Mori Gen, Tokunaga Daisaku, Takahashi Kenji A, Hojo Tatsuya, Fujiwara Hiroyoshi, Arai Yuji, Taniguchi Daigo, Takatori Ryota, Imai Kan, Otakara Eigo, Ito Hirotoshi, Nishimura Tsunehiko, Kubo Toshikazu
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan.
Mod Rheumatol. 2008;18(3):247-51. doi: 10.1007/s10165-008-0043-2. Epub 2008 Mar 4.
In this study, we investigated the usefulness of contrast-enhanced MRI with maximum intensity projection (MIP) as a convenient tool for detecting early rheumatoid arthritis (RA). A total of 21 patients with undiagnosed arthritis of the hands at the initial visit were enrolled in a prospective study over a 1-year period. The number of swollen joints found during physical examination at this first visit, the results of serological tests and the number of synovitis joints diagnosed on MIP images were compared between the RA group and non-RA group. Of the 21 patients, 17 (81%) from the initial study who were followed up for an additional 1 year entered this study. Of these, 5 met the conditions for diagnosis of RA during follow-up, and 12 did not. MIP images were used to review the arthritis of RA patients, and a significant difference was found in the number of synovitis inflammations detected with MIP images when compared with findings after physical examinations. The two criteria of positive CARF and/or anti-CCP antibody and symmetrical synovitis in bilateral hands on MIP images allowed the prediction of RA with 100% sensitivity and 75% specificity. Thus, MIP is a useful tool for making early diagnosis of RA because it yields clear visualization even with just one image.
在本研究中，我们调查了采用最大强度投影（MIP）的对比增强磁共振成像（MRI）作为检测早期类风湿关节炎（RA）的便捷工具的实用性。共有21例初诊时手部关节炎未确诊的患者参加了为期1年的前瞻性研究。比较了RA组和非RA组在首次就诊时体格检查发现的肿胀关节数量、血清学检测结果以及MIP图像上诊断的滑膜炎关节数量。在最初研究的21例患者中，有17例（81%）在后续又随访了1年并进入本研究。其中，5例在随访期间符合RA诊断标准，12例不符合。使用MIP图像复查RA患者的关节炎情况，与体格检查结果相比，MIP图像检测到的滑膜炎炎症数量存在显著差异。CARF和/或抗CCP抗体阳性以及MIP图像上双手对称性滑膜炎这两个标准对RA的预测敏感性为100%，特异性为75%。因此，MIP是早期诊断RA的有用工具，因为即使仅通过一张图像也能实现清晰的可视化。
