动态增强MRI和肌骨超声对类风湿关节炎活动性的诊断价值  

Diagnostic value of dynamic contrast-enhanced MRI and musculoskeletal ultrasound for rheumatoid arthritis activity

作　　者：陈真[1] 雷皓天 徐旋 CHEN Zhen;LEI Hao-tian;XU Xuan(Department of Radiology,Yan'an People's Hospital,Yan'an 716000,Shaanxi,China;Department of Imaging,Yan'an People's Hospital,Yan'an 716000,Shaanxi,China)

机构地区：[1]延安市人民医院放射科,陕西延安716000 [2]延安市人民医院影像科,陕西延安716000

出　　处：《川北医学院学报》2025年第3期323-326,共4页Journal of North Sichuan Medical College

基　　金：陕西省重点研发计划项目(2021SF-254)。

摘　　要：目的:探讨动态增强MRI(DCE-MRI)和肌骨超声(MSUS)对类风湿关节炎(RA)活动性的诊断价值。方法:回顾性分析97例行DCE-MRI和MSUS检查的RA患者的临床资料,比较入院时DCE-MRI、MSUS检查对RA患者典型病理特征的检出率;根据患者病情活动性[类风湿性关节炎疾病活动性评分系统(DAS28)评分]分为活动组(DAS28≥2.6分,n=56)与非活动组(DAS28<2.6分,n=41),比较入院检查时不同病情活动性患者DCE-MRI定量参数[早期强化率(EER)、最大强化率(MER)、达峰时间(TTP)]和MSUS(滑膜厚度、血流信号评分、滑膜动脉RI)定量参数,采用受试者工作特征(ROC)曲线分析两种影像技术定量参数对RA患者病情活动性的诊断效能。结果:DCE-MRI、MSUS对RA患者滑膜增生的检出率比较,差异无统计学意义(P>0.05);DCE-MRI对RA患者骨侵蚀的检出率高于MSUS(P<0.05);对关节积液的检出率低于MSUS(P<0.05)。入院时,活动组患者EER、MER、滑膜厚度、血流信号评分高于非活动组(P<0.05);TTP、滑膜动脉RI低于非活动组(P<0.05)。ROC曲线显示,EER、MER、TTP、滑膜厚度、血流信号评分、滑膜动脉RI单一指标检测曲线下面积(AUC)分别为0.788、0.846、0.806、0.865、0.626、0.819;敏感度分别为75.61%、92.68%、70.73%、78.05%、87.80%、75.61%;特异度分别为71.43%、64.29%、76.79%、78.57%、32.14%、82.14%,均对RA患者病情活动性有较好诊断效能(P<0.05)。结论:DCE-MRI和MSUS对RA活动性均具有较好的诊断价值,但DCE-MRI对RA患者骨侵蚀的检出率更高,且MSUS对关节积液的检出率更高。Objective:To investigate and compare the diagnostic value of dynamic contrast-enhanced MRI(DCE-MRI) and musculoskeletal ultrasound(MSUS) for the activity of rheumatoid arthritis(RA).Methods:The clinical data of 97 patients with RA who received DCE-MRI and MSUS in the hospital were retrospectively analyzed.The detection rates of typical pathological features of RA patients by DCE-MRI and MSUS at admission were compared.The patients were divided into an active group(DAS28≥2.6 points,n=56) and an inactive group(DAS28<2.6 points,n=41) according to the disease activity [rheumatoid arthritis disease activity scoring system(DAS28) score].The quantitative parameters of DCE-MRI [early enhancement rate(EER),maximum enhancement rate(MER),time to peak(TTP)] and MSUS [synovial thickness,blood flow signal score,synovial artery resistance index(RI)] of patients with different disease activities were compared at admission.The diagnostic efficiency of quantitative parameters of these two imaging techniques for the disease activity of RA patients was analyzed by receiver operating characteristic curve(ROC).Results:There was no statistical significance in the detection rate of synovial hyperplasia in RA patients between the two imaging techniques(P>0.05).The detection rate of bone erosion in RA patients by DCE-MRI was higher than that by MSUS while the detection rate of joint effusion was lower than that by MSUS(P<0.05).At admission,the EER,MER,synovial thickness and blood flow signal score in active group were higher while the TTP and synovial artery RI were lower than those in inactive group(P<0.05).ROC analysis showed that the areas under the ROC curves(AUCs) for EER,MER,TTP,synovial thickness,blood flow signal score and synovial artery RI were 0.788,0.846,0.806,0.865,0.626 and 0.819,the sensitivities were 75.61%,92.68%,70.73%,78.05%,87.80% and 75.61%,and the specificities were 71.43%,64.29%,76.79%,78.57%,32.14% and 82.14%,respectively(P<0.05).Conclusion:Both DCE-MRI and MSUS have good diagnostic value on RA activity,but DCE-M

关 键 词：动态增强MRI 肌骨超声 类风湿关节炎 活动性 诊断价值 

分 类 号：R445.1[医药卫生—影像医学与核医学]