MRI findings of juvenile psoriatic arthritis
MRI findings of juvenile psoriatic arthritis
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DOI：
10.1007/s00256-008-0537-1
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发表时间：
2008-11-01
影响因子：
2.1
通讯作者：
Kleinman, Paul K.
中科院分区：
文献类型：
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作者：
Lee, Edward Y.;Sundel, Robert P.;Kleinman, Paul K.
目的探讨儿童幼年型银屑病关节炎（juvenile psoriatic arthritis，JpsA）的MRI表现特点，以利于早期诊断和治疗（9名男孩，22名女孩;年龄范围1-17岁;平均年龄9.4岁），明确诊断为JpsA并接受了MRI。评价了每个MRI的滑膜异常（增厚和增强）、关节积液（小、中、大）、骨髓异常（水肿、增强和异常位置）、软组织异常（水肿、增强、萎缩和脂肪浸润）、肌腱异常（增厚、水肿、腱鞘液和增强）和关节异常（关节间隙狭窄和侵蚀）。评价了37次MRI检查中6类异常MRI结果的分布。评估每次MRI检查的异常MRI结果数量。结果31例患儿37次MRI检查中，共发现96例异常MRI表现，其中12例为异常MRI表现，1例为异常MRI表现，2例为异常MRI表现。37例异常MRI检查包括手（n=8）、膝（n=8）、踝（n= 5）、骨盆（n = 5）、颞下颌关节（n=4）、腕（n=3）、足（n=2）、肘（n=1）和肩（n=1）。弥漫性滑膜增厚和/或强化28例（29.2%）。关节积液MRI异常22例（22.9%）。16例（16.7%）骨髓水肿和/或强化异常，7例（7.3%）骨髓水肿累及非关节部位。软组织异常表现为水肿和（或）强化者14例（14.5%）。有10个MRI异常（10.4%）涉及肌腱。关节异常表现为关节间隙狭窄和/或骨质侵蚀，其中6例（6.2%）为MRI异常。大多数MRI检查有一个以上的异常发现（84%）。进行MRI检查的年龄在男孩和女孩之间没有显著差异。所有六类异常MRI结果没有显着差异的男孩和女孩。结论儿童JpsA通常存在一个以上的异常发现在他们的MRI研究。虽然滑膜异常是JpsA儿童最常见的MR表现，但关节和非关节部位的多灶性骨髓水肿和增强也是JpsA儿童的显著表现。与银屑病关节炎成人相比，JpsA儿童的关节异常率要低得多。我们的研究结果表明，MRI可以发挥有用的作用，在诊断和持续评估这种罕见的，但重要的，儿科风湿性疾病。
Objective The aim of this study was to describe the magnetic resonance imaging (MRI) features of juvenile psoriatic arthritis (JpsA) in children in order to facilitate early diagnosis and proper management.Materials and methods Two pediatric radiologists retrospectively reviewed in consensus a total of 37 abnormal MRI examinations from 31 pediatric patients (nine boys, 22 girls; age range 1-17 years; mean age 9.4 years) who had a definite diagnosis of JpsA and underwent MRI. Each MRI was evaluated for synovium abnormality (thickening and enhancement), joint effusion (small, moderate, and large), bone marrow abnormality (edema, enhancement, and location of abnormality), soft tissue abnormality (edema, enhancement, atrophy, and fatty infiltration), tendon abnormality (thickening, edema, tendon sheath fluid, and enhancement), and articular abnormality (joint space narrowing and erosion). The distribution of abnormal MRI findings among the six categories for the 37 MRI examinations was evaluated. The number of abnormal MRI findings for each MRI examination was assessed. Age at MRI examination and all six categories of abnormal MRI findings according to gender were evaluated.Results There were a total 96 abnormal MRI findings noted on 37 abnormal MRI examinations from 31 pediatric patients. The 37 abnormal MRI examinations included MRI of the hand (n=8), knee (n=8), ankle (n=5), pelvis (n=5), temporomandibular joint (n=4), wrist (n=3), foot (n=2), elbow (n=1), and shoulder (n=1). Twenty-eight diffuse synovial thickening and/or enhancement were the most common MRI abnormality (29.2%). Joint effusion comprised 22 abnormal MRI findings (22.9%). There were 16 abnormal MRI bone marrow edema and/or enhancement findings (16.7%), and in seven (7.3%) the edema involved non-articular sites. Soft tissue abnormality manifested as edema and/or enhancement constituted 14 abnormal MRI findings (14.5%). There were ten MRI abnormalities (10.4%) involving tendons. Articular abnormality seen as joint space narrowing and/or bone erosion comprised six abnormal MRI findings (6.2%). Most MRI examinations had more than one abnormal finding (84%). Age at which MRI examinations were performed was not significantly different between boys and girls. All six categories of abnormal MRI findings were not significantly different between boys and girls.Conclusion Children with JpsA typically present with more than one abnormal finding on their MRI studies. While synovial abnormality is the most common MR finding in children with JpsA, multi-focal bone marrow edema and enhancement at both articular and non-articular sites are also notable findings in children with JpsA. The rate of articular abnormality is much lower in children with JpsA in comparison to adults with psoriatic arthritis. Our findings suggest that MRI can play a useful role in the diagnosis and ongoing assessment of this uncommon, though important, pediatric rheumatologic disorder.