Krolak C, Wirth S, Hoepfner S, Treitl M, Becker-Gaab C, Reiser M
Institut für Klinische Radiologie-Innenstadt, Ludwig-Maximilians-Universität München, Munich.
Ultraschall Med. 2003 Apr;24(2):101-6. doi: 10.1055/s-2003-38666.
The early stage of rheumatoid arthritis (RA) is primarily manifested in the soft tissue of the hand. Although ultrasound (US) is regarded as an important imaging process in diagnostic medicine, precise characterization of sonomorphological changes has not yet been undertaken.
20 patients with RA were examined with US. Two radiologists described semiquantitatively the characteristics of synovial changes in the hand in a consensus-based process and measured the synovial width. Statistical methods were used to determine whether the various synovial changes differed significantly and to identify the most frequent locations of changes.
On the basis of the significant differences in morphology and synovial width, it is possible to distinguish between unremarkable findings, pannus tissue and band-like synovitis. Pannus tissue is most frequently found on the finger flexor tendons (FFT), the metacarpophalangeal joints (MCP) and the tendon of M. extensor carpi ulnaris (ECU). Band-like synovitis exhibits an uncharacteristic distribution pattern with a slight propensity to favour these locations.
The FFT, MCP joints and ECU tendons are particularly important in systematic US screening of the hand for the purpose of establishing reliable evidence of inflammatory changes. Different stages of RA can be identified on the basis of the characteristic types of synovitis and the number of joints and tendons affected.
类风湿关节炎（RA）的早期主要表现在手部软组织。尽管超声（US）在诊断医学中被视为一种重要的成像检查方法，但尚未对超声形态学变化进行精确表征。
对20例RA患者进行超声检查。两名放射科医生以基于共识的流程半定量描述手部滑膜变化的特征，并测量滑膜宽度。采用统计方法确定各种滑膜变化是否存在显著差异，并确定最常见的变化部位。
基于形态和滑膜宽度的显著差异，可以区分无明显异常表现、血管翳组织和带状滑膜炎。血管翳组织最常见于指屈肌腱（FFT）、掌指关节（MCP）和尺侧腕伸肌（ECU）肌腱。带状滑膜炎表现出无特征性的分布模式，略有倾向于这些部位。
在对手部进行系统性超声筛查以建立炎症变化的可靠证据时，FFT、MCP关节和ECU肌腱尤为重要。根据滑膜炎的特征类型以及受累关节和肌腱的数量，可以识别RA的不同阶段。
