Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease
Dynamic gadolinium-enhanced magnetic resonance imaging of the wrist in patients with rheumatoid arthritis can discriminate active from inactive disease
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DOI：
10.1002/art.10962
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发表时间：
2003-05-01
影响因子：
--
通讯作者：
Garlaschi, G
中科院分区：
文献类型：
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作者：
Cimmino, MA;Innocenti, S;Garlaschi, G
目标。目的探讨腕部动态钆增强磁共振成像（MRI）在类风湿关节炎（RA）患者疾病活动性评价中的作用。研究对象为36例不同疾病活动度的RA患者和5例健康对照者。MRI采用低场（0.2T）肢体专用机器。静脉滴注钆-二乙烯三胺五乙酸后，每18秒获得3片腕关节连续20张快速自旋回波图像。滑膜增强曲线分为两组：对照组和缓解期RA患者，以及活动性或中度活动性RA患者。活动性RA患者的早期增强率（REE）和相对增强率（RE）均显著高于非活动性RA患者和对照组。REE和再保险的关节肿胀有显著相关性(P < 0.00001, P = 0.003),分别招标关节的数量(P < 0.00001, P = 0.004),分别里奇指数(P = 0.0002 REE和RE),疾病活动评分(分别为P = 0.0004, P = 0.0008),健康评估问卷(HAQ)(分别为P = 0.0002, P = 0.0007),清晨刚度(分别为P = 0.001, P = 0.009),c反应蛋白水平（P = 0.015, P = 0.03）、红细胞沉降率（P = 0.03，仅RE）、α 2球蛋白（P = 0.036, P = 0.028）。我们的数据支持使用动态MRI来区分活动性和非活动性RA。增强曲线不仅与炎症的实验室和临床指标相关，还与HAQ相关，HAQ是RA功能结局的相关预测因子。这项技术可以经常重复，是RA患者随访的理想方法。
Objective. To determine the efficacy of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) of the wrist in the evaluation of disease activity in patients with rheumatoid arthritis (RA).Methods. Thirty-six patients with RA (with different degrees of disease activity) and 5 healthy controls were studied. MRI was performed with a low-field (0.2T), extremity-dedicated machine. After an intravenous bolus injection of gadolinium-diethylenetriamine pentaacetic acid, 20 consecutive fast spin-echo images of 3 slices of the wrist were obtained every 18 seconds.Results. The curves of synovial membrane enhancement identified the following 2 groups: controls and RA patients in remission, and RA patients with active or intermediately active disease. Both the rate of early enhancement (REE) and relative enhancement (RE) were significantly higher in patients with active RA than in those with inactive RA and controls. The REE and RE were significantly correlated with the number of swollen joints (P < 0.00001 and P = 0.003, respectively), the number of tender joints (P < 0.00001 and P = 0.004, respectively), the Ritchie index (P = 0.0002 for both REE and RE), the Disease Activity Score (P = 0.0004 and P = 0.0008, respectively), the Health Assessment Questionnaire (HAQ) (P. = 0.0002 and P = 0.0007, respectively), early morning stiffness (P = 0.001 and P = 0.009, respectively), the C-reactive protein level (P = 0.015 and P = 0.03, respectively), the erythrocyte sedimentation rate (P = 0.03, RE only), and alpha2 globulins (P = 0.036 and P = 0.028, respectively).Conclusion. Our data support use of dynamic MRI for discriminating active from inactive RA. Enhancement curves are associated not only with laboratory and clinical indicators of inflammation, but also with the HAQ, a relevant predictor of RA functional outcome. This technique can be repeated frequently and is an excellent candidate for the ideal method for the followup of patients with RA.