Mochizuki T, Mitobe M, Mifune N, Takahashi M
Department of Nephrology, Kameda General Hospital, Chiba, Japan.
Nihon Jinzo Gakkai Shi. 1999 Jan;41(1):14-20.
Dialysis-related amyloidosis (DRA) is a major complication of long-term hemodialysis patients. The onset of arthropathy is frequently preceded by carpal tunnel syndrome, but the early non-invasive diagnosis of DRA remains unclear. beta 2-microglobulin amyloid deposits in joint synovia and soft tissue precede radiological abnormalities. Magnetic resonance imaging (MRI) may play a more important role in the early diagnosis of DRA, because it allows direct visualization of synovitis and deposition of abnormal soft tissue. The purpose of this study was to evaluate the usefulness of MRI of the wrist for the early diagnosis of DRA. The study included 72 patients (male 37, female 35) undergoing hemodialysis from initiation to 20 years. The patients were examined by MR images of synovitis, deposition of abnormal soft tissue and cystic bone lesions at the wrists. Normal MR images of synovia and soft tissue were defined in 6 control subjects (2 normal 4 non-dialysis patients). Synovitis of the carpal bones was found in 23% of the patients at the start of hemodialysis. Deposition of abnormal soft tissue in the carpal canal and cystic bone lesions were detected after 1 and 2 years of hemodialysis, respectively. All findings were increased significantly with an increasing duration of dialysis. Synovitis was present in 90% of the patients with deposition of abnormal soft tissue, and in 80% of the patients with cystic bone lesions. beta 2-microglobulin value was significantly higher in patients with synovitis, deposition of abnormal soft tissue and cystic bone lesions than in patients without these findings. Our experience suggest that synovitis examined by MRI of the wrists is useful for the early diagnosis of DRA. Thereby, intensive follow-up and management of DRA are required in patients with synovitis at the start of hemodialysis.
透析相关性淀粉样变（DRA）是长期血液透析患者的主要并发症。关节病的发作常常先于腕管综合征，但DRA的早期非侵入性诊断仍不明确。β2-微球蛋白淀粉样沉积物在关节滑膜和软组织中出现早于放射学异常。磁共振成像（MRI）可能在DRA的早期诊断中发挥更重要的作用，因为它可以直接观察滑膜炎和异常软组织的沉积。本研究的目的是评估腕关节MRI对DRA早期诊断的实用性。该研究纳入了72例血液透析患者（男性37例，女性35例），透析时间从开始到20年。对患者进行腕关节滑膜炎、异常软组织沉积和囊性骨病变的磁共振成像检查。在6名对照受试者（2名正常，4名非透析患者）中定义了滑膜和软组织的正常磁共振图像。血液透析开始时，23%的患者发现腕骨滑膜炎。分别在血液透析1年和2年后检测到腕管内异常软组织沉积和囊性骨病变。所有结果均随着透析时间的延长而显著增加。90%有异常软组织沉积的患者存在滑膜炎，80%有囊性骨病变的患者存在滑膜炎。有滑膜炎、异常软组织沉积和囊性骨病变的患者的β2-微球蛋白值显著高于无这些表现的患者。我们的经验表明，通过腕关节MRI检查的滑膜炎对DRA的早期诊断有用。因此，对于血液透析开始时患有滑膜炎的患者，需要对DRA进行密切随访和管理。
