Døhn Uffe Møller, Ejbjerg Bo J, Hasselquist Maria, Narvestad Eva, Møller Jakob, Thomsen Henrik S, Østergaard Mikkel
Department of Rheumatology, Copenhagen University Hospital Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
Arthritis Res Ther. 2008;10(1):R25. doi: 10.1186/ar2378. Epub 2008 Feb 28.
The objectives of the present study were, with multidetector computed tomography (CT) as the reference method, to determine the performance of magnetic resonance imaging (MRI) and radiography for the detection of bone erosions in rheumatoid arthritis wrist bones, and to test whether measuring volumes of erosions on CT and MRI is reproducible and correlated to semiquantitative assessments (scores) of erosions on CT, MRI and radiography.
Seventeen patients with rheumatoid arthritis and four healthy control individuals underwent CT, MRI and radiography of one wrist, performed on the same day. CT was performed on a Philips Mx8000IDT unit (voxel size 0.4 mm x 0.4 mm x 1 mm) and MRI was performed on a Philips Panorama 0.6T unit (voxel size 0.4 mm x 0.4 mm x 0.4 mm). Images were evaluated separately for erosions in all wrist bones and were scored according to the principles of the Outcome Measures in Rheumatology Rheumatoid Arthritis MRI Scoring System (CT and MRI) and the Sharp/van der Heijde (radiographs) scoring methods. Measurements of erosion volumes of all erosions were performed twice with a 1-week interval.
With CT as the reference method, the overall sensitivity, specificity and accuracy (concordance) of MRI for detecting erosions were 61%, 93% and 77%, respectively, while the respective values were 24%, 99% and 63% for radiography. The intramodality agreements when measuring erosion volumes were high for both CT and MRI (Spearman correlation coefficients 0.92 and 0.90 (both P < 0.01), respectively). Correlations between volumes and scores of individual erosions were 0.96 for CT and 0.99 for MRI, while they were 0.83 (CT) and 0.80 (MRI) for persons' total erosion volume and total score (all P < 0.01).
With CT as the reference method, MRI showed moderate sensitivity and good specificity and accuracy for detection of erosions in rheumatoid arthritis and healthy wrist bones, while radiography showed very low sensitivity. The tested volumetric method was highly reproducible and correlated to scores of erosions.
本研究的目的是以多排螺旋计算机断层扫描（CT）作为参考方法，确定磁共振成像（MRI）和X线摄影术在检测类风湿性关节炎腕骨骨侵蚀方面的性能，并测试在CT和MRI上测量侵蚀体积是否具有可重复性，以及是否与CT、MRI和X线摄影术上侵蚀的半定量评估（评分）相关。
17例类风湿性关节炎患者和4名健康对照个体于同一天对一只手腕进行了CT、MRI和X线摄影检查。CT检查使用飞利浦Mx8000IDT设备（体素大小为0.4mm×0.4mm×1mm），MRI检查使用飞利浦全景0.6T设备（体素大小为0.4mm×0.4mm×0.4mm）。对所有腕骨的侵蚀情况分别进行图像评估，并根据风湿病学类风湿性关节炎MRI评分系统（CT和MRI）及Sharp/van der Heijde（X线片）评分方法的原则进行评分。对所有侵蚀的侵蚀体积测量进行两次，间隔1周。
以CT作为参考方法，MRI检测侵蚀的总体敏感性、特异性和准确性（一致性）分别为61%、93%和77%，而X线摄影术的相应值分别为24%、99%和63%。CT和MRI在测量侵蚀体积时的模态内一致性都很高（Spearman相关系数分别为0.92和0.90（均P<0.01））。单个侵蚀的体积与评分之间的相关性，CT为0.96，MRI为0.99，而个体的总侵蚀体积与总分之间的相关性，CT为0.83，MRI为0.80（均P<0.01）。
以CT作为参考方法，MRI对类风湿性关节炎和健康腕骨侵蚀的检测显示出中等敏感性、良好的特异性和准确性，而X线摄影术的敏感性非常低。所测试的体积测量方法具有高度可重复性，且与侵蚀评分相关。
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