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目的使用全身MRI检测系统性硬皮病并有骨肌症状病人的骨肌的侵犯。材料与方法 18例系统性硬皮病并有骨肌症状的病人接受了1.5T全身MR成像检查(男性8例,女性10例,平均年龄46岁)。通过影像评估信号异常和(或)皮下脂肪组织隔膜、肌筋膜、肌间隔膜的增厚,通过短T1反转恢复序列(STIR)影像或注射钆对比剂后的扫描来观察肌肉信号强度、关节及腱鞘内滑液的异常。此外,还要确定C反应蛋白、肌酸酐和改良Rodnan皮肤硬化评分。结果 MR成像显示16例(89%)病人有筋膜炎、关节滑膜炎、皮下软组织增厚。MRI表现与14例肌病或肌炎病人(78%)、11例腱鞘炎病人(61%)和14例肌腱炎病人(56%)相一致。其典型表现是分布对称且范围广泛。改良Rodnan皮肤硬化评分、C反应蛋白及肌酸酐之间没有明显的相关性。结论在患系统性硬皮病并有骨肌症状的病人中,全身MR成像对肌肉、筋膜、关节、肌腱的检测比临床及实验室参数更可信。要点①全身MR成像可以可靠地检出系统性硬皮病病人骨肌受累的情况。②有症状的系统性硬皮病病人经常出现MR成像的异常表现。③MR骨肌表现仅与部分临床评分和实验室的生物标记物有关。④MRI早期发现骨肌的异常有助于提高临床分期。
Objective To detect the invasion of systemic scleroderma by using whole-body MRI with osteomyelitis in patients with osteomyelitis. MATERIALS AND METHODS Eighteen patients with systemic scleroderma and osteomyelitis received a 1.5T whole-body MR imaging examination (8 males and 10 females, mean age 46 years). Muscle signal intensity was visualized by image assessment of signal abnormalities and / or thickening of subcutaneous adipose tissue septum, myofascial, intramedullary septum, scanning of short T1 inversion recovery sequence (STIR) images or after injection of gadolinium contrast agent, Abnormalities in synovial and tendon sheath synovial fluid. In addition, C-reactive protein, creatinine, and modified Rodnan sclerosis score were also determined. Results MR imaging showed fasciitis, synovitis and subcutaneous soft tissue thickening in 16 patients (89%). MRI findings were consistent with 14 patients with myopathy or myositis (78%), 11 patients with tenosynovitis (61%) and 14 patients with tendinitis (56%). Its typical performance is distributed symmetry and a wide range. There was no significant correlation between modified Rodnan sclerosis score, C-reactive protein and creatinine. Conclusion In patients with systemic scleroderma and osteosarcoma, whole-body MR imaging is more reliable than clinical and laboratory parameters in muscle, fascia, joint, and tendon detection. Points ① Whole body MR imaging can reliably detect the involvement of the skeletal muscle of patients with systemic scleroderma. ② Symptoms of patients with systemic scleroderma often appear abnormal MR imaging. ③ MR bone performance only with some clinical scores and laboratory biomarkers. ④ MRI early detection of abnormal bone muscular contribute to improve clinical staging.