膝类风湿关节炎与骨关节炎的MRI及超声表现分析

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英文篇名：Analysis of MRI and ultrasonic manifestation in knee rheumatoid arthritis and osteoarthritis patients 作者：汤晓菲 ; 丁秋玲 ; 孙鹏飞 ; 佟颖 ; 于孟学 ; 刘坚 英文作者：Tang Xiaofei;Ding Qiuling;Sun Pengfei;Tong Ying;Yu Mengxue;Liu Jian;Department of Rheumatology and Immunology, Aerospace Central Hospital; 关键词：膝关节 ; 类风湿关节炎 ; 骨关节炎 ; 磁共振成像 ; 超声 英文关键词：knee joint;;rheumatoid arthritis;;osteoarthritis;;MRI;;ultrasound 中文刊名：BJYX 英文刊名：Beijing Medical Journal 机构：航天中心医院风湿免疫科;航天中心医院超声科;承德医学院附属医院影像科;北京协和医院风湿免疫科; 出版日期：2019-07-10 出版单位：北京医学 年：2019 期：v.41 语种：中文; 页：BJYX201907002 页数：4 CN：07 ISSN：11-2273/R 分类号：8-11

摘要

目的总结中晚期活动性膝类风湿关节炎(rheumatoid arthritis, RA)及膝骨关节炎(osteoarthritis, OA)的MRI及超声表现。方法选取2015年5月至2018年10月于航天中心医院住院的中晚期活动性膝RA患者30例和症状性膝OA患者20例,所有患者均行膝关节MRI及超声检查,分析两组膝关节滑膜、骨髓水肿、关节软骨及半月板等病变的差异。结果 MRI检查显示,RA组膝关节滑膜炎发生率显著高于OA组(86.7%比25.0%, P <0.05),髌骨、股骨及胫骨骨髓病变程度均显著高于OA组(P <0.05);两组半月板、软骨病变程度的差异无统计学意义。膝关节超声检查显示,RA组滑膜平均厚度显著高于OA组[(5.4±2.3)mm比(2.6±1.3)mm,P <0.05],滑膜增厚及滑膜内血流信号丰富程度均显著高于OA组(P <0.05)。结论膝关节MRI及超声对中晚期活动性膝RA及OA的鉴别诊断有一定价值,尤其是滑膜炎及骨髓水肿程度的判断对RA的诊断有一定帮助。
        Objective To summarize MRI and ultrasound(US) manifestations of knee joints in middle-late active knee rheumatoid arthritis(RA) and osteoarthritis(OA). Methods There were 30 cases with knee RA and 20 cases with knee OA in Aerospace Central Hospital from May 2015 to October 2018. All the patients received MRI and US examination. The differences in the synovitis, bone marrow edema(BME), menisci and articular cartilage between the two groups were analyzed. Results Knee MRI showed that the incidence of synovitis in RA group was significantly higher than that in OA group(86.7%vs. 25.0%, P < 0.05); the degree of BME in patella, femora and tibia was more severe in RA group than that in OA group(P <0.05), while the differences in lesions of menisci and articular cartilage between the two groups were not statistically significant. The US results of knee joints showed that the mean synovial thickness in RA group was higher than that in OA group[(5.4±2.3) mm vs.(2.6±1.3)mm, P < 0.05]; the degree of synovial thickness and blood flow signal in the synovium was more severe in RA group compared with OA group(P < 0.05). Conclusions MRI and US are valuable to differentiate knee RA and OA.Especially, the degree of synovitis and BME is helpful for diagnosis of knee RA.

引文

[1]中华医学会风湿病学分会.类风湿关节炎诊断及治疗指南[J].中华风湿病学杂志, 2010, 14:265-270.
    [2]中华医学会骨科学分会关节外科学组.骨关节炎诊疗指南(2018版)[J].中华骨科杂志, 2018, 38:705-715.
    [3]王植,孟祥虹,锁咏梅,等.膝关节类风湿关节炎与骨关节炎MRI对比研究[J].国际医学放射学杂志, 2013, 36:409-413.
    [4] Baker JF, Conaghan PG, Gandjbakhch F. Update on magnetic resonance imaging and ultrasound in rheumatoid arthritis[J]. Clin Exp Rheumatol, 2018, 114:16-23.
    [5] Song IH, Althoff CE, Hermann KG, et al. Knee osteoarthritis. Efficacy of a new method of contrast-enhanced musculoskeletal ultrasonography in detection of synovitis in patients with knee osteoarthritis in comparison with magnetic resonance imaging[J]. Ann Rheum Dis,2008, 67:19-25.
    [6] Hussain S, Sivakumaran P, Gill A, et al. Ultrasonography-detected subclinical inflammation in patients with hand osteoarthritis and established rheumatoid arthritis:a comparison between two different pathologies using the same ultrasound examination protocol[J]. Musculoskeletal Care, 2018, 16:26-31.
    [7] Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria[J]. Rheumatology(Oxford), 2012, 51:vi5-9.
    [8] Altman R, Asch E, Bloch D. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association[J]. Arthritis Rheum, 1986, 29:1039-1049.
    [9] Stoller DW, Martin C, Crues JV, et al. Meniscal tears:pathologic correlation with MR imaging[J]. Radiology, 1987, 163:731-735.
    [10] Hammer HB, Bolton-King P, Bakkeheim V, et al. Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis[J].Ann Rheum Dis, 2011, 70:1995-1998.
    [11]孟祥虹,王植,万业达,等.膝类风湿关节炎的MRI与病理对照研究[J].国际医学放射学杂志, 2015, 38:511-515.
    [12] Ostrowska M, Masliński W, Prochorec-Sobieszek M, et al. Cartilage and bone damage in rheumatoid arthritis[J]. Reumatologia, 2018, 56:111-120.