肌肉骨骼超声与MRI诊断类风湿性膝关节炎及评估其活动度的价值比较  

Comparison of values of musculoskeletal ultrasound and MRI in the diagnosis of rheumatoid knee arthritis and the evaluation of disease activity

作　　者：朱永涛[1] 回瑾 郭玲[1] 张丁丁[1] 耿进朝[2] 安立国 周显飞 ZHU Yongtao;HUI Jin;GUO Ling;ZHANG Dingding;GENG Jinchao;AN Liguo;ZHOU Xianfei(Department of Ultrasound,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Department of Radiology,Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China;Taizhou Municipal Hospital,Taizhou 318099,China)

机构地区：[1]中国中医科学院望京医院超声科,北京100102 [2]中国中医科学院望京医院放射科,北京100102 [3]浙江省台州市立医院,浙江台州318099

出　　处：《长春中医药大学学报》2022年第11期1253-1257,共5页Journal of Changchun University of Chinese Medicine

基　　金：浙江省医药卫生科技计划项目(CI2021A0202)。

摘　　要：目的 对比肌肉骨骼超声与磁共振成像(MRI)诊断类风湿性膝关节炎及评估其活动度的价值。方法 对类风湿性关节炎累及膝关节患者122例行肌肉骨骼超声及MRI检查,以关节镜检查结果为“金标准”,比较肌肉骨骼超声及MRI对类风湿性膝关节炎的诊断价值,并对所有患者进行疾病活动度分级,观察类风湿性膝关节炎疾病活动度与滑膜厚度、关节积液及血流信号分级的相关性。结果 122例患者244个膝关节,经关节镜明确受累关节为152个(62.30%),滑膜增厚138个(90.79%),均伴有关节腔积液,关节骨质改变113个(74.34%),骨侵蚀95个(62.50%),血管翳形成113个(74.34%)。肌肉骨骼超声正确检出受累关节136个,准确率为89.47%(136/152),MRI正确检出受累关节135个,准确率为88.82%(135/152),2种检查方式对滑膜增生、骨质改变、骨侵蚀及血管翳检出率比较,差异无统计学意义(P>0.05),但肌肉骨骼超声关节积液检出率高于MRI(P<0.05)。肌肉骨骼超声及MRI诊断类风湿性膝关节炎的特异度、敏感度、诊断符合率、Kappa值均较高。类风湿性膝关节炎患者DAS28评分与血流分级、滑膜血流分级、髌上囊积液厚度均呈正相关(P<0.05)。结论 肌肉骨骼超声及MRI对类风湿性膝关节炎均具有较高的诊断价值,但与MRI相比,肌肉骨骼超声对关节积液的诊断价值较高,二者均可通过对滑膜厚度、髌上囊积液厚度及血流分级的检测来判断膝关节疾病活动度,对临床诊疗及病情监测具有一定的借鉴意义。Objective To compare the value of musculoskeletal ultrasound and magnetic resonance imaging (MRI) in the diagnosis of rheumatoid knee arthritis and the evaluation of the disease activity.Methods A total of 122 patients with rheumatoid arthritis involving knee joints were examined by musculoskeletal ultrasound and MRI.The results of arthroscopy were used as the “gold standard” to compare the diagnostic value of musculoskeletal ultrasound and MRI for rheumatoid knee arthritis.The disease activity grading was performed on all the patients,and the correlation between the disease activity of RA and the synovial thickness,joint e?usion and blood ?ow signal grading was observed.Results Of the 244 knee joints in the 122 patients,152 (62.30%) were involved according to the examination of arthroscopy,including 138 (90.79%) of synovial thickening with joint e?usion,113 (74.34%) of joint bone changes,95 (62.50%) of bone erosion and 113 (74.34%) of pannus formation.Musculoskeletal ultrasound correctly detected 136 involved joints,with an accuracy rate of 89.47% (136/152),while MRI correctly diagnosed 135 involved joints,with an accuracy rate of 88.82% (135/152).There were no statistically significant di?erences in the detection rates of synovial thickening,bone changes,bone erosion and pannus between the two examination methods (P>0.05),but the detection rate of joint effusion by musculoskeletal ultrasound was higher than MRI (P<0.05).The specificity,sensitivity,diagnostic coincidence rate and Kappa value of musculoskeletal ultrasound and MRI were all higher in the diagnosis of rheumatoid knee arthritis.The DAS28 scores in patients with RA were positively correlated with the blood ?ow grading,synovial blood ?ow grading and suprapatellar bursa e?usion thickness (P<0.05).Conclusion Both musculoskeletal ultrasound and MRI have a high diagnostic value for rheumatoid knee arthritis,but compared with MRI,musculoskeletal ultrasound has a higher diagnostic value for joint effusion.Both of them can determine the disease activity o

关 键 词：肌肉骨骼超声 磁共振 类风湿性膝关节炎 疾病活动度 

分 类 号：R445.1[医药卫生—影像医学与核医学]