MRI联合CT对类风湿性关节炎骨质侵蚀程度检测与预后的相关性

摘要

Objective To investigate the clinical value of bone marrow edema (BME) and bone erosions score in assessing therapeutic effect of Rheumatoid arthritis (RA) using MRI and CT scoring system. Methods All patients underwent MRI and CT examination before treatment and after treatment at Six months later. CT and MR images of both wrists and the 2nd to 5th metacarpophalangeal joints of 34 patients with RA were analyzed. BME score and bone erosion score of each patient were obtained using OMERACT RAMRIS Scoring System. CT scores were acquired simple erosion narrowing score(SENS),which was based on initial SENS and reduced the scores of the proximal interphalangeal joints,distal interphalangeal joints and 1st metacarpophalange-al joints. We analyzed the sign score difference before and after treatment between response and non-response group and the rela-tionships between the scores of each sign. Results There were significant correlation between BME score and bone erosions score ( r =0.919,P =0.000),and SENS score( r =0.884,P =0.000),and treatment effect( r =0.493,P =0.003),between treatment effect and bone erosions score( r =0.487,P =0.004),and SENS score( r =0.509,P =0.002). There was a sig-nificant difference of MRI BME score change after therapy between response and non-response group (10.0 ± 5.9 vs 0.9 ± 10.5),Mann-Whitney Test,P =0.003. The result of ROC analysis for identification of responding lesions showed that threshold MRI BME score changes after therapy of 6.5 h and 80% sensitivity and 77.8% specificity. There was a significant difference of bone erosion score and SENS score change after therapy between response and non-response group, Mann-Whitney Test,P =0.679;P =0.055. Conclusion MRI combined with CT examination can semi quantitatively reflect the degree of bone erosion and joint destruction,MRI edema score was significantly correlated with the degree of bone erosion,which may help to judge the prognosis. MRI bone marrow edema can be used as an important indicator of clinical efficacy, with high specificity and sensitivity.%目的 探讨骨髓水肿和骨侵蚀对类风湿性关节炎(RA)疗效观察的价值,以及与预后的关系.方法 选取确诊的类风湿患者34例,于治疗前进行腕关节的MRI、CT检查,检查范围包括双侧腕关节和第2~5掌指关节,所有患者确诊后均进行正规类风湿治疗,间隔6个月后对患者进行MRI、CT随访观察,参照 OMERACT RAMRIS评分系统和X线简易狭窄侵蚀评分(simple erosion narrowing score,SENS)对RA骨髓水肿(bone marrow edema, BME)、骨侵蚀进行评分,分析治疗有效组和无效组之间各征象治疗前后评分差异,以及各征象相关性.结果 MRI的BME评分和骨侵蚀评分、SENS评分、治疗效果有显著相关性( r = 0.919,P =0.000;r =0.884,P =0.000;r =0.493,P =0.003),治疗效果和MRI骨侵蚀评分、SENS评分显著相关( r =0.487,P =0.004;r =0.509,P =0.002).有效组和无效组MRI骨髓水肿治疗前后评分变化值差异有统计学意义,有效组平均变化值10.0 ± 5.9,无效组0.9 ± 10.5,(Mann-Whitney Test,P =0.003),ROC曲线下面积为0.836,P =0.003,治疗前后评分差值≥6.5为治疗有效标准,敏感度为80%,特异度为77.8%;有效组和无效组MRI骨侵蚀评分和SENS评分治疗前后评分变化值差异无统计学意义(Mann-Whitney Test,P =0.679;P =0.055).结论 MRI联合CT检查可半定量反映患者骨侵蚀和关节破坏程度,MRI水肿评分与骨侵蚀程度显著相关,可为预后判断提供帮助.MRI骨髓水肿作为临床疗效观察的指标,具有较高的特异度和敏感度.