| ObjectiveCurrently, the diagnosis of rheumatoid arthritis primarily relies on clinical manifestations, imaging findings and serum rheumatoid factor test. In imaging examination,X-ray changes in the wrists typical of rheumatoid arthritis, with destruction of bone around the involved joints. However, the changes of early-stage disease, such as, intra-articular soft tissue lesion and articular cartilage of the damaged couldn’t be determined. Computed tomography (CT) scan could show more detail than general x-rays, but still difficult to display intra-articular soft tissue lesions. Therefore, although X-ray and CT angiography joints could clear display intra-articular structure and articular cartilage edge profile, improve the sensitivity of the joint disease, but due to the complicated technology and invasive examination lead to hardly extensive clinical application. Magnetic resonance imaging (MRI) has more sequence, many parameter imaging characteristics and higher soft tissue resolution, has been demonstrated as one of the important and successful approaches for rheumatoid arthritis diagnosis. Magnetic resonance scan can display synovial thickening, synovial pannus formation, articular cartilage damage, bone erosion, articular cavity effusion and other pathological changes, but.MRI sequences are numerous, different sequences may display inconsistent organization structure change with pathological changes. In the literature, however, the systematic contrast of MRI sequence in the wrist rheumatoid arthritis application has rarely been studied. Therefore, in this study, we will comparison and analyze the value of MRI FSE-T1WI, FS-FSE-T2WI, FS-PDWI,3D-ME,3D-FLASH-WE, T1-WATER and scanning sequence on the wrist rheumatoid arthritis lesions to further optimize MRI wrist rheumatoid arthritis scanning techniques, and improve the early-stage diagnosis rate of wrist joint rheumatoid arthritis and accurate disease staging.Methods1.Clinical research subjects:Sixty rheumatoid arthritis patients from November2009to December2011that had been confirmed by clinical diagnosis, imaging and serology and other related test in our hospital and follow-up been confirmed wrist rheumatoid arthritis patients had been studied. All the diagnoses were consistent with the American Rheumatism Association/European League Against Rheumatism (ARA/EULAR)2009diagnostic criteria [1].18cases were male,42were female, age covers21～71year old, and average is40.9years old. The other25, gender, age matched healthy volunteers were collected as a control group.In the60cases of RA, the main clinical manifestations include:hand and wrist stiffness (52cases), joint pain (53cases), joint swelling (50cases), activity limitation (43cases), duration of3months to5years. All patients were at least in the presence of bilateral carpal and hand small articular symptoms, the majority of treatment began within4to6months after the appearance of symptoms. Laboratory examination:39cases showed positive rheumatoid factor,43cases caused the high erythrocyte sedimentation rate,34cases showed C reactive protein elevating.2.MRI examination methods:MRIs scan of the wrist joints was obtained with a1.5T superconducting scanner (Siemens) MRI from60cases of patients with rheumatoid arthritis and25cases of healthy volunteers. Specific scanning sequences and parameters are as follows:①FSE (fast spin echo) T1WI coronary patients (TR360ms, TE13ms, matrix640x640, FOV180mm, layer thickness3mm),②FSE- T2WI fat suppression sequence coronary patients (TR3520ms, TE79ms, matrix256x256, FOV180mm, layer thickness3mm),③PDWI fat suppression sequence transverse position (TR2100ms, TE26ms, matrix654x400, FOV140mm, layer thickness3mm),④T1-WATER sequence (TR450ms, TE11ms, matrix512x512, FOV180mm, layer thickness of3.0mm),⑤3D-FLASH-WE sequence (TR17.3ms, TE6.4ms, matrix512x384, FOV300mm, layer thickness of1.2mm),⑥3D-ME sequence (TR39ms, TE22ms, matrix512x512, FOV140mm, layer thickness of1.2mm). In addition, twenty-one patients and4healthy volunteers were performed enhancement scan. In brief, injected contrast agent gadolinium acid meglumine (Gd-DTPA) by the contralateral cubital vein with a dosage of0.2mmol/kg body weight, then performed SE T1WI coronary patients (TR480ms, TE15ms, matrix512x512, FOV130mm, layer thickness of3.0mm) and cross sectional patients (TR450ms, TE13ms, matrix256x256, FOV130mm, layer thickness of3.0mm) pressure grease enhancement scanning. Then analysis and compare the MRIs characteristics of different wrist rheumatoid arthritis patients.3.Evaluation method of