Palosaari Kari, Vuotila Jorma, Takalo Reijo, Jartti Airi, Niemelä Raija K, Karjalainen Anna, Haapea Marianne, Soini Irma, Tervonen Osmo, Hakala Markku
Department of Diagnostic Radiology, Oulu University Hospital, Kajaanintie 50, FIN-90029, BOX 50, Oulu, Finland.
Rheumatology (Oxford). 2006 Dec;45(12):1542-8. doi: 10.1093/rheumatology/kel137. Epub 2006 May 2.
To investigate if disease assessment by contrast-enhanced dynamic and static magnetic resonance imaging (MRI) and quantitative nanocolloid (NC) scintigraphy gives useful additional information in early rheumatoid arthritis (RA).
Twenty-seven patients with early RA (disease duration < or =12 months) were followed up for 1 yr and 24 of them for 2 yrs with contrast-enhanced MRI and NC scintigraphy of the wrist joint. Synovial inflammation was assessed by measuring time-dependent enhancement rates (E-rate) from dynamic MRI scans and technetium(99m)-labelled nanocolloid ((99m)Tc-NC) uptake from scintigraphy scans. Synovial membrane hypertrophy, bone oedema and erosions were semiquantitatively scored according to the Outcome Measures in Rheumatology Clinical Trials RA-MRI scoring system from static MR images. Response to the treatment was evaluated based on whether or not > or = 50% improvement was achieved in the tender and swollen joint scores and the Health Assessment Questionnaire score, with normal C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) levels. Progression of the erosion score on wrist MRI was evaluated as the outcome.
The baseline MRI bone oedema score (rho= 0.67), MRI synovitis score (rho= 0.57), ESR (rho= 0.56), CRP (rho= 0.48), E-rate (rho= 0.47) and (99m)Tc-NC uptake (rho= 0.45) were related with the change in the MRI erosion score from baseline to 2 yrs (rho= Spearman's correlation). In the multivariate logistic regression model, the bone marrow oedema score was the only baseline variable that predicted erosive progression at 2 yrs' follow-up (OR 4.2, 95% CI 1.3-13.8). The median (interquartile range) change in the erosion score from baseline to 2 yrs was 0 (0, 0) and 4 (2, 5) in the patients with (n= 9) and without (n= 15) a persistent clinical response over the 2 yrs, respectively (P= 0.001). The non-responders who presented with erosive progression from 1 yr to 2 yrs had higher MRI synovitis scores, bone oedema scores, E-rate and (99m)Tc-NC uptake at 1-yr follow-up than the non-responders without progressive bone damage.
The degree of local synovial inflammation at baseline, evaluated by dynamic and static MRI and quantitative NC scintigraphy, is closely related to the progression of wrist joint erosions during the first 2 yrs of the disease. Furthermore, at follow-up, if no persistent clinical response is achieved, these imaging methods may help to predict future erosiveness and help in clinical therapeutic decision making.
研究通过对比增强动态和静态磁共振成像（MRI）以及定量纳米胶体（NC）闪烁扫描术进行疾病评估是否能为早期类风湿关节炎（RA）提供有用的额外信息。
对27例早期RA患者（病程≤12个月）进行了为期1年的随访，其中24例进行了为期2年的随访，采用腕关节对比增强MRI和NC闪烁扫描术。通过测量动态MRI扫描的时间依赖性增强率（E率）和闪烁扫描术扫描的锝（99m）标记纳米胶体（（99m）Tc-NC）摄取量来评估滑膜炎症。根据类风湿关节炎临床试验MRI评分系统中的结果测量指标，对静态MR图像中的滑膜肥厚、骨髓水肿和侵蚀进行半定量评分。根据压痛和肿胀关节评分以及健康评估问卷评分是否改善≥50%且C反应蛋白（CRP）或红细胞沉降率（ESR）水平正常来评估治疗反应。将腕部MRI上侵蚀评分的进展作为结果进行评估。
基线MRI骨髓水肿评分（rho = 0.67）、MRI滑膜炎评分（rho = 0.57）、ESR（rho = 0.56）、CRP（rho = 0.48）、E率（rho = 0.47）和（99m）Tc-NC摄取量（rho = 0.45）与从基线到2年时MRI侵蚀评分的变化相关（rho = Spearman相关性）。在多变量逻辑回归模型中，骨髓水肿评分是唯一能预测2年随访时侵蚀进展的基线变量（比值比4.2，95%置信区间1.3 - 13.8）。在2年期间有（n = 9）和无（n = 15）持续临床反应的患者中，从基线到2年侵蚀评分的中位数（四分位间距）变化分别为0（0，0）和4（2，5）（P = 0.001）。从1年到2年出现侵蚀进展的无反应者在1年随访时的MRI滑膜炎评分、骨髓水肿评分、E率和（99m）Tc-NC摄取量高于无进行性骨损伤的无反应者。
通过动态和静态MRI以及定量NC闪烁扫描术评估的基线局部滑膜炎症程度与疾病最初2年期间腕关节侵蚀的进展密切相关。此外，在随访时，如果未实现持续的临床反应，这些成像方法可能有助于预测未来的侵蚀性，并有助于临床治疗决策。
