滑膜超声造影在类风湿关节炎患者诊断及疗效评估中的应用价值  

The Value of Synovial Contrast-enhanced Ultrasound in the Diagnosis and Curative Effect of Patients with Rheumatoid Arthritis

作　　者：李巧凤[1] 蒋俊杰[1] 曾鸽 孙婞 董海燕 Li Qiaofeng;Jiang Junjie;Zeng Ge;Sun Xing;Dong Haiyan(Department of Ultrasound,Huzhou Third People's Hospital,Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市第三人民医院超声科,浙江省湖州市313000

出　　处：《中国超声医学杂志》2022年第10期1178-1182,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 探究超声造影(CEUS)对类风湿关节炎(RA)患者腕关节滑膜病变的诊断及疗效评估价值。方法 选取确诊的RA患者42例为RA组,收集健康志愿者21例为对照组。采用常规超声及超声造影评估两组腕关节滑膜增生厚度、血流信号及积液。对RA患者治疗,比较治疗前后RA患者滑膜面积(SA)、上升时间(RT)、峰值强度(PI)、达峰时间(TTP)、曲线下面积(AUC)、平均通过时间(MTT)、半降时间(HT)及内洗斜率(S)等参数。结果 RA组42例RA患者84个腕关节中滑膜增厚、关节积液、骨质侵蚀及滑膜厚度均高于对照组(P<0.05)。治疗前,65个腕关节滑膜有不同程度的增厚,增厚的滑膜增强早期多呈较高增强,治疗后,增厚的滑膜增强明显减低且多呈不均匀增强。CEUS与28个关节的疾病活动度评分(DAS28)诊断RA的一致性较好(Kappa=0.832,P<0.05)。65个腕关节滑膜治疗前后的SA、PI、AUC、HT、S及TTP均差异显著(P<0.05)。受试者工作特征曲线(ROC)显示,SA、PI、TTP、AUC、HT及S等CEUS参数评估RA疗效的AUC均>0.86。结论 CEUS可清晰显示RA腕关节滑膜病变,对RA的早期诊断及疗效评估均具有重要价值。Objective To explore the value of contrast-enhanced ultrasound(CEUS) in the diagnosis and efficacy evaluation of wrist joints synovial lesions in patients with rheumatoid arthritis(RA). Methods 42 cases RA patients in our hospital were selected as the RA group, and 21 healthy volunteers at the same period were collected as the control group. Routine ultrasound and CEUS were used to assess the thickness of synovial hyperplasia, blood flow signals and fluid accumulation of 2 groups. The CEUS parameters such as synovial area(SA), rise time(RT), peak intensity(PI), time to peak(TTP), area under the curve(AUC), mean transit time(MTT), half fall time(HT) and slope(S) of RA patients were compared before and after treatment. Results The thickening of synovium, joint effusion, bone erosion and thickness of synovial membrane in 84 knee joints of 42 RA patients in the RA group were significantly higher than those in the control group(P<0.05). Before treatment, the synovium of 65 wrist joints had different degrees of thickening. The thickened synovial membrane was usually enhanced in the early stage. After treatment, the thickened synovial membrane was significantly reduced and mostly showed uneven enhancement. CEUS had good consistency with disease activity score in 28 joints(DAS28) in diagnosing RA(Kappa=0.832, P<0.05). The SA, PI, AUC, HT, S and TTP of the 65 wrist joint synovium before and after treatment were significantly different(P<0.05). The receiver operating characteristic curve(ROC) showed that the areas under the curve of CEUS parameters such as SA, PI, TTP, AUC, HT and S evaluating the efficacy of RA were all>0.86. Conclusions CEUS can clearly show RA wrist synovial lesions, which is of great value for the early diagnosis and curative effect evaluation of RA.

关 键 词：类风湿关节炎 超声造影 滑膜 腕关节 

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]