Østergaard Mikkel, Hansen Michael, Stoltenberg Michael, Jensen Karl Erik, Szkudlarek Marcin, Pedersen-Zbinden Brigitta, Lorenzen Ib
Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
Arthritis Rheum. 2003 Aug;48(8):2128-31. doi: 10.1002/art.11076.
In a 5-year followup study, we investigated the temporal relationship between development of wrist joint erosions as visualized by magnetic resonance imaging (MRI) versus conventional radiography (CR), in patients with rheumatoid arthritis. We also evaluated the risk of erosive progression on CR associated with the presence of MRI erosions.
In 10 patients with rheumatoid arthritis, MRI and CR of the dominant wrist were performed annually for 5 years. In each image set, each wrist bone (metacarpal bases, carpal bones, radius, and ulna) was assessed for the absence or presence of bone erosions.
Nine bones showed radiographic erosions at baseline. Twenty-seven new radiographic erosions developed during the 5-year followup period. Of these 27 new erosions, 21 were detected 1-5 years earlier by MRI than by CR, 3 were simultaneously detected by both methods, 2 were detected 1-2 years later by MRI than by CR, and 1 erosion (radiographically detected at 5-year followup) was not visualized with MRI. MRI detection of new radiographic erosions preceded CR detection by a median of 2 years. In bones with MRI erosions at baseline, the relative risk of radiographic erosions at 5-year followup was 4.5 (95% confidence interval [95% CI] 2.6-7.6), compared with bones without baseline MRI erosions. If bones with baseline radiographic erosions were excluded from the analysis, the relative risk was 4.1 (95% CI 2.2-7.5).
Most new radiographic bone erosions (78%) were visualized at least 1 year earlier by MRI than by CR. This illustrates that the information on joint destruction provided by CR is considerably delayed compared with that provided by MRI. A significantly increased risk of progression of radiographic erosion in bones with baseline MRI erosions was observed, demonstrating a prognostic value of MRI with respect to long-term radiographic outcome.
在一项为期5年的随访研究中，我们调查了类风湿关节炎患者通过磁共振成像（MRI）与传统X线摄影（CR）观察到的腕关节侵蚀发展的时间关系。我们还评估了与MRI侵蚀的存在相关的CR上侵蚀性进展的风险。
对10例类风湿关节炎患者的优势腕进行了为期5年的年度MRI和CR检查。在每组图像中，评估每块腕骨（掌骨基底、腕骨、桡骨和尺骨）是否存在骨侵蚀。
9块骨骼在基线时显示有X线侵蚀。在5年的随访期内出现了27处新的X线侵蚀。在这27处新侵蚀中，21处通过MRI比CR早1 - 5年检测到，3处两种方法同时检测到，2处通过MRI比CR晚1 - 2年检测到，1处侵蚀（在5年随访时通过X线检测到）MRI未显示。MRI检测新的X线侵蚀比CR检测提前的中位数为2年。与基线时无MRI侵蚀的骨骼相比，基线时有MRI侵蚀的骨骼在5年随访时出现X线侵蚀的相对风险为4.5（95%置信区间[95%CI]2.6 - 7.6）。如果将基线时有X线侵蚀的骨骼排除在分析之外，相对风险为4.1（95%CI 2.2 - 7.5）。
大多数新的X线骨侵蚀（78%）通过MRI比CR至少早1年显示。这表明与MRI相比，CR提供的关节破坏信息明显延迟。观察到基线时有MRI侵蚀的骨骼中X线侵蚀进展的风险显著增加，证明了MRI对长期X线结果的预后价值。
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