Author/Editor		Jevtič, V; Watt, I; Rozman, B; Kos-Golja, M; Praprotnik, S; Logar, D; Presetnik, M; Jarh, O; Demšar, F; Mušikić, P; Campion, G
Title		Morphological categorization and differential diagnosis of inflammatory changes in small hand joints in rheumatoid arthritis and seronegative spondylarthritis by contrast enhanced (Gd-DTPA) magnetic resonance imaging
Translated title		Morfološke značilnosti in diferencialna diagnoza vnetnih sprememb malih sklepov rok pri revmatoidnem artritisu in seronegativnih spondilartritisih s kontrastno ojačenim (Gd-DTPA) magnetnoresonančnim slikanjem
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 64, št. Suppl 2
Publication year		1995
Volume		str. II-33-40
Language		slo
Abstract		Background. The first part of the study was done in an attempt to demonstrate whether clinically selected joints of the hand in active rheumatoid arthritis had consistent MRI findings. 45 patients were examined, in whom one joint in each was selected by both the referring clinician and patient as being active and symptomatic. Such joints, in order to be included in the study, were required to conform to ARA criteria of activity, and usually showed mild to moderate X-ray changes. The joints were imaged using spinecho sequences with T1W and T2W precontrast images, followed by T1W images after intravenous administration of Gd-DTPA. Different patterns of joint abnormalities were found. In 27 joints, MRI findings suggested highly active synovitis or destructive pannus. In further 12 joints, findings were thought to represent less active synovitis and pannus. MRI did not any demonstrate inflammatory activity in six joints. In two of these, pannus was presumed to be fibrotic and inert, and four were normal in all pulse sequences. The results suggest that clinical features of synovitis, even in carefully selected joints, do not produce a homogeneous group when examined by MRI imaging. The second part of the study was an attempt to demonstrate the differences between the early morphological intra- and extraarticular findings in spin- echo T1W precontrast, T1W postcontrast and T2W images in individual small hand joints of 16 patients with clinically active rheumatoid arthritis and 16 patients with active seronegative spondylarthritis. In all cases of rheumatoid arthritis, soft tissue inflammatory changes were localized within the joint cavity affecting both sides of the joint, and only minimal abnormalities have been determined in immediate periarticular tissue.(trunc.)
Summary		V prvem delu raziskave smo želeli ugotoviti, ali klinično enotno izbrani sklepi rok z znaki aktivnega revmatoidnega artritisa kažejo tudi enotne spremembe z MRI. 45 bolnikov je skupaj z zdravnikom izbralo po en mali sklep rok, ki je bi po sodbi obeh aktivno vnet. Te sklepe smo slikali z magnetno resonanco. Pogoj za vključitev v raziskavo je bil, da je v sklepu aktivnost, ki ustreza merilom ARA; v večini primerov so bile na preglednih rentgenogramih teh sklepov vidne začetne ali zmerne spremembe. Sklepe smo slikali s tehnilo spin-odmev. Napravili smo T1W- in T2W-predkontrastne slike, po intravenski aplikaciji Gd-DTPA pa še slike T1W. Magnetoresonančne slike so pokazale, da so sklepi morfološko različno prizadeti: v 27 sklepih so bile vidne spremembe, ki jih povzročata zelo aktiven sinovitis in destruktivni panus; znake manj aktivnega fibrotičnega panusa v dveh, v štirih sklepih pa MRI ni pokazala odstopanja od normale. Rezultati prvega dela študije dokazujejo, da sklepi s kliničnimi znaki aktivnega sinovitisa pri slikanju z magnetno resonanco niso homogena skupina. V drugem delu raziskave smo želeli ugotoviti, ali se v magnetnoresonančnih slikah (predkontrastne slike T1W inT2W, pokontrastne like T1W s tehniko spin-odmev) zgodnje intra- in ekstraartikularne vnetne spremembe malih sklepov rok pri 16 bolnikih s klinično aktivnim revmatoidnim artritisom razlikujejo od sprememb pri 16 bolnikih z aktivimi seronegativnimi spondilartiritisi. Pri vseh bolnikih z revmatoidnim artritisom so bile mehkotkivne vnetne spremembe skoraj izključno znotraj sklepne votline, enakomerno na obeh straneh sklepne špranje, obsklepni vnetni znaki pa so bili neznatni. Pri devetih bolnikih s seronegativnim spondilartritisom, šestimi s psoriatičnim artritisom in tremi z Reiterjevim sindromom, so bile mehkotkivne spremembe drugače razporejene, obsežnejše in izrazitejše kot pri bolnikih, ki so imeli revmatoidni artritis.(krajš.)
Descriptors		ARTHRITIS, RHEUMATOID MAGNETIC RESONANCE IMAGING SPONDYLITIS HAND DTPA GADOLINIUM