Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis - Comparison with magnetic resonance imaging, conventional readiography, and clinical examination
Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis - Comparison with magnetic resonance imaging, conventional readiography, and clinical examination
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DOI：
10.1002/art.20333
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发表时间：
2004-07-01
影响因子：
--
通讯作者：
Ostergaard, M
中科院分区：
文献类型：
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作者：
Szkudlarek, M;Narvestad, E;Ostergaard, M
客观的。比较超声检查 (US) 与磁共振成像 (MRI)、常规放射线照相和临床检查在评估类风湿关节炎 (RA) 患者跖趾 (MTP) 关节骨质破坏和炎症体征方面的效果。方法。通过 B 型超声、对比增强 MRI、常规 X 线摄影和临床检查对 40 名 RA 患者的 200 个 MTP 关节和 20 名健康对照受试者的 100 个 MTP 关节进行了骨破坏和关节炎症体征的评估。结果。以 MRI 为参考方法，超声检测骨侵蚀的敏感性、特异性和准确性分别为 0.79、0.97 和 0.96，而 X 线摄影的相应值分别为 0.32、0.98 和 0.93。超声检测滑膜炎的敏感性、特异性和准确性分别为0.87、0.74和0.79，而临床检查的相应值分别为0.43、0.89和0.71。超声检查发现 26 名患者患有糜烂性疾病，而 MRI 诊断为 20 名患者，放射线检查诊断为 11 名患者。超声评估显示 36 名患者有炎症迹象，MRI 和临床检查分别显示 31 名患者和 20 名患者有炎症迹象。 US 和 MRI 基于体积的滑膜炎分级显示组内相关系数为 0.56-0.72 (P < 0.0001)。 US 检测到的骨变化的 MRI 和放射线可视化与 US 上基于大小的分级密切相关。结论。 US 能够检测 RA 患者 MTP 关节的破坏性和炎症变化并对其进行分级。与 MRI 相比，超声检查明显比临床检查和传统放射线检查更灵敏、更准确。考虑到 MTP 关节早期且频繁受累，超声对这些关节的评估可能对 RA 具有重要的临床意义。
Objective. To compare ultrasonography (US) with magnetic resonance imaging (MRI), conventional radiography, and clinical examination in the evaluation of bone destruction and signs of inflammation in the metatarsophalangeal (MTP) joints of patients with rheumatoid arthritis (RA).Methods. Two hundred MTP joints of 40 patients with RA and 100 MTP joints of 20 healthy control subjects were assessed with B-mode US, contrast-enhanced MRI, conventional radiography, and clinical examination for signs of bone destruction and joint inflammation.Results. With MRI considered the reference method, the sensitivity, specificity, and accuracy of US for the detection of bone erosions were 0.79, 0.97, and 0.96, respectively, while the corresponding values for radiography were 0.32, 0.98, and 0.93. The sensitivity, specificity, and accuracy of US for the detection of synovitis were 0.87, 0.74, and 0.79, while for clinical examination, the corresponding values were 0.43, 0.89, and 0.71. Erosive disease was identified in 26 patients by US, compared with 20 patients by MRI and 11 patients by radiography. Evaluation by US indicated signs of inflammation in 36 patients, while MRI and clinical examination revealed signs of inflammation in 31 patients and 20 patients, respectively. US and MRI volume-based gradings of synovitis showed intraclass correlation coefficients of 0.56-0.72 (P < 0.0001). The MRI and radiographic visualizations of US-detected bone changes were closely related to their size-based gradings on US.Conclusion. US enables detection and grading of destructive and inflammatory changes in the MTP joints of patients with RA. By comparison with MRI, US was found to be markedly more sensitive and accurate than clinical examination and conventional radiography. Considering the early and frequent involvement of the MTP joints, evaluation of these joints by US may be of major clinical importance in RA.