Objective To evaluate the interactive relationship between inflammation detected by single photon emission computed tomography combined with computed tomography (SPECT/CT) and magnetic resonance imaging (MRI) detection of synovitis,bone marrow edema (BME) in the early rheumatoid arthritis (RA) patients.Methods Twenty patients with early RA were included into this study.All patients were diagnosed based on the 2010 ACR/EULAR classification criterion.Patients' unilateral hands (MCP 2-5 and PIP 2-5 joints) were inspected by SPECT/CT (label:99Tcm-MDP) and MRI (3.0 T).SPECT/CT and MRI images were analyzed by two reviewers blinded to other clinical information.Increased bone metabolism of the regional area of interest (ROI) was analyzed and the uptake ratio was calculated.MRI quantitative evaluation was completed by RAMRIS score system.Statistical analysis was performed using SPSS 17.0 software.Student's t-test,analysis of variance (ANOVA),x2 test and post-hoc analysis (Scheffe) were used for comparison of datas,correlation analysis was carried out with Spearman rank correlation test.Results Twent ypatients with a total of 160 joints were examined.MRI examination revealed synovitis (39,24.4％),or BME (24,15.0％) in 63(39.4％) joints.99Tcm-MDP uptake increased in 79(49.4％) joints,and the uptake ratio was higher than normal joints (1.59±0.26 vs 1.15±0.09,t=6.408,P＜0.01).The uptake ratio between the graded synovitis level and RAMRIS synovitis score had a moderate correlation (r=0.535,P=0.001).The uptake ratio of BME level and BME score was well correlated (r=0.765,P=0.001).Conclusion In early RA patients,MRI is sensitive for synovitis and BME.SPECT/CT can detect early abnormal bone metabolism associated with inflammation,which is more sensitive than MRI.SPECT/CT can be used to detect changes of RA at the molecular level.Compared with synovitis,BME is more closely related to bone metabolism changes,which may suggest that BME may play a major role in the bone destruction in RA.However,further studies are needed to verify this hypothesis.%目的 通过单光子发射计算机断层扫描/X线计算机断层扫描(SPECT/CT)应用于早期RA的检测并与MRI检测的滑膜炎、骨髓水肿比较,探讨其分子病理基础.方法 20例早期RA患者纳入研究.所有患者行SPECT/CT[标记物:99Tcm亚甲基二膦酸盐(99Tcm-MDP)]单手(第2～5掌指关节和近端指间关节)局部断层扫描和MRI(3.0 T)检查.SPECT/CT和MRI图像分别由2名医生进行盲法读片分析.对骨代谢增加区域行感兴趣区分析计算摄取率,MRI采用RA MRI评分指数(RAMRIS)进行定量评价.采用t检验、单因素方差分析、Scheffe检验、x2检验和Spearman相关性检验进行统计分析.结果 20例早期RA患者单侧手共计160个关节中,MRI检查发现滑膜炎39处(24.4％),骨髓水肿24处(15.0％),共63处(39.4％).标记物99Tcm-MDP在79处(494％)关节区域增加,摄取率高于正常关节区域(分别为1.59±0.26,1.15±0.09,t=6.408,P＜0.01).SPECT/CT发现与炎症相关的异常信号(49.4％,79/160)高于MRI对炎性病灶的检出率(39.4％,63/160)(x2=9.608,P=0.002).不同滑膜炎等级摄取率与RAMRIS的滑膜炎评分呈正相关(r=0.535,P=0.001).不同骨髓水肿等级的摄取率与骨髓水肿评分呈正相关(r=0.765,P=0.001).结论 在早期RA患者中,SPECT/CT可以发现与炎症相关的骨代谢异常,而且比MRI对炎症病灶的检出率高,SPECT/CT可以作为早期RA关节炎症分子病理改变的检测手段.
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