Department of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Eur J Radiol. 2011 Jan;77(1):149-55. doi: 10.1016/j.ejrad.2009.06.020. Epub 2009 Jul 24.
In psoriatic arthritis (PsA) multiple locations may show inflammatory changes not always readily accessible to clinical exam. Often, clinical exam is inconclusive and the decision to initiate or adapt therapy is difficult. Whole body (WB)-MRI may help in this situation by providing a comprehensive overview of affected areas/joints. The purpose of this study was to make a proof of concept whether WB-MRI in psoriatic arthritis is feasible and can provide additional information compared to clinical examination alone with regard to therapeutic decision making in patients with PsA and inconclusive clinical situation.
30 patients with PsA and diffuse musculoskeletal pain were examined. A WB-MRI protocol was implemented on a 1.5 Tesla scanner using coronal and sagittal STIR- (TR: 5800, TE: 54, matrix 384(2) pixels, FOV 400 mm) and pre- and steady-state-post-Gadolinium-VIBE sequences (TR: 9.82, TE: 4.53, matrix 384×307 pixels, FOV: 400 mm). MRI was evaluated for image quality and inflammatory findings by two readers in consensus and compared to clinical exam.
The WB-MR-exam was well tolerated by all patients. Image quality was rated good to excellent in 26 of 30 patients (86.6%). WB-MRI detected significantly (p<0.001) more areas of synovitis/enthesitis than clinical exam except for the hands and feet. MRI was able to detect unknown destructive bony changes in 10 patients (53%). In 22 patients (73.3%) the therapy regimen was modified, in 18 patients (62%) TNF-alpha-inhibitors were started.
Whole-body MRI (WB-MRI) may be integrated in the diagnostic work-up of patients with psoriatic arthropathy facilitating individual adaptation of therapeutic strategy.
在银屑病关节炎（PsA）中，多个部位可能会出现炎症改变，而这些改变并不总是容易通过临床检查发现。通常，临床检查结果不确定，难以做出开始或调整治疗的决策。全身磁共振成像（WB-MRI）可以通过提供受影响区域/关节的全面概述来帮助解决这一问题。本研究的目的是验证在银屑病关节炎患者中，WB-MRI 是否可行，并且是否可以在临床检查结果不确定的情况下，为治疗决策提供比单独临床检查更多的信息。
对 30 例患有弥漫性肌肉骨骼疼痛的银屑病关节炎患者进行检查。在 1.5T 扫描仪上使用冠状和矢状位 STIR（TR：5800，TE：54，矩阵 384（2）像素，视野 400mm）和预稳态钆后 VIBE 序列（TR：9.82，TE：4.53，矩阵 384×307 像素，视野：400mm）进行 WB-MRI 检查。由两名读者进行共识评估，根据图像质量和炎症表现对 MRI 进行评估，并与临床检查进行比较。
所有患者均能很好地耐受 WB-MR 检查。26 例（86.6%）患者的图像质量被评为良好至优秀。WB-MRI 检测到的滑膜炎/肌腱炎区域明显多于临床检查（除了手和脚）（p<0.001）。MRI 能够在 10 例患者（53%）中检测到未知的破坏性骨改变。在 22 例患者（73.3%）中，治疗方案发生了改变，在 18 例患者（62%）中开始使用 TNF-α抑制剂。
全身磁共振成像（WB-MRI）可整合到银屑病关节炎患者的诊断中，有助于个体化调整治疗策略。
