Department of Medicine, Division of Rheumatology, University of Alberta, 562 Heritage Medical Research Centre, Edmonton, Alberta, Canada.
Skeletal Radiol. 2011 Sep;40(9):1153-73. doi: 10.1007/s00256-011-1204-5. Epub 2011 Aug 17.
In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.
在过去的二十年中，MRI 在炎症性关节炎患者的研究和临床管理中发挥了重要作用，特别是在脊柱关节炎（SpA）、类风湿关节炎（RA）和骨关节炎（OA）中。MRI 被认为是检测有炎症性背痛和骶髂关节正常 X 线表现的年轻 SpA 患者早期 SpA 的最敏感影像学方法。最近发表的评估 SpA 国际学会（ASAS）的轴性 SpA 分类标准首次将阳性 MRI 作为 SpA 的影像学标准之一，包括至少一个 SpA 的临床特征。最近的数据表明，对 MRI 上显示的骶髂关节炎进行系统评估的诊断效用远大于先前报道的结果，并强调了结构损伤的诊断相关性。在 RA 中，MRI 对新发未分化关节炎疾病的发展具有预测价值，疾病发病时的 MRI 病理学是放射学侵蚀的高度显著预测因子。因此，MRI 在 2010 年 ACR/EULAR 新的 RA 分类标准中被认为具有重要作用。在 OA 中，骨髓水肿（BME）和滑膜炎可能作为介入试验的生物标志物。针对炎症性关节炎中 MRI 观察到的 BME 和滑膜炎的治疗干预措施可能具有疾病修饰作用，因为这些病变是潜在可逆转的，并且与结构进展相关。研究应集中在 MRI 病变在更大队列中的预后意义上，以及在炎症性关节炎患者中常规护理中添加 MRI 是否改善临床和放射学结局。
