摘要目的：以磁共振成像(MRI)对血友病骨关节病变诊断及评分结果为参照,探讨超声对血友病骨关节病变诊断及评分的价值。方法对42例血友病患者的42个关节(膝关节、踝关节、肘关节各14个)进行超声和 MRI 检查,比较超声与 MRI 对血友病患者关节病变检出的一致性,并对病变程度进行评分,比较两者评分的一致性。最后,比较超声检查评分者间的一致性和评分者自身的一致性。结果超声和 MRI 对于血友病患者关节早期软组织病变(关节积液/积血、滑膜增厚和含铁血黄素沉积)检出的一致性优秀(κ=0763~0896,P <0001),对软骨破坏检出的一致性优秀(κ=0793, P <0001),对骨边缘侵蚀检出的一致性差(κ=0133,P =0132),对软骨下骨囊肿检出的一致性差(κ=0100,P =0137)。超声与 MRI 对早期软组织病变评分的一致性为好至优秀(κ=0684~0833, P <0001),对晚期骨软骨病变(软骨破坏和骨破坏)评分的一致性为差至好(κ=0145~0635,P <0001)。超声对早期软组织病变的评分者间的一致性为好至优秀(κ=0676~0870,P <0001),对晚期骨软骨病变的评分者间的一致性为中等至优秀(κ=0421~0751,P <0001)。超声对早期软组织病变评分者自身的一致性为好至优秀(κ=0705~0885,P <0001),对晚期骨软骨病变的评分者自身的一致性为中等至好(κ=0532~0732,P <0001)。结论超声对于血友病骨关节疾病早期软组织病变以及软骨破坏的检出具有重要作用,有利于随访观察以及指导临床治疗。

abstractsObjective To explore the diagnostic and score value of ultrasound on hemophiliac arthropathy referring to MRI on the diagnosis and score of hemophiliac arthropathy Methods The ultrasound and MRI examinations were performed on 42 joints of 42 hemophilia patients 14 knees 14 ankles and 14 elbows The consistency of ultrasound and magnetic resonance imaging in the detection and score of joint diseases was compared Finally inter-and intra-observer agreement of ultrasound scoring system were tested Results The consistency of ultrasound and magnetic resonance imaging was excellent κ=0 763-0 896 P < 0 001 in the detection of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy hemosiderin excellent κ=0 793 P <0 001 in the detection of cartilage loss poor κ=0 133 P = 0 132 in the detection of erosions and poor κ= 0 100 P = 0 137 in the detection of subchondral cysts The consistency of ultrasound and magnetic resonance imaging was good to excellentκ=0 684-0 833 P < 0 001 in the score of early soft tissue lesions effusion or hemarthrosis synovial hypertrophy and hemosiderin and poor to good κ=0 145 -0 635 P <0 001 in the score of advanced osteochondral lesions cartilage loss and bone erosions The inter-observer agreement was good to excellent κ=0 676-0 870 P <0 001 for early soft tissue lesions and moderate to excellent κ=0 421- 0 75 1 P < 0 001 for advanced osteochondral lesions The intra-observer agreement was good to excellent κ=0 705-0 885 P <0 001 for early soft tissue lesions and moderate to good κ=0 532 -0 732 P <0 001 for advanced osteochondral lesions Conclusions Ultrasound plays an important role in detecting early soft tissue changes effusion or hemarthrosis synovial hypertrophy hemosiderin and cartilage loss which helps follow-up and guide clinical treatment.