双手磁共振成像比单侧手磁共振成像更有利于类风湿关节炎。

Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis.

机构信息

From the Departments of Rheumatology and Radiology, Sun Yat-Sen Memorial Hospital; Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.

Y.Q. Mo, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Z.H. Yang, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; H.N. He, Zhongshan School of Medicine, Sun Yat-Sen University; J.D. Ma, MD, PhD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J.J. Liang, MD, Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; W.K. Zeng, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; G.Z. Shi, MD, Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; J. Shen, MD, PhD, Prof., Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; L. Dai, MD, PhD, Prof., Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Drs. Mo and Yang contributed equally to this work.

出版信息

J Rheumatol. 2018 Jul;45(7):895-904. doi: 10.3899/jrheum.171044. Epub 2018 May 1.

DOI:10.3899/jrheum.171044

PMID:29717034

Abstract

OBJECTIVE

To explore the advantages of magnetic resonance imaging (MRI) of bilateral hands in rheumatoid arthritis (RA).

METHODS

Consecutive patients with active RA were recruited for clinical assessments, radiographs, and MRI of bilateral hands. Bilateral hands were scanned simultaneously on 3.0 T whole-body MRI system and were scored on synovitis, osteitis, and bone erosion according to the RA MRI scoring (RAMRIS) system.

RESULTS

Among 120 patients included, wrist bones and metacarpophalangeal joint (MCPJ) 2 proximal showed bone erosion in early RA. The second to fifth metacarpal bases and the second to fourth MCPJ distal showed more bone erosion in mid-stage or late-stage RA. When MRI of dominant unilateral hand was analyzed, MRI synovitis and osteitis in 5% of wrists and 3 MRI features in 5-14% of MCPJ were misdiagnosed (McNemar test, all p < 0.05). There were 46% wrist synovitis, 29-52% MCPJ2-5 synovitis, 45% wrist osteitis, and 20%-34% MCPJ2-5 osteitis not detected by joint tenderness and/or swelling. When the clinically more severe hand was selected for MRI of unilateral hand according to physical examination, MRI synovitis in 5% of wrists and 3 MRI features in 7-15% of MCPJ were misdiagnosed (all p < 0.05). Scatter plots and linear regression analyses were used to illustrate RAMRIS between dominant or selected hand (Y values) and nondominant or nonselected hand (X values). All linear models were markedly different from a Y = X linear model, indicating the dominant or clinically more severe hand could not represent the contralateral hand to evaluate RAMRIS.

CONCLUSION

MRI of bilateral hands is more optimal than MRI of the unilateral hand in RA.

摘要

目的

探讨磁共振成像（MRI）双侧手在类风湿关节炎（RA）中的优势。

方法

连续招募活动期 RA 患者进行临床评估、X 线摄影和双侧手 MRI。双侧手在 3.0T 全身 MRI 系统上同时扫描，并根据 RA MRI 评分（RAMRIS）系统对滑膜炎、骨炎和骨侵蚀进行评分。

结果

在 120 例患者中，腕骨和掌指关节（MCPJ）2 近侧在早期 RA 中出现骨侵蚀。中晚期 RA 中第二至第五掌骨基底和第二至第四 MCPJ 远侧出现更多骨侵蚀。当分析优势侧单侧手 MRI 时，5%的腕部和 5-14%的 MCPJ 中有 3 个 MRI 特征的滑膜炎和骨炎被误诊（McNemar 检验，均 p<0.05）。46%的腕部滑膜炎、29-52%的 MCPJ2-5 滑膜炎、45%的腕部骨炎和 20%-34%的 MCPJ2-5 骨炎未通过触诊和/或肿胀检测到。根据体格检查选择更严重的手进行单侧手 MRI 时，5%的腕部和 7-15%的 MCPJ 中有 3 个 MRI 特征的滑膜炎被误诊（均 p<0.05）。散点图和线性回归分析用于说明优势或所选手（Y 值）与非优势或非选择手（X 值）之间的 RAMRIS。所有线性模型与 Y=X 线性模型明显不同，表明优势或临床更严重的手不能代表对侧手来评估 RAMRIS。