Departments of Radiology and Rheumatology, Hospital Universitario de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Spain.
Radiographics. 2010 Jan;30(1):143-63; discussion 163-5. doi: 10.1148/rg.301095089.
Early diagnosis and treatment have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. However, diagnosis is somewhat difficult in the early stages of the disease because the diagnostic criteria were developed from data obtained in patients with established rheumatoid arthritis and therefore are not readily applicable. Magnetic resonance (MR) imaging is increasingly being used in the assessment of rheumatoid arthritis due to its capacity to help identify the key pathologic features of this disease entity at presentation. MR imaging has demonstrated greater sensitivity for the detection of synovitis and erosions than either clinical examination or conventional radiography and can help establish an early diagnosis of rheumatoid arthritis. It also allows the detection of bone marrow edema, which is thought to be a precursor for the development of erosions in early rheumatoid arthritis as well as a marker of active inflammation. In addition, MR imaging can help differentiate rheumatoid arthritis from some clinical subsets of peripheral spondyloarthropathies by allowing identification of inflammation at the insertions of ligaments and tendons (enthesitis).
早期诊断和治疗已被认为是改善早期类风湿关节炎患者临床结局的关键。然而，由于诊断标准是根据已确诊的类风湿关节炎患者的数据制定的，因此在疾病早期的诊断有些困难，并不容易适用。由于磁共振成像（MRI）能够帮助识别该疾病实体在发病时的关键病理特征，因此它在类风湿关节炎的评估中越来越多地被使用。与临床检查或常规 X 射线相比，MRI 对滑膜炎和侵蚀的检测具有更高的敏感性，有助于早期诊断类风湿关节炎。它还可以检测骨髓水肿，骨髓水肿被认为是早期类风湿关节炎侵蚀发展的前兆，也是炎症活动的标志物。此外，MRI 通过识别韧带和肌腱附着处的炎症（附着点炎），有助于将类风湿关节炎与某些外周脊柱关节炎的临床亚型区分开来。
