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目的对类风湿性关节炎的DR及MRI诊断分析进行探讨,以期提高临床对本病早期诊断的准确率。方法回顾分析2016年9月至2017年7月经本院临床明确诊断证实的65例类风湿性关节炎患者的病例档案资料,以对比DR和MRI影像学的诊断准确率情况。结果本组65例患者,DR检查显示60例阳性、5例阴性;DR主要表现为病变关节的周围软组织呈现肿胀、关节间隙狭窄、关节面与边缘骨质发生局限性损坏,且周围骨质出现明显疏松脱钙现象,其中7例表现出关节半脱位。MRI检查显示均为阳性,MRI主要表现为滑膜炎渗出时,T1WI为低信号、T2WI呈高信号;骨髓水肿时,T1WI为低信号,T2WI为高信号,增强后T1WI信号强化;血管翳发生时,T1WI为中等强度信号,T2WI呈高信号,增强后T1WI信号明显强化;关节破坏时,软骨层次模糊甚至消失,信号改变,T1WI为低信号,T2WI呈不规则性高信号,且软骨面毛糙、高低不平,呈小囊状改变;关节骨质侵蚀,T1WI呈低信号,T2WI呈高信号;关节积液及韧带、关节囊增厚时,T1WI为低信号,T2WI呈高信号。结论对比应用DR与MRI影像学检查方法进行诊断类风湿性关节炎,得知MRI的敏感性与特异性更高,是早期明确诊断类风湿性关节炎的首选及最佳的一种影像学检查方法。
Objective To investigate the DR and MRI diagnosis of rheumatoid arthritis in order to improve the clinical accuracy of early diagnosis of this disease. Methods A retrospective analysis was made on the case files of 65 rheumatoid arthritis patients confirmed by clinical definite diagnosis in our hospital from September 2016 to July 2017 to compare diagnostic accuracy of DR and MRI. Results In the group of 65 patients, the DR examination showed 60 cases were positive and 5 cases were negative. The main manifestations of DR were swelling of the surrounding soft tissues, narrowing of the joint space, limited damage of the articular surface and marginal bone, and the presence of the surrounding bone Clear loose decalcification phenomenon, of which 7 cases of joint subluxation. MRI showed positive results. The main manifestations of MRI were synovitis infiltration, T1WI low signal, T2WI high signal; bone marrow edema, T1WI low signal, T2WI high signal enhanced T1WI signal enhancement; T1WI was moderate intensity signal, T2WI was high signal, enhanced T1WI signal significantly enhanced; joint destruction, the cartilage level fuzzy or even disappear, the signal changes, T1WI is low signal, T2WI showed irregular high signal, and the cartilage surface Rough, uneven and small cystic changes; joint erosion, T1WI was low signal, T2WI was high signal; joint effusion and ligament, articular capsule thickening, T1WI is low signal, T2WI was high signal. Conclusion Compared with the DR and MRI imaging diagnosis of rheumatoid arthritis, that the sensitivity and specificity of MRI higher, early clear diagnosis of rheumatoid arthritis is the first choice and the best kind of imaging examination method.