Fujimori Motoshi, Kamishima Tamotsu, Kato Masaru, Seno Yumika, Sutherland Kenneth, Sugimori Hiroyuki, Nishida Mutsumi, Atsumi Tatsuya
1 Master Course of Health Sciences, Graduate School of Health Sciences, Hokkaido University, Sapporo , Hokkaido , Japan.
2 Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University , Hokkaido, Sapporo , Japan.
Br J Radiol. 2018 Jun;91(1086):20170748. doi: 10.1259/bjr.20170748. Epub 2018 Apr 10.
Power Doppler ultrasonography (PDUS) and MRI are independently useful to predict structural damage in patients with rheumatoid arthritis (RA). We hypothesize that there is a complementary relationship between these modalities. The aim of this study is, therefore, to investigate the usefulness of the predictive value of composite assessment of PDUS and contrast-enhanced MRI in radiographic outcomes in patients with RA.
20 patients (17 females and 3 males) with RA on disease-modifying antirheumatic drugs underwent PDUS and MRI of both hands at baseline. Radiography of the bilateral hands was performed at baseline and at 1 year. Articular synovitis on PDUS was evaluated according to quantitative measurement. Synovitis, bone marrow edema and bone erosion were scored according to the RA MRI scoring method. The changes of joint space narrowing and bone erosion on radiograph were assessed by the Sharp/van der Heijde method. We applied t-statistics to combine the assessment of quantitative PDUS with semiquantitative MRI.
Structural damage progression for radiography was not correlated with any evaluations for MRI, while it showed significant correlation with synovitis on PDUS (r = 0.597, p = 0.005). The composite assessment of both modalities (synovitis for PDUS and bone marrow edema for MRI) was correlated with structural damage progression on radiograph (r = 0.792, p < 0.0001).
Composite assessment of PDUS and MRI may have a stronger predictive value in radiographic progression than PDUS or MRI alone in RA. Advances in knowledge: Composite assessment of PDUS and MRI may be an effective predictor of structural damage in RA.
能量多普勒超声检查（PDUS）和磁共振成像（MRI）在预测类风湿关节炎（RA）患者的结构损伤方面各自具有重要作用。我们推测这两种检查方式之间存在互补关系。因此，本研究旨在探讨PDUS与对比增强MRI的综合评估对RA患者影像学结局的预测价值。
20例正在使用改善病情抗风湿药物治疗的RA患者（17例女性，3例男性）在基线时接受了双手的PDUS和MRI检查。在基线和1年时对双侧手部进行X线摄影。根据定量测量评估PDUS上的关节滑膜炎。根据RA的MRI评分方法对滑膜炎、骨髓水肿和骨侵蚀进行评分。通过Sharp/van der Heijde方法评估X线片上关节间隙变窄和骨侵蚀的变化。我们应用t检验将定量PDUS评估与半定量MRI评估相结合。
X线摄影的结构损伤进展与MRI的任何评估均无相关性，但与PDUS上的滑膜炎显著相关（r = 0.597，p = 0.005）。两种检查方式的综合评估（PDUS的滑膜炎和MRI的骨髓水肿）与X线片上的结构损伤进展相关（r = 0.792，p < 0.0001）。
在RA中，PDUS和MRI的综合评估对影像学进展的预测价值可能比单独使用PDUS或MRI更强。知识进展：PDUS和MRI的综合评估可能是RA结构损伤的有效预测指标。
