摘要
目的探讨肌骨超声与核磁共振成像(MRI)在诊断类风湿性关节炎(RA)膝关节病变中的应用价值。方法方便选取2018年4月—2020年4月该院收治的RA膝关节病变患者79例,对患者分别采用肌骨超声诊断(A方案)、MRI扫描诊断(B方案),分析膝关节病变在两种诊断方案中的声像特征,比较两种诊断方案对腘窝囊肿、滑膜病变、关节软骨改变、关节积液、半月板损伤、韧带改变、血痂形成等7种膝关节病变的诊断差异,分析两种诊断方案对类风湿性关节炎膝关节病变的临床诊断价值。结果肌骨超声的声像特征表现为:内部血流信号增多,滑膜明显增厚,形态不规则,髌上囊可探及积液,回声不匀质。MRI的声像特征表现为:膝关节滑膜增生,周围邻近软组织改变,关节软骨破坏、关节囊积液、骨质受侵。对关节软骨改变的诊断比较,肌骨超声的诊断率为29例(36.71%),MRI的诊断率为45例(56.96%),MRI的诊断率更高,差异有统计学意义(χ^(2)=6.507,P=0.012)。对滑膜病变、韧带改变和关节积液的诊断比较,肌骨超声的诊断率分别为51例(64.56%)、27例(34.18%)、49例(62.02%),MRI的诊断率分别为30例(37.97%)、9例(11.39%)、31例(39.24%),肌骨超声的诊断率更高,差异有统计学意义(χ^(2)=11.172、11.656、8.204,P=0.001、0.001、0.004)。两种诊断方案对腘窝囊肿、半月板损伤和血痂形成的诊断率比较,差异无统计学意义(P>0.05)。结论MRI与肌骨超声对RA膝关节病变患者的腘窝囊肿、半月板损伤和血痂形成等病变的诊断结果较为一致,MRI对膝关节软骨改变的诊断比较敏感,肌骨超声对滑膜病变、韧带改变和关节积液的诊断比较敏感,各有优势,两者可以相互补充。
Objective To investigate the application value of musculoskeletal ultrasound and magnetic resonance imaging(MRI)in the diagnosis of rheumatoid arthritis(RA)knee joint disease.Methods Included 79 patients with RA knee joint disease admitted in the hospital from April 2018 to April 2020.The patients were diagnosed by musculoskeletal ultrasound(A plan)and MRI scan diagnosis(B plan).The acoustic and image characteristics of knee joint lesions in the two diagnostic plans were analyzed,and the diagnosis differences between the two diagnostic programs for seven kinds of knee joint diseases,including popliteal cyst,synovial disease,articular cartilage change,joint effusion,meniscus injury,ligament change,blood callus formation,etc.were compared.The clinical diagnosis value of two diagnostic schemes for rheumatoid arthritis knee joint diseases was analyzed.Results The acoustic characteristics of musculoskeletal ultrasound were as follows:internal blood flow signal increased,synovial membrane was obviously thickened,morphology was irregular,suprapatellar sac was detectable and effusion,and echo was uneven.The sound image characteristics of MRI are as follows:the synovial hyperplasia of the knee joint,the surrounding soft tissue changes,the destruction of articular cartilage,joint capsule effusion,and bone invasion.Compared with the diagnosis of articular cartilage changes,the diagnosis rate of musculoskeletal ultrasound was 29 cases(36.71%),the diagnosis rate of MRI was 45 cases(56.96%),and the diagnosis rate of MRI was higher,the difference was statistically significant(χ^(2)=6.507,P=0.012).Compared the diagnosis of synovial lesions,ligament changes,and joint effusion,the diagnosis rate of musculoskeletal ultrasound was 51 cases(64.56%),27 cases(34.18%),49 cases(62.02%),and the diagnosis rate of MRI was 30 cases(37.97%),9 cases(11.39%),31 cases(39.24%),the diagnosis rate of musculoskeletal ultrasound was higher,the difference was statistically significant(χ^(2)=11.172,11.656,8.204,P=0.001,0.001,0.004).There was no statistically significant difference in the diagnosis rate of popliteal cyst,meniscus injury,and blood call between the two diagnostic programs(P>0.05).Conclusion MRI and musculoskeletal ultrasound are more consistent in the diagnosis of popliteal cysts,meniscus injury,and blood callus formation in patients with RA knee joint disease.MRI is more sensitive to the diagnosis of knee cartilage changes,and musculoskeletal ultrasound is more sensitive to synovial lesions.The diagnosis of ligament changes and joint effusion is more sensitive,each has its own advantages,and the two can complement each other.
作者
张婧如
杨鑑
丘洪林
唐平太
ZHANG Jingru;YANG Jian;QIU Honglin;TANG Pingtai(Department of Ultrasound,Longyan First Hospital Affiliated to Fujian Medical University,Longyan,Fujian Province,364000 China)
出处
《中外医疗》
2021年第15期180-182,198,共4页
China & Foreign Medical Treatment
作者简介
张婧如(1985-),女,本科,主治医师,主要从事超声诊断工作。
