Objective To investigate the predictive value of dynamic enhanced MRI time-intensity curve in rheumatoid arthritis (RA) conversion from undifferentiated arthritis (UA). Methods We analyzed the baseline data of dy-namic enhanced MRI in 61 patients (female n=53, male n=8;age range 22-68 years old, mean age 49.93 ±10.27 years old, median disease history 2.7 months, range 7 d-12 months) with UA from January 2014 to August 2015 in the Department of Immunology of Tianjin First Center Hospital. After 1 year follow-up, 25 cases converted to RA, 22 cases were clinically diag-nosed non-RA. The student's t-test or Wilcoxon Rank-Sum Test for two independent samples were used to compare the dif-ference in each time-intensity curve index between the two groups. The receiver operating characteristic (ROC) curve analy-sis was carried out to test the diagnostic value of each index. Results The relative enhancement (RELENH), maximum rela tive enhancement (MAXRELENH), maximum enhancement (MAXENH), wash in rate (WASHIN), area under the curve (AREACURV) were significantly higher in the RA than in the non-RA group (P<0.001). The time to peak(TTP) did not sig-nificantly differ between the two groups (P>0.05). The areas under the ROC curve of RELENH, MAXRELENH, MAXENH, WASHIN, and AREACURV were 0.838, 0.829, 0.855, 0.955, and 0.864, respectively;the sensitivities were 92.0％, 92.0％, 88.0％, 92.0％, and 96.0％, respectively;and the specificities were 77.3％, 77.3％, 81.8％, 86.4％, and 68.2％, respectively. Therefore, the area under the ROC curve of WASHIN was the highest, and the sensitivity of AREACURV was the highest in the five indexes. Conclusion RELENH, MAXRELENH, MAXENH, WASHIN, and AREACURV of dynamic enhanced MR time-intensity curve had high clinical value to predict the conversion from UA to RA, and had important guiding significance for clinical early diagnosis and early treatment.%目的 探讨MRI动态增强时间-强度曲线各指标在手未分化性关节炎(UA)向类风湿性关节炎(RA)转归预测中的价值.方法 分析2014年1月—2015年8月于天津市第一中心医院风湿免疫科就诊的61例UA病人动态增强MRI基线资料,其中女53例,男8例,年龄22～68岁,平均(49.93±10.27)岁,中位病程2.7个月(7 d～12个月).将随访1年后确诊为RA病人25例和确诊为非RA病人22例纳入研究,采用t检验或两独立样本的秩和检验比较2组间时间-强度曲线各指标差异,采用受试者操作特征(ROC)曲线下面积评价各指标的诊断价值.结果 RA组相对增强(RELENH)、最大相对增强(MAXRELENH)、最大增强(MAXENH)、最大强化斜率(WASHIN)、曲线下面积(AREACURV)均高于非RA组(均P<0.001);RA组达峰时间(TTP)差异无统计学意义(P>0.05).RELENH、MAXRELENH、MAXENH、WASHIN、AREACURV的ROC曲线下面积分别为0.838、0.829、0.855、0.955、0.864,敏感度分别为92.0％、92.0％、88.0％、92.0％、96.0％,特异度分别为77.3％、77.3％、81.8％、86.4％、68.2％.其中,WASHIN的ROC曲线下面积在5项指标中诊断效能最高,AREACURV的敏感度在5项指标中最高.结论 MRI动态增强时间-强度曲线RELENH、MAXRELENH、MAXENH、WASHIN、AREACURV对预测UA向RA转归具有较高的临床价值,对临床早期诊断、早期治疗具有重要指导意义.
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