image data and the observed indicators:To evaluate the MRI each sequence unenchanced and enhanced images that obtained from all patients and healthy volunteers, double blind analysis method were performed by two experienced radiologists, respectively. Observation indicators of MRI of wrist rheumatoid arthritis patients include:synovial thickening of the wrist, damaged articular cartilage, soft tissue swelling, joint effusion, edema, bone marrow damage, such as tendinitis, Tenosynovitis. Meanwhile, different checkout of the check sequence for the above indicators was compared. In addition, wrist joint cartilage of healthy volunteers and patients with rheumatoid arthritis were measured, which mainly about measuring signal intensity of the same cross-section of bone cartilage and bone marrow, and followed by calculating the signal-to-noise ratio of capitate bone cartilage and the contrast-to-noise ratio of cartilage/bone marrow. Right decision need to be made by discussing when two doctors hold dissent.4.Statistical analysis:All data were calculated by SPSS13software. Chi-square test was used to analyze multiple group positive rate difference; random analysis of variance were used to analyze the signal-to-noise ratio of capitate bone cartilage and the contrast-to-noise ratio of cartilage/bone marrow. Then, different sequence were analyzed by q test, the multiple comparisons should be carried out. P<0.05was considered significant.This study was performed under the permission of the ethics committee. All subjects before examination were informed consent informing, and signed informed consent.Results1.Different sequences comparisons of MRI of healthy volunteers’ wrists.(1) All the scanning sequence showed that synovial thickening, bone marrow edema, bone destruction, joint effusion and the other abnormal pathological signs were not found in25cases healthy volunteers’ wrists. Meanwhile, the enhancement inspection results showed that joint synovial was not found abnormal strengthening in4cases volunteers.(2) Signal to noise ratio of capitate bone cartilage and contrast to noise ratio of cartilage/bone marrow analysis from healthy volunteers group:The results showed that the3D-FLASH-WE sequence cartilage signal to noise ratio was the highest one, the value is25.33～50.39±1.44～2.19, FS-PDWI series was lower than3D-FLASH-WE,21.25±2.44. The3D-FLASH-WE sequence on cartilage and bone marrow of the contrast-to-noise ratio was the highest one,14.17～27.89±1.19～1.31, FS-PDWI sequence was secondary high,13.31±2.06.MRI different sequence inspection overall comparison signal-to-noise ratio analysis of variance have statistical significance.There was no significant difference about signal-to-noise ratio between FS-FSE-T2WI and T1-WATER (P>0.05). However, there were significant differences about signal to noise ratio among other sequences (P<0.01). However, there were no significant difference about contrast-to-noise ratio between FSE-T1WI and FS-FSE-T2WI, FSE-T1WI and Tl-WATER, respectively (P>0.05). But it is significance different in contrast-to-noise ratio among other sequences (P<0.01).2.Different sequences comparisons of MRI of Rheumatoid arthritis’s wrists.(1) The60cases of wrist joint RA patients With the clinical situation is different, appear different degree abnormal signs, such as synovial hyperplasia, synovial pannus formation,cartilage damage, soft tissue swelling, joint effusion, bone marrow edema, bone destruction, tendonitis and tenosynovitis confirmed in. Different sequences MRI performance results are as follows:1) The FSE-T1WI sequence showed synovial thickening、including synovial pannus formation in39cases (65.0%), and cartilage damage in28cases (46.7%),28cases (46.7%) of soft tissue swelling, joint effusion in27patients (45.0%),36cases of bone marrow edema (60.0%), bone destruction in29cases (48.3%), the tendinitis in7cases (11.7%), tenosynovitis3cases (5.0%).2) The FS-FSE-T2WI sequence showed49cases(81.7%) of synovial thickening、including synovial pannus formation, and cartilage damage in39cases(65.0%), soft tissue swelling in28cases(46.7%),41cases(68.3%) of joint effusion, bone marrow edema in41cases(68.3%), bone destruction in24cases(40.0%), nine cases (15.0%)of tendinitis, tenosynovitis five cases(8.3%).3) The FS-PDWI sequence showed synovial thickening、including synovial pannus formation in52cases(86.7%),52cases(86.7%) of cartilage damage, soft tissue swelling in32cases(53.3%) and joint effusion in46cases(76.7%),49cases(81.7%) of bone marrow edema, bone destruction in27cases(45.0%),15cases(25.0%) of