Preliminary Study Of Dynamic Contrast-enhanced MRI Of Early RA Lesions Of The Hand And Wrist

Objective:To investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in evaluating the activity of RA on early stage. To explore the correlation between the hemodynamic parameters and clinical laboratory indicators, disease activity score (DAS28). To analysis its feasibility in evaluating the prognosis of RA and provide a reliable basis for the reasonable development of early RA treatment programs.Material and Methods:32patients diagnosed as early RA by clinical were selected. All patients visit the doctor with the wrist,carpometacarpal joint and interphalangeal joint swelling and pain as chief complaint,duration of2to24months, of which12were in clinical remission.X-ray of the hand were negative.Clinical diagnosis according to the ACR/EULAR2010(American College of Rheumatology/European League Against Rheumatism Union) meet amendments to RA classification score>6points.Plain MRI, enhanced MRI of whole hand and Dynamic contrast-enhanced MRI(DCE-MRI) of single slice were perfermed in all patients of RA and10healthy volunteers.The DCE-MRI hemodynamic parameters (including the early enhancement ratio and relative enhancement ratio) of active RA group, the remission group and control group statistically were compared between each other with rank sum test and T test. MRI scores (RAMRIS) of RA and Disease Aetivity Seore28(DAS28) were calculated.The early enhancement ratio with DAS28, the relative enhancement ratio with DAS28were compared by using correlation analysis.Results:(1)The RA active group synovial dynamic enhancement curves were rapidly ascending and then reached a stabel value.The TIC of remission group showed a slow rise.The relative enhancement ratio (RE) of active RA group was significantly higher than that of remission RA group (P<0.005) and the RE of remission group was significantly higher than that of control group(P<0.005).The difference of synovial early enhancement ratio(REE) of the three groups was statistically significant.(2)In active RA group, the early enhancement ratio(REE) and the relative enhancement ratio(RE) was positive correlation with DAS28.(3)There was a positive correlation between MRI scores of synovitis and bone marrow edema, bone marrow edema and bone erosion.However,the MRI scores of synovitis and bone erosion did not have correlation.(4)The total MRI scores of wrist of RA patients which also had a correlation with DAS28score had a significant correlation with the anti-CCP antibodies, CRP and ESR. However, there was no clear correlation between the MRI score of the remaining single lesion sign of wrist and clinical laboratory indicators. Conclusion:(1)The dynamic contrast-enhanced MRI can provide useful information to evaluate the activity degree and the pathology phase of RA through hemodynamic parameters such as REE and RE. The synovial enhancement ratio of patients with active RA was significantly higher than remission patients, the speed markedly accelerated.(2)Dynamic contrast-enhanced MRI and MRI scores of RA patients can provide comprehensive evaluation of the progression of RA. The various MR signs of lesions were of great value to the evaluation of the prognosis of RA, and provided the reliable basis for formulating reasonable RA treatment early.