Synovial Volume Quantitative Analysis of MRI and Serological Comparison in the Evaluation of Juvenile Idiopathic Arthritis
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摘要:
目的 建立体积定量分析模型，评价滑膜体积定量分析在幼年特发性关节炎（juvenile idiopathic arthritis，JIA）的应用价值。 方法 进行定量分析模型预实验及临床前瞻性研究，收集活动期30例经规律治疗1 a的JIA患者入组。对每例患者的同一关节进行治疗前、后MRI扫描，应用自主研发MRI体积定量分析软件测量治疗前、后滑膜炎体积，并获取入组患者MRI检查同期的红细胞沉降率（Erythrocyte sedimentation rate ESR）、C反应蛋白（C-reactive protein CRP）。 结果 体积定量分析模型预实验结果满意，测量精准。治疗后患者滑膜炎体积、ESR、CRP均显著降低（P < 0.05），滑膜炎变化量与ESR、CRP变化量呈正相关（r = 0.655，r = 0.752，P均 < 0.05）。 结论 MRI滑膜体积定量测定可作为一种准确客观的量化指标应用于JIA病情监测和疗效评价。 Abstract:Objective To establish volume quantitative analysis and explore the value of MRI with synovial quantitative analysis for treatment evaluation of juvenile idiopathic arthritis （JIA）. Methods Quantitative analysis model pretest and clinical prospective study were conducted. A total of 30 patients with JIA whom were treated regularly for 1 year were studied. The same joint was scanned before and after treatment for each patient and the corresponding for treatment synovial volume were measured by a self- designed software （The MRI software for synovial volume quantitative analysis, Kunming University of Science and Technology）, as well as Erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） of studied patients were simultaneously measured. Results The volume quantitative analysis model has satisfactory results and accurate measurement. The synovial volume, ESR and CRP decreased significantly after treatment （P < 0.05）. Synovial volume change is significantly correlated to those of ESR （r = 0.655） and CRP （r = 0.752）. Conclusion Synovial volume quantitative analysis is an accurate measure for disease severity assessment and treatment effect evaluation. -
图 3 滑膜体积测量图
注：患者，男，8岁，幼年特发性关节炎，左上图为膝关节矢状位三维容积增强扫描，滑膜明显增厚、强化，右上图为选择的感兴趣区间（滑膜所在区间），左下图为滑膜大致范围，右下图为滑膜断层体积。
Figure 3. Synovial volume measurement diagram
图 4 同一患者治疗前后滑膜量对比图
a：膝关节治疗前3D-FS SPGR矢状位增强图，滑膜明显增厚、强化，b：治疗后增强图，滑膜量较前明显减少。
Figure 4. Synovial volume of the same patient before and after treatment
表 1 3D-FSPGR参数
Table 1. The parameters of 3D-FSPGR
分组 TR TE Slicethickness Slicegap FA Matrix FOV 膝关节（矢状） 10.56 ms 1.55 ms 2 mm 1 mm 15 512 × 512 180 mm × 180 mm 踝关节（矢状） 10.56 ms 1.35 ms 2 mm 1 mm 15 512 × 512 250 mm × 250 mm 髋关节（冠状） 9.97 ms 1.34 ms 3 mm 1 mm 15 512 × 512 350 mm × 350 mm 
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表 2 JIA受累关节（膝、髋、踝关节）治疗前与治疗后滑膜炎体积、ESR、CRP值比较[
$\bar x \pm s$ /M（P25，P75）]Table 2. Comparison of synovitis volume （mm3），ESR and CRP values of affected joints （knee，hip and ankle） of JIA before and after treatment [
$\bar x \pm s$ /M（P25，P75）]测量指标 滑膜炎体积（mm3） ESR（mm/h） CRP（mg/L） 治疗前 1450（574.88，16750.60） 24.00 ± 14.83 8.30（5.80，26.10） 治疗后 354.24（0，948.50） 9.17 ± 4.31 4.90（3.82，8.00） t/z −2.700 3.470 −2.402 P 0.007* 0.006* 0.016* *P < 0.05。
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表 3 JIA受累关节（膝、髋、踝关节）治疗前后滑膜体积、ESR、CRP变化值相关性分析
Table 3. Correlation analysis of synovial volume，ESR and CRP changes of Jia affected joints （knee，hip and ankle） before and after treatment
两者间变化值比较 r P 滑膜体积变化值 VS ESR变化值 0.655 0.014* 滑膜体积变化值 VS CRP变化值 0.752 0.004* ESR变化值 VS ESR变化值 0.625 0.020* *P < 0.05。
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