Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya30566Editorial articleПередовая статьяMagnetic resonance imaging of the hand as an early diagnostic method for rheumatoid arthritisМагнитно-резонансная томография кистей как метод ранней диагностики ревматоидного артритаRapoportIl'ya EmmanuilovichРапопортИлья Эммануилович

мл. науч. сотр., лаб. лучевой диагностики; Научно-исследовательский институт ревматологии РАМН

rapoport@inbox.ruLuchikhinaElena L'vovnaЛучихинаЕлена Львовна

канд. мед. наук, ст. науч. сотр., отд. ранних артритов, тел.: 8-499-614-71-37; Научно-исследовательский институт ревматологии РАМН

PogozhevaElena Yur'evnaПогожеваЕлена Юрьевна

мл. науч. сотр., отд. медико-социальных исследований, тел.: 8-499-614-44-76; Научно-исследовательский институт ревматологии РАМН

SmirnovAleksandr ViktorovichСмирновАлександр Викторович

д-р мед. наук, лаб. лучевой диагностики, тел.: 8-499-614-15-78; Научно-исследовательский институт ревматологии РАМН

KarateevDmitriy Evgen'evichКаратеевДмитрий Евгеньевич

д-р мед. наук, отд. ранних артритов, зав., зам. дир. по научной деятельности, тел.: 8-499-614-71-37; Научно-исследовательский институт ревматологии РАМН

RapoportI E

Research Institute of Rheumatology, Russian Academy of Medical Sciences

LuchikhinaE L

Research Institute of Rheumatology, Russian Academy of Medical Sciences

PogozhevaE Yu

Research Institute of Rheumatology, Russian Academy of Medical Sciences

SmirnovA V

Research Institute of Rheumatology, Russian Academy of Medical Sciences

KarateyevD E

Research Institute of Rheumatology, Russian Academy of Medical Sciences

Научно-исследовательский институт ревматологии РАМНResearch Institute of Rheumatology, Russian Academy of Medical Sciences15052010825NO5 (2010)ТОМ 82, №5 (2010)142209042020Copyright ©; 2010, Consilium MedicumCopyright ©; 2010, ООО "Консилиум Медикум"2010Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/30566

Aim. To provide the qualitative and quantitative characteristics of changes revealed by the data of magnetic resonance imaging (MRI) of the hand and by those of X-ray study of the hand and foot in patients with early rheumatoid arthritis (ERA). Subjects and methods. The study enrolled 110 patients (90 females, 20 males; age 49.6 ± 12.2 years) examined in the framework of the RADICAL program at the Research Institute of Rheumatology, Russian Academy of Medical Sciences. The mean duration of the disease was 5.61 ± 3.17 months. The diagnosis of rheumatoid arthritis was established by the 1987 ARA criteria in all the patients on primary standard examination comprising X-ray study of the hand and feet and evaluation by the modified Sharp method. MRI of the hand was performed in all the patients, by assessing the result by the OMERACT-RAMRIS procedure. Results. Destructive changes (cysts and erosions) evidenced by X-ray study were found in the wrists, metacarpophalangeal articulations (MPA), and foot in 7.27, 8.2, and 13.64%, respectively. MRI revealed destructions in the wrist, MPA, and metacarpal bone base in 50, 60, and 16.36%, respectively. Overall, erosions could be seen on X-ray films and MRI scans in 20.91 and 67.27%, respectively (p < 0.001). MRI revealed bone edema (osteitis) in 46.4% of the patients; there was no difference in the detection rate between the extremities. MRI synovitis was found in 99% of the patients, the right hand being significantly more commonly affected. Detailed characterization of the changes revealed by MRI and X-ray was obtained in patients with ERA. Conclusion. MRI detected erosions significantly more frequently than did X-ray (p < 0.001), which confirms the high value of low-field MRI diagnosis on primary examination of patients with ERA and supports the opinion that the results of this study should be included into the diagnostic criteria of ERA.

Цель исследования. Качественная и количественная характеристика изменений, выявляемых по данным магнитно-резонансной томографии (МРТ) кистей, а также рентгенографии кистей и стоп больных ранним ревматоидным артритом (РРА). Материалы и методы. В исследование включили 110 пациентов (90 женщин, 20 мужчин, возраст 49,6 ± 12,2 года), обследованных в НИИР РАМН в рамках программы "РАДИКАЛ". Средняя продолжительность заболевания составила 5,61 ± 3,17 мес. Диагноз "ревматоидный артрит" был установлен согласно критериям АRА (1987) у всех пациентов при первичном стандартном обследовании, включавшем рентгенографию кистей и стоп, оценку по модифицированному методу Sharp. Всем пациентам было проведено МРТ кистей с оценкой результата по методике OMERACT-RAMRIS. Результаты. Деструктивные изменения (кисты и эрозии) по данным рентгенографии выявлены у 7,27% пациентов в костях запястий, у 8,2% - в пястно-фаланговых суставах (ПФС), у 13,64% - в костях стоп. По данным МРТ в костях запястий деструкции определялись у 50% пациентов, в ПФС - у 60%, в основаниях пястных костей - у 16,36%. Суммарно на рентгенограммах эрозии были выявлены у 20,91% пациентов, на МРТ - у 67,27% (р < 0,001). Отек костного мозга (остеит) был выявлен при МРТ у 46,4% пациентов, разницы по частоте выявления между конечностями не было. Синовиты на МРТ были выявлены у 99% пациентов, при этом правая кисть поражалась достоверно чаще. Получена детальная характеристика изменений, выявляемых на МРТ и рентгенограммах у больных РРА. Заключение. При помощи МРТ эрозии выявлялись достоверно чаще (р < 0,001), чем при рентгенографии, что подтверждает высокую ценность низкопольной МРТ-диагностики в рамках первичного обследования больных РРА и позволяет поддержать мнение о необходимости включения результатов этого исследования в диагностические критерии РРА.

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