Relevant Research Between Ultrasonography And Magnetic Resonance Imaging, Serum VEGF Expression In Wrists Of Rheumatoid Arthritis

PART ONEDiagnosis of rheumatoid arthritis on wrist and hand by CDFIBackgroudRheumatoid arthritis is a common autoimmune disease, its main pathological features are synovitis, tenosynovitis, joint effusion and bone erosion. It can damage the adjacent tissue, or even involving the heart, lung, kidney and other systems. This disease accounts for about 1% of the world’s population, more common age of onset of 30 years of age, the incidence rate in women is 3 times higher than in men, the rate of deformity and disability of this dieases is high.Now internationally recognized as the New York Rheumatism Association (ARA) 1987 revised in rheumatoid arthritis (RA) is still the diagnostic criteria for the X-ray imaging evidence, X-ray can show RA articular osteoporosis, joint space narrowing, joint swelling and bone destruction, soft tissue changes, but these changes are not part of the early lesions. High-frequency ultrasound has excellent soft tissue contrast, more evaluation of joint disease has been widely used. Compared with the X ray, ultrasound is more sensitive and specific, able to display X ray can not determine the synovitis, inflammatory exudate around the joint and early bone destruction, and cost-effective and superior to CT, MRI. In this study, untreated RA patients and healthy volunteers underwent color Doppler ultrasound, the wrist and metacarpophalangeal joints were observed, in order to probe early diagnosic value of RA in ultrasound.ObjectiveTo explore the Color Doppler flow imaging (CDFI) characteristics of wrist and hand damage in rheumatoid arthritis (RA) patients and its diagnostic value.MethodsUsing PHILIPS iu22 color ultrasound, the sonogram of 78 patients in RA and 50 healthy volunteers were observed and recorded, the synovium, tendon, joint space and articular surface changes were study. Measuring synovial thickness of bilateral wrist and metacarpophalangeal, using Color Doppler flow imaging (CDFI) and color Doppler energy (PDI) to detect synovial blood flow, Semi-quantitative method according to Alder abundance of synovial blood flow is divided into 0 to 3, synovial artery resistance index and pulse index were measured.Results1. In RA group, the thickness of synovial membrane of wrist was 2.95±1.50mm, the thickness of synovial membrane of metacarpophalangeal (MCP) jiont was 1.86±0.30mm. In healthy control group, the thickness of synovial membrane of wrist was 1.53±0.20mm, the thickness of synovial membrane of MCP was 1.22±0.10mm. The difference was statistically significant (P<0.05).2. Among the 78 cases, the synovial of 57 cases of RA is heterogeneous hypoechoic,21 cases of non-uniform high echo. With the increase of blood flow grade (1 to 3), RI progressively reduced, flow grade was negatively correlated with the RI. With the increase of blood flow grade (1 to 3), PI changed little, flow grade was no significant correlation with the PI.3. Among the 78 paients,48 cases were detected joint effusion, of which 35 cases(59 jionts) in wrist,13 cases(37 jionts) in MCP .43 cases were found tendon tenosynovitis,35 cases(70 jionts) in wrist,8 cases(23 jionts) in MCP.31 cases were detected irregular bone erosion on articular surface,19 cases (38 jionts)in wrist,12 cases (35 jionts)in MCP. Conclusion1. Ultrasonography is simple, inexpensive, non-radioactive, can be repeated, can show the basic lesions of joint synovitis, tenosynovitis tendon, joint effusion, bone erosion of wrist in RA, can make up for lack of X-ray in diagnosis of RA.2. For patients with clinically suspected of RA, the wrist should undergo ultrasound examination routinly in order to improve the detection rate of lesions. Ultrasound can contribute to early diagnosis and reasonable treatment of RA.PART TWODiagnosis of Wrists in Early Rheumatoid Arthritis with Ultrasonography and Magnetic Resonance Imaging:Comparison StudyBackgroudSmall joints of wrist, hand, foot is the most commonly involved site of the early Rheumatoid arthritis. Early diagnosis and timely treatment can significantly reduce, slow organic joint damage, and early diagnosis can be a good effect of drugs while avoiding unnecessary damage. Currently, the clinical diagnosis of rheumatoid arthritis mainly relies on clinical manifestations, serological tests and imaging (X ray, ultrasound, CT, MRI). MRI and color Doppler ultrasound has a good soft tissue contrast, early diagnosis of RA is the most valuable imaging method. But the two imaging methods, the