Wakefield R J, O'Connor P J, Conaghan P G, McGonagle D, Hensor E M A, Gibbon W W, Brown C, Emery P
Chapel Allerton Hospital, Leeds, UK.
Arthritis Rheum. 2007 Oct 15;57(7):1158-64. doi: 10.1002/art.23016.
To investigate the frequency and distribution of finger tenosynovitis in patients with early, untreated rheumatoid arthritis (RA) using gray-scale ultrasound (US) and magnetic resonance imaging (MRI).
Fifty patients underwent US and MRI of metacarpophalangeal (MCP) joints 2-5. Twenty healthy controls underwent US only. Flexor and extensor involvement was documented for each joint. Intrareader reliability (IRR) was calculated by rereading static images.
Flexor tenosynovitis was found in 57 (28.5%) of 200 joints in 24 (48%) of 50 patients on US compared with 128 (64%) of 200 joints in 41 (82%) of 50 patients on MRI. Periextensor tenosynovitis was found in 14 (7%) joints in 9 (18%) patients on US compared with 80 (40%) joints in 36 (72%) patients on MRI. No controls had imaging tenosynovitis. Using MRI as the gold standard, the sensitivity, specificity, and negative and positive predictive values for US were 0.44, 0.99, 0.49, and 0.98, respectively, for flexor tenosynovitis and 0.15, 0.98, 0.63, and 0.86 for extensor tenosynovitis, respectively. The IRR was 0.85 and 0.8 for US and MRI, respectively. The most frequently involved joints on US and MRI were the second and third MCP joints.
This is the first study to compare US and MRI for the detection of tenosynovitis in the fingers of patients with early untreated RA. Tenosynovitis was found to be common using both modalities, with MRI being more sensitive. A negative US scan does not exclude inflammation and an MRI should be considered. Further work is recommended to standardize definitions and image acquisition for both US and MRI images.
采用灰阶超声（US）和磁共振成像（MRI）研究早期未经治疗的类风湿关节炎（RA）患者手指腱鞘炎的发生率及分布情况。
50例患者接受了第2至5掌指（MCP）关节的超声和磁共振成像检查。20名健康对照者仅接受了超声检查。记录每个关节的屈肌和伸肌受累情况。通过重新读取静态图像计算阅片者内可靠性（IRR）。
超声检查发现，50例患者中24例（48%）的200个关节中有57个（28.5%）存在屈肌腱鞘炎，而磁共振成像检查发现50例患者中41例（82%）的200个关节中有128个（64%）存在屈肌腱鞘炎。超声检查发现9例（18%）患者的14个（7%）关节存在伸肌周围腱鞘炎，而磁共振成像检查发现36例（72%）患者的80个（40%）关节存在伸肌周围腱鞘炎。对照组均未出现影像学腱鞘炎。以磁共振成像作为金标准，超声检查对于屈肌腱鞘炎的敏感性、特异性、阴性预测值和阳性预测值分别为0.44、0.99、0.49和0.98，对于伸肌腱鞘炎分别为0.15、0.98、0.63和0.86。超声和磁共振成像的阅片者内可靠性分别为0.85和0.8。超声和磁共振成像检查中最常受累的关节是第二和第三掌指关节。
这是第一项比较超声和磁共振成像在早期未经治疗的类风湿关节炎患者手指腱鞘炎检测中的研究。两种检查方式均发现腱鞘炎很常见，磁共振成像更敏感。超声扫描阴性不能排除炎症，应考虑进行磁共振成像检查。建议进一步开展工作以规范超声和磁共振成像图像的定义及采集。
