肌肉骨骼超声和磁共振成像能否在相同关节和肌腱处识别滑膜炎和腱鞘炎？早期炎症性关节炎和临床疑似关节炎的对比研究。
Do musculoskeletal ultrasound and magnetic resonance imaging identify synovitis and tenosynovitis at the same joints and tendons? A comparative study in early inflammatory arthritis and clinically suspect arthralgia.
机构信息
Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
出版信息
Arthritis Res Ther. 2019 Feb 14;21(1):59. doi: 10.1186/s13075-019-1824-z.
OBJECTIVE
Ultrasound (US) and magnetic resonance imaging (MRI) are recommended in the diagnostic process of rheumatoid arthritis. Research on its comparability in early disease phases is scarce. Therefore, we compared synovitis and tenosynovitis detected by US and MRI on joint/tendon level.
METHODS
Eight hundred forty joints and 700 tendons of 70 consecutive patients, presenting with inflammatory arthritis or clinically suspect arthralgia, underwent US and MRI of MCP (2-5), wrist and MTP (1-5) joints at the same day. Greyscale (GS) and power Doppler (PD) synovitis were scored according to the modified Szkudlarek method (combining synovial effusion and hypertrophy) and the recently published EULAR-OMERACT method (synovial hypertrophy regardless of the presence of effusion) on static images. US-detected tenosynovitis was scored according to the OMERACT. MRI scans were scored according to the RAMRIS. Test characteristics were calculated on joint/tendon level with MRI as reference. Cut-off for US scores were ≥ 1 and ≥ 2 and for MRI ≥ 1.
RESULTS
Compared to MRI, GS synovitis according to EULAR-OMERACT (cut-off ≥ 1) had a sensitivity ranging from 29 to 75% for the different joint locations; specificity ranged from 80 to 98%. For the modified Szkudlarek method, the sensitivity was 68-91% and specificity 52-71%. PD synovitis had a sensitivity of 30-54% and specificity 97-99% compared to MRI. The sensitivity to detect GS tenosynovitis was 50-78% and the specificity 80-94%. For PD tenosynovitis, the sensitivity was 19-58% and specificity 98-100%.
CONCLUSION
Current data showed that US is less sensitive than MRI in the early detection of synovitis and tenosynovitis, but resulted in only few non-specific findings. The higher sensitivity of MRI is at the expense of less accessibility and higher costs.
目的
超声（US）和磁共振成像（MRI）在类风湿关节炎的诊断过程中被推荐使用。关于其在早期疾病阶段的可比性的研究很少。因此，我们比较了 US 和 MRI 在关节/肌腱水平上检测到的滑膜炎和腱鞘炎。
方法
70 名连续患者的 840 个关节和 700 个肌腱，表现为炎症性关节炎或临床上可疑的关节炎，在同一天接受了 MCP（2-5）、腕关节和 MTP（1-5）关节的 US 和 MRI。根据改良的 Szkudlarek 方法（结合滑膜积液和肥厚）和最近发表的 EULAR-OMERACT 方法（无论是否存在积液，仅滑膜肥厚）对静态图像进行灰阶（GS）和功率多普勒（PD）滑膜炎评分。根据 OMERACT 对 US 检测到的腱鞘炎进行评分。根据 RAMRIS 对 MRI 扫描进行评分。以 MRI 为参考，在关节/肌腱水平上计算测试特征。US 评分的截断值为≥1 和≥2，MRI 为≥1。
结果
与 MRI 相比，根据 EULAR-OMERACT（截断值≥1）的 GS 滑膜炎在不同关节部位的敏感性范围为 29-75%；特异性范围为 80-98%。对于改良的 Szkudlarek 方法，敏感性为 68-91%，特异性为 52-71%。与 MRI 相比，PD 滑膜炎的敏感性为 30-54%，特异性为 97-99%。检测 GS 腱鞘炎的敏感性为 50-78%，特异性为 80-94%。对于 PD 腱鞘炎，敏感性为 19-58%，特异性为 98-100%。
结论
目前的数据表明，在早期检测滑膜炎和腱鞘炎方面，US 不如 MRI 敏感，但仅导致少数非特异性发现。MRI 的更高敏感性是以可及性和成本较低为代价的。
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