| Objective To explore the value of Dynamic Enhanced Magnetic Resonance Imaging technology to quantitatively evaluate the activity of knee joint rheumatoid arthritis and the therapeutic effect of minimally invasive needle-knife mirror combined photodynamic therapy.Materials and methods We collected a total of 41 cases of patients who were diagnosed with rheumatoid arthritis of the knee between September 11th,2017 and January 3 th,2020 and planned to receive minimally invasive needle-knoscope combined with photodynamic therapy.We collect the clinical data of the research subjects(course duration、morning stiffness、DAS-28、etc.)and laboratory examination indicators before and after hospitalization(ESR、CRP、etc.).All patients underwent DCE-MRI scanning before and 3 months after treatment.After importing multi-phase dynamic enhancement scan images using post-processing software,we select three locations where synovial thickening and enhancement are more significant to outline the ROI,and obtain quantitative parameters Endothelial transfer constant(Ktrans)、Reflux rate(Kep)、Fractional Extravascular extracellular spacevolume(Ve)、Fractional plasma volume.At the same time,the three most obvious places of synovial thickening and the deepest part of the joint cavity effusion were selected to obtain corresponding average values,and the morphological signs of knee joint bone marrow edema,bone destruction,joint effusion,synovitis and other occurrences were observed and statistically reported.Comparative analysis of different disease levels and related parameters before and after treatment(average),synovial thickness and depth of effusion(average),laboratory indicators,etc was conduted later.Results There was no statistically significant difference in morphological changes between the highly active group and the moderately active group before and after treatment,the highly active group and the moderately active group before and after treatment(p>0.05);the difference in the depth of fluid accumulation before and after treatment was statistically significant(p=0.004,p<0.01)There was no statistically significant difference between the synovial thickness and the depth of fluid accumulation in the highly active group and the moderately active group before and after treatment,and the thickness of the synovial membrane before and after treatment(p>0.05);We conducted Spearman correlation analysis of quantitative parameters of all patients before treatment.Quantitative MRI parameters Ktrans,Kep,Ve,Vp were correlated with DAS-28、ESR、CRP.Ktrans value was strongly correlated with DAS-28 score(r=0.703,p<0.01),and moderately correlated with CRP(r=0.424,p=0.010);Kep value is moderately correlated with the difference in DAS-28 score(r=0.437,p=0.008);Vp value is weakly correlated with CRP(r=0.339,p=0.043);The other parameters were extremely weakly correlated or not significantly correlated with the DAS-28、ESR and CRP.Before receiving minimally invasive needle-knife-scope combined with photodynamic therapy,the Ktrans、Kep、Ve and Vp were 1.235±0.605 ml/min,0.628±0.250 ml/min,0.935±0.917 ml/ml,0.151 ±0.150 ml/ml respectively of all the patients in the group,highly active group Ktrans、Kep、Ve and Vp were 1.586±0.634 ml/min,0.740±0.219 ml/min,0.923±0.097 ml/ml,0.194±0.171 ml/ml,Ktrans、Kep、Ve and Vp in the moderate active group were 0.921±0.365 ml/min,0.528±0.238 ml/min,0.938±0.897 ml/ml,0.112±0.120 ml/ml respectively.After treatment,all patients in the group Ktrans、Kep、Ve and Vp are 0.783±0.641 ml/min,0.436±0.230 ml/min,0.890±0.167 ml/ml,0.105±0.146 ml/ml,and highly active groups Ktrans、Kep、Ve and Vp are 1.007±0.691 ml/min,0.526±0.256 ml/min,0.945±0.699 ml/ml,0.102±0.103 ml/ml respectively;Ktrans、Kep、Ve and Vp in the moderate active group were 0.495±0.466 ml/min,0.320±0.130 ml/min,0.795±0.219 ml/ml,0.109±0.198 ml/ml.The Ktrans and Kep values were statistically significant before and after treatment between the highly active group and the moderately active group,and between the highly active group and the moderately active group before and after treatment(p<0.05).Area under curve(AUC)analysis of DCE-MRI quantitative parameters Ktrans and Kep for the diagnosis of RA inflammation high activity:when Ktrans value>1.6661,AUC is 0.820,sensitivity and specificity are 52.9%and 100%;when Kep value>0.584,AUC is 0.777,sensitivity and specificity are 82.4%and 68.4%,respectively.Conclusion DCE-MRI technology has high value in evaluating the activity of knee joint rheumatoid arthritis and evaluating the efficacy of minimally invasive needle and knife combined with photodynamic therapy. |
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