Li Xubin, Liu Xia, Du Xiangke, Ye Zhaoxiang
Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
Department of Radiology, Peking University People's Hospital, Beijing 100044, China.
Magn Reson Imaging. 2014 May;32(4):350-3. doi: 10.1016/j.mri.2013.12.008. Epub 2014 Jan 6.
The purpose of this study was to investigate the feasibility of diffusion-weighted imaging (DWI) in detecting synovitis of wrist and hand in patients with rheumatoid arthritis (RA) and evaluate its sensitivity, specificity and accuracy as compared to T2-weighted imaging (T2WI) with short tau inversion recovery (STIR) with the reference standard contrast-enhanced magnetic resonance imaging (CE-MRI). Twenty-five patients with RA underwent MR examinations including DWI, T2WI with STIR and CE-MRI. MR images were reviewed for the presence and location of synovitis of wrist and hand. The sensitivity, specificity and accuracy of DWI and T2WI with STIR were calculated respectively and then compared. All patients included in this study completed MR examinations and yielded diagnostic image quality of DWI. For individual joint, there was good to excellent inter-observer agreement (k=0.62-0.83) using DWI images, T2WI with STIR images and CE-MR images, respectively. There was a significance between DWI and T2WI with STIR in analyzing proximal interphalangeal joints II-V, respectively (P<0.05). The k-values for the detection of synovitis indicated excellent overall inter-observer agreements using DWI images (k=0.86), T2WI with STIR images (k=0.85) and CE-MR images (k=0.91), respectively. Overall, DWI demonstrated a sensitivity, specificity and accuracy of 75.6%, 89.3% and 84.6%, respectively, for detection of synovitis, while 43.0%, 95.7% and 77.6% for T2WI with STIR, respectively. DWI showed positive lesions much better and more than T2WI with STIR. Our results indicate that DWI presents a novel non-invasive approach to contrast-free imaging of synovitis. It may play a role as an addition to standard protocols.
本研究的目的是探讨扩散加权成像（DWI）在检测类风湿关节炎（RA）患者手腕和手部滑膜炎中的可行性，并与具有参考标准的对比增强磁共振成像（CE-MRI）的短tau反转恢复（STIR）T2加权成像（T2WI）相比，评估其敏感性、特异性和准确性。25例RA患者接受了包括DWI、STIR的T2WI和CE-MRI在内的磁共振检查。对磁共振图像进行手腕和手部滑膜炎的存在和位置评估。分别计算DWI和STIR的T2WI的敏感性、特异性和准确性，然后进行比较。本研究纳入的所有患者均完成了磁共振检查，并获得了诊断质量的DWI图像。对于单个关节，使用DWI图像、STIR的T2WI图像和CE-MR图像时，观察者间一致性良好至优秀（k=0.62-0.83）。在分析近端指间关节II-V时，DWI和STIR的T2WI之间分别存在显著性差异（P<0.05）。检测滑膜炎的k值表明，使用DWI图像（k=0.86）、STIR的T2WI图像（k=0.85）和CE-MR图像（k=0.91）时，观察者间总体一致性优秀。总体而言，DWI检测滑膜炎的敏感性、特异性和准确性分别为75.6%、89.3%和84.6%，而STIR的T2WI分别为43.0%、95.7%和77.6%。DWI显示阳性病变比STIR的T2WI更好、更多。我们的结果表明，DWI是一种用于滑膜炎无对比剂成像的新型非侵入性方法。它可能作为标准方案的补充发挥作用。
