Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
J Rheumatol. 2013 Aug;40(8):1282-92. doi: 10.3899/jrheum.120713. Epub 2013 Jun 1.
To compare Doppler ultrasound (US) and 3.0-Tesla magnetic resonance imaging (3.0-T MRI) findings of synovial inflammation in the tendons and joints in an early polyarthritis cohort (patients who presented < 1 year after arthritis onset) using a bilateral hand and wrist evaluation. Also, to evaluate the diagnostic performance of US and MRI findings for rheumatoid arthritis (RA), their ability to predict RA as a diagnostic outcome, and their capacity to improve the accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) RA classification criteria in early arthritis.
Forty-five patients (40 women, 5 men; mean age 45.6 yrs) with untreated recent-onset polyarthritis participated in this prospective study and were examined using an US and MRI approach including both wrists and hands. After a followup of 12 months, patients were classified as having RA if they fulfilled the criteria for RA. The proportion of synovitis identified by US and MRI for each joint and tendon region was compared by chi-square test. The diagnostic performance of US and MRI for RA identification was evaluated using receiver-operating curve (ROC) analysis. Possible associations between synovitis for each joint and tendon region as identified by US or MRI and RA diagnosis at 12 months were tested by logistic regression analysis. The diagnostic performance of the ACR/EULAR RA classification criteria corrected by US and MRI joint and tendon counts was evaluated using ROC analysis.
Thirty patients fulfilled the ACR/EULAR criteria [early RA (ERA) patients] and the remaining 15 failed to meet these criteria (non-RA). Carpal joint synovitis and tenosynovitis of the flexor tendons was found in 86.7% and 86.7% of patients with ERA on MRI compared with 63.3% and 50% on US, respectively (p < 0.05). The global MRI and US counts revealed a good diagnostic performance for RA diagnosis of both techniques, although MRI was statistically significantly better [area under the curve (AUC) = 0.959 and AUC = 0.853, respectively; z statistic = 2.210, p < 0.05]. MRI identification of carpal joint synovitis (OR 3.64, 95% CI 1.119-11.841), tenosynovitis of the flexor tendons (OR 5.09, 95% CI 1.620-16.051), and global joint and tendon count (OR 2.77, 95% CI 1.249-6.139) were in the multivariate logistic regression model the most powerful predictors of progression toward RA. In the group of ERA patients with US joint and tendon counts ≤ 10, a statistically significant difference was found between the diagnostic performance for RA of the ACR/EULAR criteria as previously described and the diagnostic performance of the MRI-corrected ACR/EULAR criteria (AUC = 0.898 and AUC = 0.986, respectively; z statistic = 2.181, p < 0.05).
3.0-T MRI identified a higher prevalence of synovitis in comparison to US in an early polyarthritis cohort. Both techniques have good diagnostic performance for RA although MRI reveals a significantly higher diagnostic capability. Synovitis of carpal joints and of flexor tendons as identified by MRI were the most powerful predictors of progression toward RA. In patients with US joint and tendon counts ≤ 10, MRI can significantly improve the diagnostic performance of the 2010 ACR/EULAR classification criteria.
通过双侧手和腕关节评估，比较早期多关节炎队列（关节炎发病后<1 年就诊的患者）中滑液炎症的多普勒超声（US）和 3.0-T 磁共振成像（3.0-T MRI）表现。此外，评估 US 和 MRI 对类风湿关节炎（RA）的诊断性能，其预测 RA 的能力，以及提高 2010 年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）RA 分类标准在早期关节炎中准确性的能力。
45 例未经治疗的新发多关节炎患者（40 名女性，5 名男性；平均年龄 45.6 岁）参加了这项前瞻性研究，并接受了 US 和 MRI 检查，包括双手和手腕。经过 12 个月的随访，如果患者符合 RA 标准，则被归类为 RA。通过卡方检验比较每个关节和肌腱区域的 US 和 MRI 确定的滑膜炎比例。使用接收者操作特征（ROC）曲线分析评估 US 和 MRI 对 RA 识别的诊断性能。通过逻辑回归分析检验 US 或 MRI 确定的每个关节和肌腱区域的滑膜炎与 12 个月时 RA 诊断之间的可能关联。使用 ROC 分析评估经 US 和 MRI 关节和肌腱计数校正后的 ACR/EULAR RA 分类标准的诊断性能。
30 名患者符合 ACR/EULAR 标准[早期 RA（ERA）患者]，其余 15 名患者不符合这些标准（非 RA）。MRI 显示 ERA 患者腕关节滑膜炎和屈肌腱腱鞘炎分别为 86.7%和 86.7%，而 US 分别为 63.3%和 50%（p<0.05）。尽管 MRI 在统计学上表现出更好的诊断性能（AUC 分别为 0.959 和 0.853，z 统计量=2.210，p<0.05），但全球 MRI 和 US 计数均显示出两种技术对 RA 诊断的良好诊断性能。MRI 确定的腕关节滑膜炎（OR 3.64，95%CI 1.119-11.841）、屈肌腱腱鞘炎（OR 5.09，95%CI 1.620-16.051）和全球关节和肌腱计数（OR 2.77，95%CI 1.249-6.139）是向 RA 进展的最有力预测因子。在 ERA 患者的 US 关节和肌腱计数≤10 组中，发现先前描述的 ACR/EULAR 标准对 RA 的诊断性能与 MRI 校正后的 ACR/EULAR 标准之间存在统计学显著差异（AUC 分别为 0.898 和 0.986，z 统计量=2.181，p<0.05）。
3.0-T MRI 在手和腕关节的早期多关节炎队列中发现了比 US 更高的滑膜炎发生率。尽管 MRI 具有更高的诊断能力，但两种技术均具有良好的 RA 诊断性能。MRI 确定的腕关节和屈肌腱滑膜炎是向 RA 进展的最有力预测因子。在 US 关节和肌腱计数≤10 的患者中，MRI 可以显著提高 2010 年 ACR/EULAR 分类标准的诊断性能。