tendinitis, tenosynovitis of six cases(10.0%).4) The3D-FLASH-WE sequence showed58cases (96.7%)of synovial thickening、including synovial pannus formation, and cartilage damage in58cases(96.7%), soft tissue swelling in34cases(56.7%), joint effusion in39cases(65.0%),51cases (85.0%)of bone marrow edema, bone destruction in36cases(60.0%),17cases(28.3%) of tendinitis, tenosynovitis six cases(10.0%).5) The3D-ME sequence showed57cases(95.0%) of synovial thickening、 including synovial pannus formation, and cartilage damage in57cases(95.0%), soft tissue swelling in35cases(58.3%), joint effusion in47cases(78.3%),51cases(85.0%) of bone marrow edema, bone destruction in35cases(58.3%),16cases(26.7%) of tendinitis, tenosynovitis five cases(8.3%).6) The T1-WATER sequence showed synovial thickening、including synovial pannus formation in18cases(30.0%),58cases(96.7%) of cartilage damage, soft tissue swelling in27cases(45.0%), joint effusion in18cases(30.0%),17cases(28.7%) of bone marrow edema, bone destruction in23cases(38.3%), four cases(6.7%) of tendinitis, tenosynovitis two cases(3.3%).MRI sequences showed that there were a dramatically difference in synovial hypertrophy, cartilage damage. Statistical analysis showed a significant difference (P <0.01). Each sequence of joint effusion, bone marrow edema, bone destruction and pathological manifestations showed statistically difference (P<0.05). However, there were no significant differences in other indicators of pathological performance (P>0.05).(2) Comparisons of signal to noise ratio of capitate bone cartilage and contrast to noise ratio of cartilage/bone marrow among wrist arthrodesis in rheumatoid arthritis patients:The results showed that the3D-FLASH-WE sequence cartilage signal to noise ratio was the highest one, the value is23.93～48.66±1.72～2.49. the FS-PDWI sequence was lower than3D-FLASH-WE last,19.44±2.58. However, the3D-FLASH-WE sequence on cartilage and bone marrow of the contrast-to-noise ratio was the highest one,13.25～28.32±0.84～1.67, FS-PDWI sequence a little lower, was11.89±1.89. MRI inspection whole different sequences compare and contrast to noise ratio analysis of variance have statistical significance.There were no significant differences in signal-to-noise ratio between FSE-T1WI and FS-FSE-T2WI SNR, FSE-T1WI and T1-WATER SNR, FS-FSE-T2WI and T1-WATER (P>0.05), but there were significant differences in signal-to-noise ratio among other sequences (P<0.01). In addition, there were no significant differences in contrast to noise ratio between FSE-T1WI and FS-FSE-T2WI, FSE-T1WI and T1-WATER, FS-FSE-T2WI and T1-WATER (P>0.05), but there were significant differences in contrast to noise ratio among other sequences (P<0.01).(3) In21patients with RA enhanced MRI scan showed synovial hyperplasia and pannus formation clearly. According to the synovial enhancement showed high signal enhanced, synovial enhancement was slightly high signal for mild enhancement, of which14were enhanced obviously,7cases were slight enhanced. Conclusions1.MRI inspection different sequence of wrist of rheumatoid arthritis pathological morphology change shows that there is a certain difference:1) The synovial thickening positive rate from high to low as3D-FLASH-WE sequence,3D-ME sequence,FS-PDWI sequence, FS-FSE-T2WI sequence, FSE-T1WI sequence, Tl-WATER sequence.2) The Cartilage damage positive rate from high to low as3D-FLASH-WE sequence, T1-WATER sequence,3D-ME sequence, FS-PDWI sequence, FS-FSE-T2WI sequence, FSE-T1WI sequence.3) The joint effusion positive rate from high to low as3D-ME sequence, FS-PDWI sequence, FS-FSE-T2WI sequence,3D-FLASH-WE sequence, FSE-T1WI sequence, T1-WATER sequence.4) The bone marrow edema positive rate from high to low as3D-FLASH-WE sequence,3D-ME sequence, FS-PDWI sequence, FS-FSE-T2WI sequence, FSE-T1WI sequence, T1-WATER sequence.5) The bone destruction positive rate from high to low as3D-FLASH-WE sequence,3D-ME sequence, FSE-T1WI sequence, FS-PDWI sequence, FS-FSE-T2WI sequence, Tl-WATER sequence.2.The3D-FLASH-WE sequence capitate bone cartilage signal to noise ratio, cartilage and bone marrow of the contrast-to-noise ratio was the highest, followed by FS-PDWI sequence.3.According to the difference of rheumatoid arthritis disease stage, different MRI sequences should be chosen. Here, the3D-FLASH-WE, FSE-T1WI, FS-PDWI and FS-FSE-T2WI sequence are supposed to be checked as conventional sequence checking to enhance the positive rate in the detection of rheumatoid arthritis. |
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