Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints
Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints
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DOI：
10.1136/ard.61.10.895
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发表时间：
2002-10-01
影响因子：
27.4
通讯作者：
Bollow, M
中科院分区：
文献类型：
--
作者：
Backhaus, M;Burmester, GR;Bollow, M
目的：开展一项前瞻性两年随访研究，比较传统放射线照相、三相骨闪烁扫描、超声检查（US）和三维（3D）磁共振成像（MRI）与对比前和动态对比后检查在检测早期关节炎方面的作用。后续研究的目的是通过不同方式监测疾病缓解抗风湿药物治疗过程中的侵蚀过程，并确定放射学上的隐匿性变化（如最初研究中通过 MRI 和 US 检测到的指关节侵蚀性骨病变）是否会在两年后出现在常规放射照片上。此外，为了研究初始研究中描述的软组织病变的过程，并与临床结果进行比较。方法：对 49 名患有各种形式的关节炎的患者进行了两次检查，对临床上受影响较严重的手（软组织肿胀和关节压痛）的掌指关节、近端指间关节和远端指间关节（14 个关节）进行了两次检查。患者最初被分为两组。随访组 I 包括 28 名受试者（392 个关节），其所调查的手和腕部无破坏性关节炎（Larsen 等级 0-1）的影像学迹象，而组 II（对照组）包括 21 名患者（294 个关节），其 X 线照片显示所调查的手或手腕或两者在初次检查时有糜烂（Larsen 2 级）。 结果：（1）在两年的随访中，X 线检查仅检测到组 I 和组中的 2 名糜烂（两名患者）。 II 组中有 10 名（9 名患者）出现额外糜烂。最初的 MRI 已检测到第一组中的两个糜烂和第二组中 10 个糜烂中的七个（七名患者）。最初的 US 描绘了第一组中的 1 次侵蚀，以及第二组中 10 次侵蚀中的 4 次。 (2) 与传统放射线照相相比，3D MRI 和 US 表明，与最初的调查相比，侵蚀有所增加。 (3) 随访两年后，闪烁扫描检测到的异常现象有所减少。 (4) MRI 和 US 也显示，两组滑膜炎和腱鞘炎的临床症状均有显着改善。 (5)临床表现、MRI和US显示的软组织病变减少与侵蚀性骨病变显着增加之间存在显着差异，这主要在MRI和US中明显。结论：尽管临床改善并且炎性软组织病变消退，但在两年随访时侵蚀性骨病变增加，3D MRI更明显，US不那么明显。我们的研究结果表明，由于对糜烂和软组织病变的描述不充分，单独使用传统放射线照相术在治疗的中期随访中具有局限性。 US 对描绘炎症性软组织病变具有很高的敏感性，但动态 3D MRI 在区分微小糜烂方面更敏感。
Objective: To carry out a prospective two year follow up study comparing conventional radiography, three-phase bone scintigraphy, ultrasonography (US), and three dimensional (3D) magnetic resonance imaging (MRI) with precontrast and dynamic postcontrast examination in detecting early arthritis. The aim of the follow up study was to monitor the course of erosions during treatment with disease modifying antirheumatic drugs by different modalities and to determine whether the radiographically occult changes like erosive bone lesions of the finger joints detected by MRI and US in the initial study would show up on conventional radiographs two years later. Additionally, to study the course of soft tissue lesions depicted in the initial study in comparison with the clinical findings.Methods: The metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints (14 joints) of the clinically more severely affected hand (soft tissue swelling and joint tenderness) as determined in the initial study of 49 patients with various forms of arthritis were examined twice. The patients had initially been divided into two groups. The follow up group I included 28 subjects (392 joints) without radiographic signs of destructive arthritis (Larsen grades 0-1) of the investigated hand and wrist, and group II (control group) included 21 patients (294 joints) with radiographs showing erosions (Larsen grade 2) of the investigated hand or wrist, or both, at the initial examination.Results: (1) Radiography at the two year follow up detected only two erosions (two patients) in group I and 10 (nine patients) additional erosions in group II. Initial MRI had already detected both erosions in group I and seven (seven patients) of the 10 erosions in group II. Initial US had depicted one erosion in group I and four of the 10 erosions in group II. (2) In contrast with conventional radiography, 3D MRI and US demonstrated an increase in erosions in comparison with the initial investigation. (3) The abnormal findings detected by scintigraphy were decreased at the two year follow up. (4) Both groups, showed a marked clinical improvement of synovitis and tenosynovitis, as also shown by MRI and US. (5) There was a striking discrepancy between the decrease in the soft tissue lesions as demonstrated by clinical findings, MRI, and US, and the significant increase in erosive bone lesions, which were primarily evident at MRI and US.Conclusions: Despite clinical improvement and a regression of inflammatory soft tissue lesions, erosive bone lesions were increased at the two year follow up, which were more pronounced with 3D MRI and less pronounced with US. The results of our study suggest that owing to the inadequate depiction of erosions and soft tissue lesions, conventional radiography alone has limitations in the intermediate term follow up of treatment. US has a high sensitivity for depicting inflammatory soft tissue lesions, but dynamic 3D MRI is more sensitive in differentiating minute erosions.