【摘要】 目的:探讨手腕部动态增强MRI评估早期类风湿关节炎(RA)治疗效果的临床意义。方法:26例早期RA患者于治疗前1周内及治疗后4周时均行手腕部DCE-MRI检查。在增厚的滑膜或血管翳处选取感兴趣区,绘制时间-信号强度曲线,计算早期增强率(REE)和最大灌注斜率(SSmax)。观察和记录患者的临床症状及实验室检查指标,计算(disease activity score in 28joints,DAS-28),分析治疗前后REE和SSmax与DAS-28的相关性。根据时间-信号强度曲线类型将治疗后患者分为急性期和缓解期两组,比较两组间SSmax、REE及DAS-28的差异。结果:治疗前26例患者(100%)均有不同程度的滑膜增生、血管翳生成,18例(69.2%)出现骨髓水肿征象,3例(11.5%)可见腱鞘炎。治疗后滑膜的REE、SSmax值及DAS-28均较治疗前明显下降(4.66±1.30vs 3.21±0.83;6.26±1.61vs4.18±1.16;4.58±1.34vs 3.80±0.77),差异均具有统计学意义(P<0.05)。治疗后DCE-MRI显示,15例患者的灌注曲线呈速升-平台型,但信号强度较治疗前显著降低;11例患者为缓升型。急性期和缓解期患者的REE、SSmax和DAS-28(3.53±0.89vs 2.79±0.54,4.82±1.10vs 3.30±0.45,3.34±0.93vs 2.99±0.44)间的差异均具有统计学意义(P<0.05)。结论:DCE-MRI可以直观、清晰地显示手腕部早期类风湿关节炎的病理变化,确定临床分期和评估疗效,为早期类风湿关节炎临床治疗计划的制订提供有效的影像依据。更多还原

【Abstract】 Objective:To explore the value of the dynamic contrast-enhanced MRI of wrist with the early stage of rheumatoid arthritis in evaluating the therapeutic effectiveness.Methods:Twenty-six patients with early arthritis(arthritis duration <1year)were included.DCE-MRI was performed on an more inflamed wrist joint of each patient at baseline and 4weeks after treatment.A time-signal intensity(SI-T)curve was plotted from the region of interest(ROI).The rate of enhancement in early stage(REE)according to the SI-T curve was calculated.The clinical data were collected,including the level of rheumatoid factor(RF),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP),and the number of joints with swelling and pain.And then the disease activity score in 28joints(DAS-28)was calculated.Approach to find the relationship among SSmax,REE to DAS28.Classificting the curative effect to stages of activity and quiescence according to the time-signal intensity(SI-T)curve.SPSS 17.0statistic was performed to analyze the difference between the two groups.Results:MRI routine scan showed:before treatment,26 patients had different degree of synovial hyperplasia or pannus formation,18 cases of bone marrow edema,3cases of tenosynovitis.The difference of REE,SSmax and DAS-28 between the patients before and after treatment was statistically significant(P<0.01).After treatment,the perfusion curve of DCE-MRI showed that the perfusion curve of 15 patients was rapid ascending to platform type,but the signal intensity was significantly decreased,and a slow ascending type was performed in 11 patients.According to the type of time signal intensity curve,the patients were divided into two groups:acute and remission stage.The difference of REE,SSmax and DAS-28 between the two groups was statistically significant(P<0.01).Conclusion:In clinical applications,DCE-MRI can reflect the pathological change of RA and help to diagnose and discriminate diagnose.SSmax and REE can provide quantitative evidence of pathological change.So DCE-MRI of wrist can provide to detect the changes,then reflect the therapeutic efficacy.更多还原