摘要目的 比较DR、CT和MR3种影像检查方法对血友病性关节病不同征象检出的差异,以及对血友病性关节病早期征象的诊断价值.方法 对11例血友病患者的21个关节进行DR、CT和MR检查的前瞻性研究,按照Pettersson评分系统将21个关节分为3组,Pettersson评分0分为第1组(轻度),＜4分为第2组(中度),≥4分为第3组(重度).比较3种影像方法对所有关节病变征象的显示,再对第1组软骨下骨表面受侵蚀等早期征象进行CT和MRI比较,用x2检验和两样本的配对t检验进行统计学分析.结果 21个血友病性关节以中重度为主,第1组(轻度)共4个关节、第2组(中度)共8个关节、第3组(重度)共9个关节.3种影像方法对关节骨骺或骨端增大、关节间隙狭窄、关节畸形病变的检出情况相同.CT和MR检出软骨下骨表面受侵蚀、软骨下囊变、关节积血(液)明显优于DR(x2值分别为19.06、16.70、4.84,19.06、16.70、7.76；P值均＜0.05).在第1组,CT检出软骨下骨表面受侵蚀和软骨下囊变的情况优于MRI(x2 =3.29,P＜0.05).结论 MRI和CT对血友病性关节病早期病变征象的检出具有明显的优势,CT能检出更多的软骨下骨表面侵蚀和囊变.

abstractsObjective To compare the diagnostic value of magnetic resonance imaging (MRI),computed tomography (CT) and radiography in the early detection of arthropathies of haemophilia.Methods Prospective studies of 21 joints in 11 patients were studied with X-ray,CT and MR examination. The 21 joints with haemophilia arthropathies were divided into three groups according to Pettersson scoring system.0 point were the first group,＜4 points were the second group,≥4 points were the third group.Abnormal imaging findings of osteoporosis,enlarge epiphysis,erosion of cartilage,irregular subchondral surface,narrowing of joints space,joint deformity,subchondral cyst formation,effusion/haemarthrosis of joint,synovial hypertrophy with haemosiderin,deformity of joints were used for all imaging comparison.The results were analysis with Chi-square test.To compare the first group,irregular subchondral surface and the number of subchondral cyst formation of all symptomatic joints were detected by CT and MR,the results were analysis with pair-sample t test.Results Moderate and severe hemophilic joints were found in 80.95％ (17/21)of twenty-one symptomatic joints,and mild hemophilic joints were found in 19.05％ (4/21).The detected results were the same in enlarge epiphysis,narrowing of joints space,joint deformity in all joints by radiography,CT and MR.Significant difference in detection of irregular subchondral surface,subchondral cyst formation,effusion/haemarthrosis of joint,were found between radiography with either CT (x2 value 19.06,16.70,4.84,P ＜0.05 ) or MRI (x2 value 19.06,16.70,7.76,P ＜0.05),Significant difference in detection of the first group joint irregular subchondral surface and the subchondral cyst formation total number were found between CT and MR ( x2 =3.29,P ＜ 0.05 ). Conclusions MR and CT were superior in detection of the early abnormal changes in evaluating hemophilic arthropathies,however CT could detect more smaller irregular subchondral surface and subchondral cyst formation than MR.