Enache Luminita, Popescu Claudiu Costinel, Micu Mihaela, Cojocaru Adriana, Suta Victoria-Cristina, Suta Maria, Codreanu Catalin
"Dr. Ion Stoia" Clinical Centre of Rheumatic Diseases (Bucharest).
Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj Napoca.
Med Ultrason. 2019 Aug 31;21(3):265-272. doi: 10.11152/mu-2038.
To evaluate the frequency of tibiotalar and subtalar joints together with extensor, flexor and peroneal tendons inflammatory lesions in rheumatoid arthritis (RA) patients by using ultrasound (US) and magnetic resonance imaging (MRI).
Fifty RA patients and 25 healthy subjects were prospectively included. All patients and controlsunderwent clinical examination (to screen for swollen and/or tender ankles) and ankle US and MRI (to screen for synovialhypertrophy - SH, tenosynovitis and power Doppler - PD signals). The imaging tests were compared using overall agreement, positive agreement, Cohen's κ, sensitivity, specificity and positive likelihood ratio.
The subtalar joint had the highest frequency of US-detected SH (30%), as well as positive PD signals (10%). Regarding US joint effusion, the tibiotalar joint recorded the highest frequency (44%). The most frequent US tenosynovitis was detected in the tibialis posterior tendon (40%). Compared to MRI, US evaluation of tibiotalar joints had very good agreement and large effect on detection probability for both SH and effusion (kappa 0.84, positive likelihood ratio 21.1). Compared to MRI, the sensitivity and specificity for US joint involvement ranged between 72.0-88.5% and 82.4-95.8%, and for tenosynovitis were 33.3-78.6% and 85.2-100%, respectively. Compared to asymptomatic RA patients (n=25), those with at least one symptomatic ankle (n=25) had significantly higher frequencies of both SH and effusion in all the evaluated structures.
US has high sensitivity and specificity in detecting RA inflammatory lesions in the ankle and rearfoot, in very good agreement with MRI. The high frequency of ankle inflammatory lesions in RA should result in increased interest in the imaging evaluation of these structures.
通过超声（US）和磁共振成像（MRI）评估类风湿关节炎（RA）患者胫距关节和距下关节以及伸肌、屈肌和腓骨肌腱的炎性病变频率。
前瞻性纳入50例RA患者和25名健康受试者。所有患者和对照均接受临床检查（筛查踝关节肿胀和/或压痛）以及踝关节US和MRI检查（筛查滑膜增生 - SH、腱鞘炎和能量多普勒 - PD信号）。使用总体一致性、阳性一致性、科恩κ系数、敏感性、特异性和阳性似然比比较成像检查结果。
距下关节US检测到的SH频率最高（30%），阳性PD信号频率也最高（10%）。关于US关节积液，胫距关节的频率最高（44%）。最常见的US腱鞘炎发生在胫后肌腱（40%）。与MRI相比，US对胫距关节的评估具有很好的一致性，对SH和积液的检测概率有很大影响（kappa 0.84，阳性似然比21.1）。与MRI相比，US对关节受累的敏感性和特异性分别在72.0 - 88.5%和82.4 - 95.8%之间，对腱鞘炎的敏感性和特异性分别在33.3 - 78.6%和85.2 - 100%之间。与无症状的RA患者（n = 25）相比，至少有一个有症状踝关节的患者（n = 25）在所有评估结构中的SH和积液频率均显著更高。
US在检测RA患者踝关节和后足的炎性病变方面具有高敏感性和特异性，与MRI一致性良好。RA患者踝关节炎性病变的高频率应引起对这些结构成像评估的更多关注。
