Tehranzadeh Jamshid, Ashikyan Oganes, Anavim Arash, Shin John
Department of Radiological Sciences, University of California, Irvine, USA.
Skeletal Radiol. 2008 May;37(5):433-42. doi: 10.1007/s00256-008-0451-6. Epub 2008 Feb 20.
The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA).
We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session.
The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The "rheumatoid" type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%.
Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive in the wrists than in the hands.
对银屑病关节炎（PsA）患者的手部和腕部受累的软组织、肌腱、关节及骨骼进行详细分析。
我们回顾了10例临床诊断为PsA患者的23项对比增强磁共振成像研究（13例手部和10例腕部）。我们从病历中获取临床信息，并评估图像中是否存在侵蚀、骨髓水肿、关节滑膜炎、腱鞘炎、腕管及软组织受累情况。两名获得委员会认证的肌肉骨骼放射科医生独立审阅了所有图像。差异在随后的联合会议中得到解决。
疾病平均病程为71.3个月，范围从1个月至25年。10例腕部中有8例（80%）、13例手部中有6例出现骨侵蚀。10例腕部中有5例（50%）、14例手部中有4例（31%）显示骨髓异常。10例腕部中有6例（60%）出现三角纤维软骨撕裂。所有研究中均存在腕部和手部关节滑膜炎（67个腕关节和101个手部关节）。10例腕部中有9例（90%）检测到腕部软组织受累，13例手部中有12例（92%）存在手部软组织受累。软组织受累区域附近的表现包括滑膜炎（4例腕部）和腱鞘炎（3例腕部）。1例腕部可见软组织受累区域附近的骨髓水肿。10例腕部中有4例（40%）出现屈肌支持带膨出，10例腕部中有8例（80%）出现正中神经强化。所有研究中均可见腱鞘炎（所有10例手部和所有13例腕部）。在我们的研究中，骨病变的“类风湿”型分布很常见。不同发现的观察者间一致性范围为83%至100%。
对比增强磁共振成像明确显示了骨髓水肿、侵蚀、肌腱和软组织疾病以及正中神经受累情况，在手部和腕部PsA患者中观察者间可靠性良好。疾病在腕部比在手部更广泛。
