动态增强MRI和肌骨超声对类风湿关节炎活动性的诊断价值
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陕西省重点研发计划项目(2021SF-254);


Diagnostic value of dynamic contrast-enhanced MRI and musculoskeletal ultrasound for rheumatoid arthritis activity
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    摘要:

    目的:探讨动态增强MRI(DCE-MRI)和肌骨超声(MSUS)对类风湿关节炎(RA)活动性的诊断价值。方法:回顾性分析97例行DCE-MRI和MSUS检查的RA患者的临床资料,比较入院时DCE-MRI、MSUS检查对RA患者典型病理特征的检出率;根据患者病情活动性[类风湿性关节炎疾病活动性评分系统(DAS28)评分]分为活动组(DAS28≥2.6分,n=56)与非活动组(DAS28<2.6分,n=41),比较入院检查时不同病情活动性患者DCE-MRI定量参数[早期强化率(EER)、最大强化率(MER)、达峰时间(TTP)]和MSUS(滑膜厚度、血流信号评分、滑膜动脉RI)定量参数,采用受试者工作特征(ROC)曲线分析两种影像技术定量参数对RA患者病情活动性的诊断效能。结果:DCE-MRI、MSUS对RA患者滑膜增生的检出率比较,差异无统计学意义(P>0.05);DCE-MRI对RA患者骨侵蚀的检出率高于MSUS(P<0.05);对关节积液的检出率低于MSUS(P<0.05)。入院时,活动组患者EER、MER、滑膜厚度、血流信号评分高于非活动组(P<0.05);TTP、滑膜动脉RI低于非活动组(P<0.05)。ROC曲线显示,EER、MER、TTP、滑膜厚度、血流信号评分、滑膜动脉RI单一指标检测曲线下面积(AUC)分别为0.788、0.846、0.806、0.865、0.626、0.819;敏感度分别为75.61%、92.68%、70.73%、78.05%、87.80%、75.61%;特异度分别为71.43%、64.29%、76.79%、78.57%、32.14%、82.14%,均对RA患者病情活动性有较好诊断效能(P<0.05)。结论:DCE-MRI和MSUS对RA活动性均具有较好的诊断价值,但DCE-MRI对RA患者骨侵蚀的检出率更高,且MSUS对关节积液的检出率更高。

    Abstract:

    Objective:To investigate and compare the diagnostic value of dynamic contrast-enhanced MRI(DCE-MRI)and musculoskeletal ultrasound(MSUS)for the activity of rheumatoid arthritis(RA).Methods:The clinical data of 97 patients with RA who received DCE-MRI and MSUS in the hospital were retrospectively analyzed.The detection rates of typical pathological features of RA patients by DCE-MRI and MSUS at admission were compared.The patients were divided into an active group(DAS28 ≥2.6 points,n=56)and an inactive group(DAS28<2.6 points,n=41)according to the disease activity[rheumatoid arthritis disease activity sco-ring system(DAS28)score].The quantitative parameters of DCE-MRI[early enhancement rate(EER),maximum enhancement rate(MER),time to peak(TTP)]and MSUS[synovial thickness,blood flow signal score,synovial artery resistance index(RI)]of pa-tients with different disease activities were compared at admission.The diagnostic efficiency of quantitative parameters of these two ima-ging techniques for the disease activity of RA patients was analyzed by receiver operating characteristic curve(ROC).Results:There was no statistical significance in the detection rate of synovial hyperplasia in RA patients between the two imaging techniques(P>0.05).The detection rate of bone erosion in RA patients by DCE-MRI was higher than that by MSUS while the detection rate of joint ef-fusion was lower than that by MSUS(P<0.05).At admission,the EER,MER,synovial thickness and blood flow signal score in active group were higher while the TTP and synovial artery RI were lower than those in inactive group(P<0.05).ROC analysis showed that the areas under the ROC curves(AUCs)for EER,MER,TTP,synovial thickness,blood flow signal score and synovial artery RI were 0.788,0.846,0.806,0.865,0.626 and 0.819,the sensitivities were 75.61%,92.68%,70.73%,78.05%,87.80%and 75.61%,and the specificities were 71.43%,64.29%,76.79%,78.57%,32.14%and 82.14%,respectively(P<0.05).Conclusion:Both DCE-MRI and MSUS have good diagnostic value on RA activity,but DCE-MRI has a higher detection rate of bone erosion in RA pa-tients,while MSUS has a higher detection rate of joint effusion.

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陈真;雷皓天;徐旋;.动态增强MRI和肌骨超声对类风湿关节炎活动性的诊断价值[J].川北医学院学报,2025,40(3):323-326.

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  • 在线发布日期: 2025-07-24
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