类风湿关节炎的腕关节MRI及临床应用研究-影像医学与核医学专业论文.docxVIP

山西医科大学 山西医科大学 硕士论文 类风湿关节炎的腕关节NII及临床应用研究 【摘要】 目的 研究类风湿关节炎(rheumatoid arthritis，RA)腕关节 MRI表现及其临床应用价值。 方法搜集符合1987年美国风湿病协会ARA诊断标准的类风湿关 节炎患者43例，男12例，女3l例，行双腕关节帜扫描。均采用SEll。wI、 快速反转恢复(STIR)序列、增强T。wI行冠状面扫描。选取10例正常 志愿者对照。同时搜集患者的临床症状、体征、化验指标与MRI对比分 析。 结果43例患者，MRI均可见滑膜增厚，血管翳增生，血管翳明显 强化38例，骨髓水肿21例，关节积液37例，骨质破坏30例。骨髓 水肿组、关节积液组、血管翳明显强化组分别与无相应表现组在血沉降 率、健康评定调查提问(HAQ评分)、患者的整体评估(AIMS)、肿胀关 节数方面差异有非常显著意义，P值均(0．05。骨髓水肿组与无骨髓水 肿组的骨质破坏、跖趾关节(MTP)压痛、抗核周因子(APF)差异有显 著性x 2值、P值分别为8．35、0．004：10．38、0．001：5．06、0．024。 结论MRI能够显示类风湿关节炎的病理改变，并且MRI表现在疾 病预后方面有一定临床价值。 【关键词】 类风湿关节炎；磁共振成像： 腕关节 坐耍垦型查堂——————里垡型垒生————一Clinical 坐耍垦型查堂——————里垡型垒生————一 Clinical study on MRI of the Wrist in rheumatoid arthritis ABSTRACT Objective To observe the appearances of rheumatoid arthritis(RA)， assess the role of MRI in diagnosis and and evaluate disease prognosis of rheumatoid arthritis． Methods 43 patients，fulfilled 1987 American Rheumatism Assosiation(ARA)revised criteria，and 10 age-matched healthy controls entered the study．In 43 patients，all had pannus on MRI of wrists，37 patients had joint effusion，2 1 patients had bone marrow edema，38 patients had marked enhanced pannus of signal intensity，and 30 patients had bone erosions．Ti．weighted spin echo，short time inversion recovery (STIR)of both wrists，gadolinium contrast material—enhanced sequences of dominant wrists were performed in the coronal planes． MRI，the plain wrist radiographs ，clinical date，included swollen joint，patient global assessment(AIMS)，and laboratory examinations included ESR，RF，APF，AKA were obtained at the same time．Functional disability was assessed using the Health Assessment Questionnaire Disability Score(HAQ score)． Results There were significant difference in the ESR、HAQ、pain joint count as well as AIMS between patients with bone marrow edema and patients without bone malTow edema(t_5．18、p=0．000；t=5．70、p=0．000； t=3．14、p一0．001；忙5．49、p=o．000)，which is the same as patients with joint effusion and patients withoutjoint effusion(仁6．47、p=0．000；t=7．74