基于MRI的幼年特发性关节炎膝关节骨髓水肿特点及转归的初步研究  

MRI-based investigation of characteristics and outcome of knee bone marrow edema in children with juvenile idiopathic arthritis

作　　者：杨洋[1] 陶然[1] 仪晓立[1] 王新宁[2] 袁新宇[1] Yang Yang;Tao Ran;Yi Xiaoli;Wang Xinning;Yuan Xinyu(Department of Radiology,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Rheumatology and Immunology,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：《中华放射学杂志》2022年第6期650-655,共6页Chinese Journal of Radiology

摘　　要：目的:探讨幼年特发性关节炎(JIA)受累膝关节的骨髓水肿发生率、分布及其转归。方法:回顾性收集2017年1月至2019年12月首都儿科研究所附属儿童医院128例JIA患儿,共纳入136个膝关节,收集患儿临床信息。将膝关节分为8个解剖区,依据JIA MRI评分系统(JAMRIs)对各区域骨髓水肿征象进行评分并计数。根据MRI中是否存在骨髓水肿,将患儿分为骨髓水肿组(36例)和无骨髓水肿组(92例),采用χ2检验、独立样本t检验或Mann-Whitney U检验对组间临床资料进行比较。观察随访骨髓水肿的预后转归。结果:136个关节中37个关节出现骨髓水肿征象(27.2%)。骨髓水肿组和无骨髓水肿组间患儿年龄分别为(8±4)、(6±4)岁,病程分别为9(3,22)、4(2,18)个月,差异均有统计学意义(年龄:t=-2.63,P=0.010;病程:Z=-5.78,P=0.013)。23个(62.2%,23/37)膝关节的骨髓水肿为多部位同时受累,按受累频数由多到少依次为胫骨外侧平台17个、股骨外髁承重面16个、胫骨内侧平台和股骨内髁侧面均为15个、股骨内髁承重面12个、股骨外髁侧面8个、髌骨外侧7个、髌骨内侧5个。股骨内髁侧面受累时MRI评分以1分为主(8/15)。15个进行随访的骨髓水肿膝关节随访间隔为(7±3)个月,12个月内病变消失10个、好转3个、进展2个。结论:JIA受累膝关节的骨髓水肿征象发生率较低,年长儿、病程长者好发,分布以关节承重面好发,经规范治疗后总体预后良好。Objective To investigate the prevalence,distribution,and prognosis of knee joint bone marrow edema(BME)in children with juvenile idiopathic arthritis(JIA).Methods From January 2017 to December 2019,128 JIA children in the Children′s Hospital,Capital Institute of Pediatrics were analyzed retrospectively,and 136 knees were included totally.BME was evaluated and counted from eight regions according to the juvenile arthritis MRI scoring system(JAMRIS).Chi-square test,independent sample t test or Mann-Whitney U test were used to compare the clinical characteristics between BME group(36 cases)and non-BME group(92 cases).The prognosis of BME were observed.Results BME was found in 37 of 136 knee joints(27.2%).The ages of the children in BME group and non-BME were(8±4)and(6±4)years old,and the disease duration were 9(3,22)and 4(2,18)months,respectively,both with statistically significant differences(age:t=-2.63,P=0.010;duration:Z=-5.78,P=0.013).In 23 joints(62.2%,23/37),BME occurred at multiple locations simultaneously in the knee.Locations with BME,according to the frequency of involvement from most to least,were the lateral tibial plateau with 17,the lateral weight-bearing femur with 16,the medial tibial plateau and the medial femoral condyle both with 15,the medial weight-bearing femur with 12,the lateral femoral condyle with 8,the lateral patella with 7,and the medial patella with 5.The MRI score of most of medial femoral conclyle was 1(7/15).Of the 15 BME joints with the MRI follow-up data with interval(7±3)months,BME disappeared in 10 joints,improved in 3 joints and progressed in 2 joints within 12 months after the treatments.Conclusions There is a low incidence of BME in JIA affected knee joint.Older children and the children with long disease duration have a higher risk for BME,and more likely involved the weight-bearing surfaces of the joint.The overall prognosis is satisfactory after the standard treatments.

关 键 词：磁共振成像 幼年特发性关节炎 骨髓水肿 

分 类 号：R726.9[医药卫生—儿科] R445.2[医药卫生—临床医学]