Taouli Bachir, Zaim Souhil, Peterfy Charles G, Lynch John A, Stork Alexander, Guermazi Ali, Fan Bo, Fye Kenneth H, Genant Harry K
Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA 94143-0628, USA.
AJR Am J Roentgenol. 2004 Apr;182(4):937-43. doi: 10.2214/ajr.182.4.1820937.
The purpose of this study was to compare the relative results from conventional high-field-strength 1.5-T MRI, 0.2-T low-field-strength dedicated extremity MRI, and radiography to detect and grade bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis.
Eighteen patients with rheumatoid arthritis underwent conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and conventional radiography of both hands and wrists. Two independent reviewers searched for the presence and extent of bone erosions, joint-space narrowing, and synovitis. Bone erosions (E scores) and joint-space narrowing (J scores) were evaluated at 14 and 13 sites, respectively, on conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and radiography, using the Sharp-Genant scoring system. Synovitis (S scores) were evaluated at 13 sites on conventional high-field-strength MRI and low-field-strength dedicated extremity MRI.
For the detection of bone erosions, we found no significant difference (p = 0.71) between conventional high-field-strength MRI (mean +/- SD E score, 27.5 +/- 9.8) and low-field-strength dedicated extremity MRI (28.8 +/- 10.0), but a significant difference (p < 0.001) appeared between MRI and radiography (13.1 +/- 8.3). J scores derived from MRI (conventional high-field-strength MRI, 15.2 +/- 8.3; low-field-strength dedicated extremity MRI, 14.5 +/- 10.4) were higher than those derived from radiography (12.7 +/- 9.6), although the difference was not significant (p = 0.70). Conventional high-field-strength MRI (S score, 35.1 +/- 8.6) and low-field-strength dedicated extremity MRI (30.8 +/- 10.2) were equivalent (p = 0.14) for the evaluation of synovitis. The interobserver agreement for MRI scores was good to excellent (intraclass correlation coefficients, 0.83-0.94).
Conventional high-field-strength MRI and low-field-strength dedicated extremity MRI showed similar results in terms of cross-sectional grading of bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis.
本研究旨在比较传统高场强1.5-T磁共振成像（MRI）、0.2-T低场强专用四肢MRI及X线摄影在检测类风湿关节炎患者手部和腕部骨侵蚀、关节间隙狭窄及滑膜炎并对其进行分级方面的相对结果。
18例类风湿关节炎患者接受了双手和双腕的传统高场强MRI、低场强专用四肢MRI及传统X线摄影检查。两名独立的评估者查找骨侵蚀、关节间隙狭窄及滑膜炎的存在情况和范围。使用Sharp-Genant评分系统，在传统高场强MRI、低场强专用四肢MRI及X线摄影上，分别在14个和13个部位评估骨侵蚀（E评分）和关节间隙狭窄（J评分）。在传统高场强MRI和低场强专用四肢MRI上的13个部位评估滑膜炎（S评分）。
对于骨侵蚀的检测，我们发现传统高场强MRI（平均±标准差E评分，27.5±9.8）与低场强专用四肢MRI（28.8±10.0）之间无显著差异（p = 0.71），但MRI与X线摄影之间存在显著差异（p < 0.001）（13.1±8.3）。MRI得出的J评分（传统高场强MRI，15.2±8.3；低场强专用四肢MRI，14.5±10.4）高于X线摄影得出的J评分（12.7±9.6），尽管差异不显著（p = 0.70）。对于滑膜炎的评估，传统高场强MRI（S评分，35.1±8.6）与低场强专用四肢MRI（30.8±10.2）相当（p = 0.14）。MRI评分的观察者间一致性良好至优秀（组内相关系数，0.83 - 0.94）。
在类风湿关节炎患者手部和腕部骨侵蚀、关节间隙狭窄及滑膜炎的横断面分级方面，传统高场强MRI和低场强专用四肢MRI显示出相似的结果。
