Bekkelund S I, Pierre-Jerome C, Husby G, Mellgren S I
Department of Neurology, University of Tromsø, Norway.
AJNR Am J Neuroradiol. 1995 Apr;16(4):767-72.
To determine the presence of hyperintense white matter lesions and atrophy reflecting cerebral vasculitis in rheumatoid arthritis.
Thirty-three patients with rheumatoid arthritis and 48 control subjects were examined with MR. Mean age was 45.1 years (range, 26 to 55 years) for the patients and 42.2 years (range, 25 to 55 years) in the control group. To determine atrophy we measured the area of corpus callosum, the cerebrum, and the cerebellum on midline sagittal sections. On transverse images, the ventricle-to-brain ratio, the bifrontal ratio, and the bicaudate ratio were selected as atrophy parameters. Area and signal intensity were measured for the biggest and the smallest lesions in both groups.
Nine patients (27%) had hyperintense lesions compared with 15 (31%) of the control subjects. Mean numbers of hyperintense lesions were 1.3 in patients and 2.1 in control subjects. Mean area of the largest lesion in each patient was 27.4 mm2 for the patients and 29.8 mm2 in the control group. In patients with long disease duration (> 15 years) the mean ventricle-to-brain ratio was 0.09 compared with 0.08 in the control subjects. The midsagittal area of the cerebellum was 1349.8 mm2 in the patients with long disease duration and 1573.3 mm2 in the control group. No difference in number of hyperintense white matter lesions was detected between patients with long disease duration and the control subjects. Comparing the total group of patients with the control subjects, no significant differences in atrophy parameters or hyperintense white matter lesions were found. Also, there were no significant differences in relative signal intensity of the hyperintense lesions and corpus callosum between the two groups. We were not able to detect differences between treated versus untreated patients.
This study indicates a tendency of more cerebral and cerebellar atrophy in patients with severe rheumatoid arthritis. The number and size of the white matter lesions were not significantly different in the two groups and do not support a higher frequency of even clinically silent infarcts caused by vasculitis in the patients with rheumatoid arthritis compared with control subjects.
确定类风湿关节炎中反映脑血管炎的高信号白质病变和萎缩的存在情况。
对33例类风湿关节炎患者和48例对照者进行磁共振成像（MR）检查。患者的平均年龄为45.1岁（范围26至55岁），对照组的平均年龄为42.2岁（范围25至55岁）。为确定萎缩情况，我们在中线矢状面上测量胼胝体、大脑和小脑的面积。在横断面上，选择脑室与脑比率、双额叶比率和双尾状核比率作为萎缩参数。测量两组中最大和最小病变的面积及信号强度。
9例患者（27%）有高信号病变，而对照者中有15例（31%）有高信号病变。患者高信号病变的平均数量为1.3个，对照者为2.1个。每位患者最大病变的平均面积在患者组中为27.4平方毫米，在对照组中为29.8平方毫米。病程长（>15年）的患者平均脑室与脑比率为0.09，对照者为0.08。病程长的患者小脑的矢状面面积为1349.8平方毫米，对照组为1573.3平方毫米。病程长的患者与对照者之间在高信号白质病变数量上未检测到差异。将患者总体与对照者比较，在萎缩参数或高信号白质病变方面未发现显著差异。此外，两组之间高信号病变和胼胝体的相对信号强度也无显著差异。我们未能检测到治疗患者与未治疗患者之间的差异。
本研究表明重度类风湿关节炎患者有更多脑和小脑萎缩的倾向。两组白质病变的数量和大小无显著差异，不支持类风湿关节炎患者与对照者相比因血管炎导致的甚至临床无症状梗死的发生率更高。
