目的:这是一项前瞻性研究,旨在评估高频超声(HFUS)的临床价值,精湛的微血管成像(SMI),和超声造影(CEUS)在色素沉着绒毛结节性滑膜炎(PVNS)和高活性类风湿关节炎(RA)的鉴别中。
方法:选择20例PVNS患者和24例活动性RA患者行HFUS,SMI,和CEUS考试。HFUS的特点,SMI,比较PVNS和RA中的CEUS,以及HFUS的鉴别诊断性能,SMI,通过受试者工作特性(ROC)分析评估PVNS和RA的CEUS。
结果:关节积液有统计学意义,滑膜厚度,滑膜形态学,滑膜回声,滑膜血管形状,滑膜增强方向,PVNS和RA之间的模式增强(P<0.05)。然而,骨侵蚀无统计学意义,滑膜边界,滑膜血液信号分级,滑膜增强强度,和CEUS定量参数(包括PI,TTP,S,MTT,和AUC)(P>.05)。HFUS的AUC,SMI,鉴别诊断PVNS和RA的CEUS分别为0.832、0.675和0.817。HFUS+SMI的AUC,HFUS+CEUS,SMI+CEUS,HFUS+SMI+CEUS分别为0.923、0.940、0.817和0.940。HFUS+SMI和HFUS+CEUS的AUC均高于单独的AUC(P<0.05)。
结论:HFUS,SMI,和CEUS可作为PVNS和活动性RA诊断和鉴别诊断的补充方法。更重要的是,建议采用HFUS+SMI和HFUS+CEUS。
OBJECTIVE: This is a prospective study to evaluate the clinical value of high-frequency ultrasound (HFUS), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) in differentiation of pigmented villonodular synovitis (PVNS) and highly active rheumatoid arthritis (RA).
METHODS: Twenty PVNS patients and 24 active RA patients were selected to undergo HFUS, SMI, and CEUS examinations. The characteristics of HFUS, SMI, and CEUS in PVNS and RA were compared, and the differential diagnosis performances of HFUS, SMI, and CEUS in PVNS and RA were evaluated by receiver operating characteristic (ROC) analysis.
RESULTS: There were statistically significant in joint effusion, synovial thickness, synovial morphology, synovial echo, synovial vessel shape, synovial enhanced direction, and enhanced pattern between PVNS and RA (P < .05). However, no statistically significant were found in bone erosion, synovial boundary, blood signal grading of synovium, synovial enhanced strength, and CEUS quantitative parameters (including PI, TTP, S, MTT, and AUC) (P > .05). The AUC of HFUS, SMI, and CEUS for differential diagnosis PVNS and RA were 0.832, 0.675, and 0.817, respectively. The AUC of HFUS + SMI, HFUS + CEUS, SMI + CEUS, HFUS + SMI + CEUS were 0.923, 0.940, 0.817, and 0.940, respectively. The AUC of HFUS + SMI and HFUS + CEUS was higher than that of each alone (P < .05).
CONCLUSIONS: HFUS, SMI, and CEUS can be used as supplementary methods for diagnosis and differential diagnosis in PVNS and active RA. What is more, the combination of HFUS + SMI and HFUS + CEUS was suggested.