Ostendorf B, Peters R, Dann P, Becker A, Scherer A, Wedekind F, Friemann J, Schulitz K P, Mödder U, Schneider M
Center for Rheumatology, Department of Nephrology and Rheumatology, Heinrich-Heine University of Düsseldorf, Germany.
Arthritis Rheum. 2001 Nov;44(11):2492-502. doi: 10.1002/1529-0131(200111)44:11<2492::aid-art429>3.0.co;2-x.
To evaluate and characterize magnetic resonance imaging (MRI) findings in the metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients macroscopically, using miniarthroscopy (MA; needle arthroscopy).
The second MCP joint of the dominant hand of 22 RA patients (13 with various RA activities/stages; 9 with early RA [< or = 1.5 years' duration]) was examined by MRI followed by MA. Findings were evaluated by standardized semiquantitative measures of synovial and bony pathologic changes of the MCP joint, and were compared with the clinical and conventional radiologic findings.
Erosions and pre-erosions were detected in 17 of 22 patients by MRI; 2 of the other 5 patients (all early RA) displayed bony changes on MA. All 10 joints with pre-erosions on MRI (grade I bony alterations on MRI) exhibited significant cartilaginous and bony pathology on MA. Synovial membrane pathology was detected in all but 1 patient by MRI and in all patients by MA, although findings of plain radiography were normal in 6 of the 22 patients and another 9 patients had a Larsen score of 1. Semiquantitative analysis of synovial findings of MRI revealed gadolinium diethylenetriaminepentaacetic acid enhancement as a significant marker of macroscopically varied synovial vascularity and hyperemia, both of which strongly correlated with clinical activity (as measured by the Disease Activity Score). The extent of synovitis/synovial proliferation shown by MA and MRI were significantly correlated with each other, but not with any other activity or damage parameter analyzed.
In RA, both MRI and MA findings support early detection and staging of synovial changes. Ongoing longitudinal studies are aimed at evaluating the value of synovial proliferation as visualized by both methods.
使用微型关节镜检查（MA；针式关节镜），宏观评估和描述类风湿关节炎（RA）患者掌指（MCP）关节的磁共振成像（MRI）表现。
对22例RA患者优势手的第二MCP关节进行检查，其中13例处于不同的RA活动期/阶段，9例为早期RA（病程≤1.5年），先进行MRI检查，随后进行MA检查。通过对MCP关节滑膜和骨质病理变化的标准化半定量测量来评估结果，并与临床和传统放射学检查结果进行比较。
22例患者中，17例通过MRI检测到侵蚀和侵蚀前期病变；另外5例患者（均为早期RA）中有2例在MA检查中显示有骨质改变。MRI上有侵蚀前期病变的所有10个关节（MRI上的I级骨质改变）在MA检查中均表现出明显的软骨和骨质病理改变。除1例患者外，所有患者通过MRI检测到滑膜病理改变，所有患者通过MA检查均检测到滑膜病理改变，尽管22例患者中有6例平片检查结果正常，另外9例患者的 Larsen 评分为1级。对MRI滑膜表现的半定量分析显示，钆喷酸葡胺增强是宏观上不同滑膜血管化和充血的重要标志，两者均与临床活动度（通过疾病活动评分衡量）密切相关。MA和MRI显示的滑膜炎/滑膜增生程度彼此显著相关，但与分析的任何其他活动或损伤参数均无相关性。
在RA中，MRI和MA检查结果均支持滑膜变化的早期检测和分期。正在进行的纵向研究旨在评估两种方法所显示的滑膜增生的价值。
