摘要目的 探讨高频彩色多普勒超声(HFUS)及MRI在早期类风湿关节炎(RA)患者关节病变检测中的应用价值。方法 回顾性分析2010年1—12月在山东烟台毓璜顶医院确诊的39例RA患者的临床资料,男20例,女19例,平均年龄(51.8±2.2)岁。所有患者双手、双腕均行HFUS、MR检查,重点观察有无骨侵蚀、骨髓水肿、滑膜增殖、滑膜血流、关节积液、肌腱炎等影像表现,并对两种检查方法的结果采用χ2检验进行对比分析。结果 共检查关节1 248个,HFUS和MRI在观察骨侵蚀[5.1%(44/858) vs 4.1%(35/858), χ2=1.075, P>0.05]、肌腱炎[4.6%(18/390) vs 1.5%(14/390), χ2=0.521, P>0.05]、腱鞘水肿[9.5%(37/390) vs 7.7%(30/390), χ2=0.800, P>0.05]方面的检出率差异无统计学意义;HFUS在观察关节滑膜增殖[15.4%(132/858) vs 7.7%(66/858), χ2=24.870, P<0.01]、关节积液[10.4%(89/858) vs 6.1%(52/858), χ2=10.578, P<0.05]方面明显的检出率优于MRI;MRI在观察骨髓水肿方面[0%(0/858) vs 5.5%(47/858), χ2=48.324, P<0.05]优于HFUS。结论 HFUS在检测早期RA患者病变关节的骨侵蚀、肌腱炎、腱鞘水肿、滑膜增殖、关节积液等方面,与MRI具有等同、甚至更优异的诊断价值。
Abstract：Objective To investigate the value of high frequency ultrasonography (HFUS) and nucler magnetic resonance imaging (MRI) in the early diagnosis of rheumatoid arthritis(RA).Methods The data of 39 consecutive patients with RA admitted in Yantai Yuhuangding hospital from January 2010 to December 2010 were retrospectively studied. In 39 cases of patients, males were 20 cases, female were 19 cases, the average age was (51.8±2.2) years. Bilateral bilateral wrist and hands jionts were examined by HFUS and MRI. Bone erosion, bone marrow edema, synovial proliferation, synovial blood flow, jiont effusion and tendinitis were received and the differences between the two examination Results were compared. Chi-square test was used for statistical analysis.Results All of the 1 248 joints were examined. There were no differences between HFUS and MRI in bone erosion [5.1%(44/858) vs 4.1%(35/858), χ2=1.075, P>0.05], tendinitis [4.6%(18/390) vs 1.5%(14/390), χ2=0.521, P>0.05], tendon sheath edema [9.5%(37/390) vs 7.7%(30/390), χ2=0.800, P>0.05]. HFUS was better than MRI in Synovial proliferation [15.4%(132/858) vs 7.7%(66/858), χ2=24.870, P<0.05], joint effusion [10.4%(89/858) vs 6.1%(52/858), χ2=10.578, P<0.05]. MRI was better than HFUS in bone marrow edema [0%(0/858) vs 5.5%(47/858), χ2=48.324, P<0.05].Conclusions HFUS is equivalent or better than MRI in bone erosion, tendinitis, tendon sheath edema and synovial proliferation.
王明玉,王宪斌,孙雪辉,刘奉立,黄生传. 高频彩色多普勒超声与MRI在早期类风湿关节炎诊断中的价值[J]. 中华解剖与临床杂志, 2014, 19(5): 395-398.
Wang Mingyu, Wang Xianbin, Sun Xuehui, Liu Fengli, Huang Shengchuan. Value of high frequency ultrasonography and nucler magnetic resonance imaging in the early diagnosis of rheumatoid arthritis. Chinese Journal of Anatomy and Clinics, 2014, 19(5): 395-398.
Koike T, Harigai M, Inokuma S, et al. Effectiveness and safety of Tocilizumab: postmarketing surveillance of 7901 patients with rheumatoid arthritis in Japan[J]. J Rheumatol, 2014, 41(1):15-23.
Machoid KP, Stamm TA, Nell VP, et al. Very recent onset rheumatoid arthritis: clinical and serological patient characteristics associiated with radiographic progression over the first years of disease[J]. Rheumatology, 2007, 46(2): 185-187.
[4]
Scott DL. The diagnosis and prognosis of early arthritis: rationale for new prognostic criteria[J]. Arthritis Rheum, 2002, 46(2): 286-290.
[5]
Cheung PP, Dougados M, Gossec L. Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: a systematic literature review of 35 studies(1415 patients) [J]. Arthritis Care Res (Hoboken), 2010, 62(3): 323-334.
[6]
Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31(3): 315-324.
[7]
Schmidt WA, Schmidt H, Schicke B, et al. Standard reference values for musculoskeletal uhrasonography[J]. Ann Rheum Dis, 2004, 63(8): 988-994.
[8]
Alelaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European league against Rheumatism collaborative initiative[J]. Arthritis Rheum, 2010, 6(9): 2569-2581.
[9]
Mkinen H, Kaarela K, Huhtala H, et al. Do the 2010 ACR/EULAR or ACR 1987 classification criteria predict erosive disease in early arthritis?[J]. Ann Rheum Dis, 2013, 72(5): 745-747.
[10]
Taylor PC. The value of sensitive imaging modalities in rheumatoid arthritis[J]. Arthritis Res Ther, 2003, 5(5): 210-213.
[11]
Wakefiled RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography[J]. Arthtis Rheum, 2000, 43(36): 2762-2770.
[12]
McQueen FM, Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter[J]. Arthritis Res Ther, 2006, 8(6): 222-225.
[13]
Grassi W, Tittaretli E, BIasetti P, et al. Finger tendon involve. merit in rheumatoid arthritis. Evaluation with high-frequency sonography[J]. Arthritis Rheum, 1995, 38(6): 1786-1794.
[14]
Stewart NR, McQueen FM, Crabbe JP. MRI of the early rheumatoid arthritis[J]. Austalas Radio, 2001, 45(3): 268-273.
[15]
Tershv L, Torp-Pedersen S, Qvistgaard E, et al. Estimation of inflammation by Doppler ultrasound:quantitative changes after intra-articular treatment in rheumatoid arthritis[J]. Ann Rheum Dis, 2003, 62(11): 1049-1053.
2014, Vol. 19 
