Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis
Magnetic Resonance Imaging of Bilateral Hands Is More Optimal Than MRI of Unilateral Hands for Rheumatoid Arthritis
复制标题
双侧手部磁共振成像比单侧手部 MRI 更适合治疗类风湿性关节炎
DOI：
10.3899/jrheum.171044
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发表时间：
2018
影响因子：
3.9
通讯作者：
Dai Lie
中科院分区：
文献类型：
--
作者：
Mo Ying Qian;Yang Ze Hong;He Hai Ning;Ma Jian Da;Liang Jin Jian;Zeng Wei Ke;Shi Guang Zi;Shen Jun;Dai Lie
目标。探讨双侧手磁共振成像（MRI）在类风湿关节炎（RA）中的优势。方法。连续招募活动性RA患者进行临床评估、x线片和双侧手MRI。在3.0 T全身MRI系统上同时扫描双侧双手，根据RAMRI评分（RAMRIS）系统对滑膜炎、骨炎和骨侵蚀进行评分。结果。纳入的120例患者中，腕骨和掌指关节（MCPJ） 2近端在早期RA中出现骨侵蚀。中晚期RA中，第二至第五掌骨基部和第二至第四MCPJ远端出现较多的骨侵蚀。分析单侧优势手MRI时，5%的腕部MRI滑膜炎和骨炎，5-14%的MCPJ MRI 3个特征误诊（McNemar试验，均p < 0.05）。46%的腕部滑膜炎，29-52%的MCPJ2-5滑膜炎，45%的腕部骨炎，20%-34%的MCPJ2-5骨炎未被关节压痛和/或肿胀检测到。根据体格检查选择临床上较严重的手进行单侧手MRI时，5%的腕关节MRI滑膜炎和7-15%的MCPJ MRI 3个特征被误诊（均p < 0.05）。散点图和线性回归分析用于说明优势手或选择手（Y值）与非优势手或非选择手（X值）之间的RAMRIS。所有线性模型均与Y = X线性模型有显著差异，表明优势手或临床更严重的手不能代表对侧手评价RAMRIS。结论。RA患者双侧手MRI优于单侧手MRI。
Objective. To explore the advantages of magnetic resonance imaging (MRI) of bilateral hands in rheumatoid arthritis (RA). Methods. Consecutive patients with active RA were recruited for clinical assessments, radiographs, and MRI of bilateral hands. Bilateral hands were scanned simultaneously on 3.0 T whole-body MRI system and were scored on synovitis, osteitis, and bone erosion according to the RA MRI scoring (RAMRIS) system. Results. Among 120 patients included, wrist bones and metacarpophalangeal joint (MCPJ) 2 proximal showed bone erosion in early RA. The second to fifth metacarpal bases and the second to fourth MCPJ distal showed more bone erosion in mid-stage or late-stage RA. When MRI of dominant unilateral hand was analyzed, MRI synovitis and osteitis in 5% of wrists and 3 MRI features in 5–14% of MCPJ were misdiagnosed (McNemar test, all p < 0.05). There were 46% wrist synovitis, 29–52% MCPJ2–5 synovitis, 45% wrist osteitis, and 20%–34% MCPJ2–5 osteitis not detected by joint tenderness and/or swelling. When the clinically more severe hand was selected for MRI of unilateral hand according to physical examination, MRI synovitis in 5% of wrists and 3 MRI features in 7–15% of MCPJ were misdiagnosed (all p < 0.05). Scatter plots and linear regression analyses were used to illustrate RAMRIS between dominant or selected hand (Y values) and nondominant or nonselected hand (X values). All linear models were markedly different from a Y = X linear model, indicating the dominant or clinically more severe hand could not represent the contralateral hand to evaluate RAMRIS. Conclusion. MRI of bilateral hands is more optimal than MRI of the unilateral hand in RA.