleolus(5/13,38.46%)or the both(3/13,23.08%).Conclusion The main MRI manifestations of JIA involving ankle included synovitis,joint effusion and tenosynovitis,and tenosynovitis could be the only sign of involvement.Bone marrow edmatous-like lesions were common and needed to be distinguished from physiological manifestations.

关 键 词：关节炎 幼年型类风湿 踝关节 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]