Department of Molecular Medicine and Pathology, University of Auckland, New Zealand.
Ann Rheum Dis. 2010 Nov;69(11):1971-5. doi: 10.1136/ard.2009.127324. Epub 2010 May 14.
To develop and test an MRI cartilage scoring system for use at the wrist in rheumatoid arthritis (RA).
MRI scans were obtained using a 3T MRI scanner with dedicated wrist coil in 22 early and 16 established RA patients plus 22 controls. Axial and coronal T1-weighted (precontrast and postcontrast) and T2-weighted turbo spin echo sequences were obtained. Eight wrist joints were scored for cartilage narrowing: distal radioulnar, radiolunate, radioscaphoid, triquetrum-hamate, capitate-lunate, scaphotrapezoid, second metacarpal base-trapezoid and third metacarpal base-capitate, using a system based on the Sharp van der Heijde x-ray joint space narrowing (JSN) score by three radiologists. Fifteen sites at the wrist were also scored for synovitis, bone oedema and erosion using the RA MRI score.
Interobserver (three-reader) and intraobserver reliability (readers 1 and 2) for the cartilage score were excellent: intraclass correlations (ICC (95% CI)) 0.91, (0.86 to 0.94), 0.98 (0.96 to 1.00) and 0.94 (0.87 to 1.00), respectively. Cartilage scores (median, range) were higher in the established RA group (11.9, 2.3-27.3) than the early RA group (2.15, 0-6) (p≤0.001) but early RA scores did not differ from healthy controls (2.3, 1-8.7). Cartilage scores correlated with synovitis (R=0.52), bone oedema (R=0.63) and erosion scores (R=0.66), p<0.001 for all, and with x-ray JSN scores (R=0.68 to 0.78).
This MRI cartilage score demonstrated excellent reliability when tested in a three-reader system. However, cartilage loss in early RA could not be distinguished from that seen in healthy controls.
开发并测试一种适用于类风湿关节炎（RA）腕关节的 MRI 软骨评分系统。
使用配备专用腕关节线圈的 3T MRI 扫描仪对 22 例早期和 16 例确诊 RA 患者以及 22 例对照者进行 MRI 扫描。获取轴向和冠状 T1 加权（对比前和对比后）和 T2 加权涡轮自旋回波序列。使用基于三位放射科医生的 Sharp van der Heijde X 射线关节间隙狭窄（JSN）评分的系统，对 8 个腕关节的软骨狭窄进行评分：桡尺远侧关节、桡月关节、桡舟关节、舟月三角关节、头月关节、舟月三角关节、第二掌骨基底-梯形关节和第三掌骨基底-头状骨关节。还使用 RA MRI 评分对 15 个腕部部位的滑膜炎、骨水肿和侵蚀进行评分。
软骨评分的观察者间（三位读者）和观察者内（读者 1 和 2）可靠性均极佳：组内相关系数（ICC（95%CI））分别为 0.91（0.86 至 0.94）、0.98（0.96 至 1.00）和 0.94（0.87 至 1.00）。确诊 RA 组的软骨评分（中位数，范围）高于早期 RA 组（11.9，2.3-27.3）（p≤0.001），但早期 RA 评分与健康对照组无差异（2.3，1-8.7）。软骨评分与滑膜炎（R=0.52）、骨水肿（R=0.63）和侵蚀评分（R=0.66）相关，所有相关均 p<0.001，且与 X 射线 JSN 评分（R=0.68 至 0.78）相关。
该 MRI 软骨评分在三读系统中测试时具有极佳的可靠性。然而，早期 RA 中的软骨丢失无法与健康对照者中的软骨丢失区分开来。