diagnostic value of how there were few studies.Our selection of clinical diagnosis of untreated RA patients, ultrasound and MRI were compared on the merits of early diagnosis of RA, aims to provide a reference for clinical choice. ObjectiveTo evaluate quantitative observation with ultrasonography and MRI in the diagnosis of wrist jiont lesions of rheumatoid arthritis.Methods31 patients of clinically diagnosed as RA with bilateral wrists underwent ultrasound and MRI before treatment, two imaging features were observed and recorded, the ability of these two techniques to reveal the changes of RA was compared.Results1. On US,62 (100%) wrist jionts (of 31 patients) were showed synovitis,42 (67.7%) with jiont effusion,34 (61.3%) with tendinitis,24 (38.8%) with bone erosions. On MRI,62(100%) were showed synovitis,43(69.3%) with jiont effusion, 37 (66.1%) with tendinitis,33 (53.2%) with bone erosions,16 (25.8%) with marrow edema.2. Two methods were of no significant difference statistically (P> 0.05) in detection synovitis, jiont effusion, and tendinitis of early RA.3. Two methods were of significant difference statistically (P<0.01) in detection bone erosions.Conclusion1. Ultrasound and MRI can show synovitis, tenosynovitis tendon, joint effusion, bone erosion of basic early lesions with RA, can assess the activity of inflammation. MRI is superior to ultrasound in detection of bone erosion and bone marrow edema.2. Ultrasound has characteristics of economic, fast, repeatable inspection, real-time dynamic scanning, as for diagnosis of early RA, ultrasonography examination is the first choice, and for atypical ones, MRI follows. PART THREEStudy on the Correlation between Synovial flow on wrist and Serum VEGF Expression in Rheumatoid ArthritisBackgroudRheumatoid arthritis is a chronic inflammatory disease, its early targets is the synovial tissue, synovitis lasting recurrent disease, followed by destruction of articular cartilage and bone, causing joint deformity and dysfunction. Vascular endothelial growth factor (vascular endothelial growth factor, VEGF) is able to specifically promote the proliferation of endothelial cells, vascular endothelial cell differentiation to maintain and improve the microvascular permeability of cytokines, which in many cancers and inflammatory process showed a high expression of VEGF reported in the pathogenesis of RA play an important role.In recent years, ultrasound imaging technology continues to improve, color Doppler ultrasound for the display and evaluation of synovial blood flow creats more and more attention. The purpose of this study is to explore the relationship between serum levels of VEGF expression and synovial blood flow in patients with RA, to provide the basis of early diagnosis, evaluateing treatment and assessing prognosis of RA.ObjectiveTo study the relationship between the synovial flow degree, arterial resistance index on wrist and serum level of VEGF expression in rheumatoid arthritis.Methods1. Color Dopple ultrasoundBilateral wrists of sixty-two patients with RA underwent ultrasonography before treatment, synovial blood flow grade was observed and recorded, the arterial resistance index was measured.2. Serum level of VEGF expression Serum level of VEGF expression were detected in 62 patients with RA and control group (30 healthy volunteers) by Enzyme linked immunosorbent assay (ELISA), analysing the correlation between synovial flow grade, arterial resistance index and serum levels of VEGF expression of RA.Results1. The expression level of serum VEGF in RA group was 1123.6±190.7 ng/1 , significantly different from the level seen in control group(307.2±175.5) ng/1 (P<0.05).2. Among 62 patients of RA, the wrist joint synovial blood flow signal 0 degree was 5,1 degree was 23,2 degree was 64,3 degree was 32. There was positive correlation between the degree of synovial blood and the level of VEGF with RA, the difference was statistically significant, (r=0.903, P<0.01)3. There was passive correlation between the arterial RI and the level of VEGF, the difference was statistically significant, (r=-0.817, P<0.01)Conclusion1. Serum VEGF in synovial tissue of patients with RA showed high expression, VEGF in RA pathogenesis and development play an important role.2. There are correlation between the expression level of serum VEGF, synovial flow grade and arterial resistance index in RA. The combination of synovial blood with ultrasound and the serum level of VEGF can pedict the activity of RA, it is helpful for the selections of clinical treatment and evaluating the prognosis.