目的:本文全面综述了骨关节炎(OA)中滑膜炎的影像学检查现状,包括最近的进展和争论,着重分析了手和膝关节的超声和核磁(MRI)的应用。并简明讨论了CT和核医学包括PET的应用。方法:在Pubmed和MEDLINE上搜索了截止到2010出版的文章,使用的关键词滑膜炎、骨关节炎、类风湿关节炎、发病机制、成像和影像学。结果:滑膜炎的定义是滑膜炎症。现代影像学技术发现,滑膜病变在OA的早期和晚期阶段很常见,且与疼痛相关。目前临床上OA影像学诊断标准是根据传统影像学检查,而滑膜炎无法直接成像。无对比增强的MRI尽管在临床研究中应用广泛,但不能直接评价滑膜炎。对比增强MRI和超声都可提供滑膜炎的直接成像,包括早期炎症改变,在RA中很常用于滑膜炎成像,在OA中的应用也在增多。结论:目前逐步认识到滑膜炎是OA发病机制的一个重要特征,尽管目前滑膜炎与疾病严重程度和临床指标相关的证据尚不明确。对比增强MRI和超声是评估OA滑膜炎最重要的方法。
Objectives: This review article provides an overview of the current state of
imaging of synovitis in osteoarthritis (OA), looking at recent advances and
controversies and focusing particularly on the application of ultrasound and
magnetic resonance imaging (MRI) in the assessment of the hand and knee joint.
Computed tomography and nuclear medicine including positron emission tomography
are also briefly discussed. Methods: PubMed and MEDLINE search for articles
published up to 2010, using the keywords synovitis, osteoarthritis, rheumatoid
arthritis, pathogenesis, imaging, radiography, computed tomography, nuclear
medicine, magnetic resonance imaging, ultrasound, and pain.Results: Synovitis is
defined as inflammation of the synovial membrane. Modern imaging techniques have
demonstrated that synovial pathology is common in the early and late stages of
OA and may be associated with pain. The current standard for OA imaging in
clinical practice is conventional radiography but it does not allow direct
visualization of synovitis. MRI without contrast administration, although widely
used in clinical studies, cannot assess synovitis directly. Contrast-enhanced
MRI and ultrasound, however, both allow direct visualization of synovitis
including early inflammatory changes. They are regularly used to image synovitis
in rheumatoid arthritis and increasingly in OA. Conclusions: Synovitis is
increasingly recognized as an important feature of the pathophysiology of OA,
although there is conflicting evidence with respect to its association with
disease severity and clinical parameters. Contrast-enhanced MRI and ultrasound
are the most important methods for assessing synovitis associated with OA.
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