关节内注射甲基强的松龙后滑膜和关节积液量的变化。通过MRI对关节炎的炎症和破坏性变化进行定量评估。

Changes in synovial membrane and joint effusion volumes after intraarticular methylprednisolone. Quantitative assessment of inflammatory and destructive changes in arthritis by MRI.

作者信息

Ostergaard M, Stoltenberg M, Gideon P, Sørensen K, Henriksen O, Lorenzen I

机构信息

Danish Research Center of Magnetic Resonance, Hvidovre Hospital, University of Copenhagen, Denmark.

出版信息

J Rheumatol. 1996 Jul;23(7):1151-61.

PMID:8823685

Abstract

OBJECTIVE

To evaluate synovial membrane volumes, effusion volumes, and cartilage and bone erosion scores determined by magnetic resonance imaging (MRI) as markers of disease activity and severity in arthritis.

METHODS

Gadolinium-DTPA enhanced MRI of 18 arthritic knees was performed before and 1, 7, 30 and 180 days after intraarticular methylprednisolone injection until clinical relapse. Intraobserver, interobserver, and inter-MRI variations were determined from 2 successive MRI of another 6 knees.

RESULTS

In all knees synovial membrane and effusion volumes decreased within the first posttreatment week (median decrease 49 and 65%, respectively), and remained low during remission. Synovial volumes, but not effusion volumes, increased to pretreatment levels in case of clinical relapse, indicating that synovial volumes were most important to the clinical appearance. The intraobserver + interobserver + inter-MRI variation was maximally 26%. Total volumes and volumes in a selected sagittal slice were highly statistically correlated. The duration of clinical remission in patients with rheumatoid arthritis (RA) was significantly inversely correlated to the pretreatment synovial volume (both total and "one slice" volumes), but not to the effusion volume, MRI or radiography scores of erosions or any clinical/laboratory variables. Cartilage and bone erosions, invisible by radiography, were visualized by MRI. No progressive erosive changes were observed.

CONCLUSION

MRI-determined synovial and effusion volumes and MRI scores of cartilage and bone erosions are reproducible and may be sensitive measures of disease activity and severity in RA. The synovial volume may rather than the effusion volume determine clinical appearance. Both are influenced by the present inflammatory activity. The pretreatment synovial volume may have predictive value to treatment outcome in RA.

摘要

目的

评估通过磁共振成像（MRI）测定的滑膜体积、积液体积以及软骨和骨侵蚀评分，作为关节炎疾病活动度和严重程度的标志物。

方法

对18个患有关节炎的膝关节在关节内注射甲泼尼龙前以及注射后1、7、30和180天进行钆喷酸葡胺增强MRI检查，直至临床复发。从另外6个膝关节的连续2次MRI检查中确定观察者内、观察者间以及MRI间的变异性。

结果

在所有膝关节中，滑膜和积液体积在治疗后的第一周内均减少（中位数分别减少49%和65%），并且在缓解期保持较低水平。在临床复发时，滑膜体积增加至治疗前水平，但积液体积未增加，这表明滑膜体积对临床表现最为重要。观察者内 + 观察者间 + MRI间的最大变异性为26%。总体积与选定矢状面切片中的体积具有高度统计学相关性。类风湿关节炎（RA）患者的临床缓解持续时间与治疗前滑膜体积（总体积和“单切片”体积）显著负相关，但与积液体积、侵蚀的MRI或X线评分或任何临床/实验室变量无关。X线检查不可见的软骨和骨侵蚀通过MRI得以显示。未观察到进行性侵蚀性变化。