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全身 MRI 在疑似风湿性疾病的儿科患者中的诊断价值。

Diagnostic Value of Whole-Body MRI in Pediatric Patients with Suspected Rheumatic Diseases.

机构信息

Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland.

Clinical Department of Pediatrics and Rheumatology, St. Louis Regional Specialised Children's Hospital, 31-034 Krakow, Poland.

出版信息

Medicina (Kaunas). 2024 Aug 28;60(9):1407. doi: 10.3390/medicina60091407.

Abstract

: The diagnosis of rheumatic diseases in children is challenging and requires the use of advanced imaging examinations such as whole-body magnetic resonance imaging (MRI). Whole-body MRI allows visualization of bone marrow edema (BME), muscle edema, joint effusion and changes in the soft tissues surrounding the joints. The aim of this study was to collect and compare whole-body MRI findings, laboratory results and clinical manifestations of pediatric patients with suspected rheumatic disease. : In this retrospective single-center study, 33 patients who underwent whole-body MRI were included. Their age ranged from 9 to 17 years, and 24 (72.73%) of the patients were female. Patients were diagnosed as follows: juvenile idiopathic arthritis (27.27%), juvenile idiopathic inflammatory myopathies (21.21%), chronic nonbacterial osteomyelitis (21.21%) and other medical conditions (30.30%), such as arthritis associated with infection, scleroderma, Takayasu arteritis, polyarteritis nodosa and joint damage. : The most common symptom reported by 26 (79.79%) patients was pain. On physical examination, the limitation of joint mobility was examined in 17 (51.51%), swelling of the joints was observed in 12 (36.36%) patients and decreased muscle strength was noticed in 11 (33.33%) patients. An increase in the C-reactive protein (12%), erythrocyte sedimentation rate (9%), leukocyte count (9%) and creatine kinase (CK) (18%) was observed. Whole-body MRI revealed myositis (30%), joint effusion (27%) and BME (24%). The statistical analysis showed a significant relationship between myositis and the elevated CK level ( < 0.05). : The most common symptom in the studied population was pain, while the limitation of joint mobility was found in more than half of patients. Myositis was the most commonly imaged lesion on the whole-body MRI and it was related to an increase in the CK level.

摘要

儿童风湿性疾病的诊断具有挑战性,需要使用全身磁共振成像(MRI)等先进的影像学检查。全身 MRI 可以观察骨髓水肿(BME)、肌肉水肿、关节积液和关节周围软组织的变化。本研究旨在收集和比较疑似风湿性疾病的儿科患者的全身 MRI 表现、实验室结果和临床表现。

在这项回顾性单中心研究中,纳入了 33 名接受全身 MRI 检查的患者。他们的年龄在 9 至 17 岁之间,24 名(72.73%)患者为女性。患者的诊断如下:幼年特发性关节炎(27.27%)、幼年特发性炎症性肌病(21.21%)、慢性非细菌性骨髓炎(21.21%)和其他医学病症(30.30%),如感染相关关节炎、硬皮病、Takayasu 动脉炎、结节性多动脉炎和关节损伤。

26 名(79.79%)患者最常见的症状是疼痛。体格检查时,17 名(51.51%)患者的关节活动受限,12 名(36.36%)患者的关节肿胀,11 名(33.33%)患者的肌肉力量下降。C 反应蛋白(12%)、红细胞沉降率(9%)、白细胞计数(9%)和肌酸激酶(CK)(18%)升高。全身 MRI 显示肌炎(30%)、关节积液(27%)和 BME(24%)。统计分析显示,肌炎与 CK 水平升高(<0.05)之间存在显著关系。

在研究人群中,最常见的症状是疼痛,而超过一半的患者存在关节活动受限。肌炎是全身 MRI 上最常见的病变,与 CK 水平升高有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8191/11434450/e4b6fdc24aa6/medicina-60-01407-g001.jpg

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