ARD：超声扫描探查RA骨侵蚀具有较高准确性

骨体积丢失越多，超声探出率越高；超声优势关节中，即使骨体积丢失量较少，探出率依然可观

影像学提示的骨侵蚀是类风湿关节炎（RA）诊断中重要的组成部分，防治骨破坏是RA诊治的重要目标。目前一些研究发现，超声扫描（US）对骨侵蚀的敏感性不逊于常规X线摄片。为明确US对探查骨侵蚀的准确性、确定所有骨侵蚀中US可探查到的最小骨体积丢失量、比较两种半定量的US-骨侵蚀积分方法，来自丹麦哥本哈根大学医院风湿科的Uffe Møller Døhn医生等研究者以螺旋CT作为参照，对RA所侵犯的各掌指关节（MCP）进行了超声扫描研究。研究结果发表于2013年4月《风湿病学年鉴》（Ann Rheum Dis）杂志上。研究认为，超声扫描探查RA骨侵蚀具有较高准确性。

研究者使用CT和US对49例RA患者的第2-第5 MCP进行检查，评估骨侵蚀在每个MCP关节中的发生率。CT检查中，骨侵蚀体积根据OMERACT-RAMRIS积分法确定（骨体积缩小达原骨体积的10%）。超声对骨侵蚀的探查中，根据Szkudlarek标准将骨侵蚀分为0-3级，根据超声结构侵蚀（ScUSSe）系统将骨侵蚀分为0-3分。
共有784个MCP关节接受了检查。CT检查共发现了259个关节出现骨侵蚀，US检查发现了142个关节出现骨侵蚀。US检查的总体敏感性/特异性/准确性为44%/95%/78%，而相比之下，US优势部位（桡侧第2 MCP，尺侧第5 MCP，全部的手背和手掌）的相应结果为71%/95%/90%。在所有骨体积丢失＞20%的骨侵蚀中，有95%可被US检查探出。在US优势部位，骨体积丢失量在1-10%的骨侵蚀中，有63%可被探出。骨体积丢失＞10%的骨侵蚀中，有94%可被探出。两种US评分系统对较大的骨侵蚀具有良好的一致性，而较小的骨侵蚀（Szkudlarek 1级，86%由CT确认）在ScUSSe系统中不能得到积分。
在超声优势部位，US对RA骨侵蚀的探查和半定量评估具有较高准确性。即使在那些通过CT检查而确认的较小的骨侵蚀中，仅对一个平面进行扫描，亦可得出相同的结论。
与类风湿关节炎相关的拓展阅读：

• Ann Rheum Dis：日光浴或预防类风湿关节炎
• Rheumatology：类风湿关节炎患者整体肿瘤罹患风险高
• Lancet：依那西普维持治疗可控制类风湿关节炎疾病活动
• Arthritis Rheum：类风湿关节炎患者 THA后易脱臼，TKA后易感染
• FDA批准第一个治疗类风湿关节炎口服生物制剂Xeljanz
• Arthritis Rheum：类风湿关节炎患者牙周炎高发 更多信息请点击：有关类风湿关节炎更多资讯

Detection, scoring and volume assessment of bone erosions by ultrasonography in rheumatoid arthritis: comparison with CT.
OBJECTIVES
To determine the accuracy of ultrasonography (US) for bone erosion detection in different areas of rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints with multislice CT as the reference method. Second, to establish the necessary bone volume loss on CT for US to reliably detect it as an erosion, and finally to compare two semiquantitative US-erosion scoring methods.
METHODS
The 2nd-5th MCP joints of 49 patients with RA were examined by CT and US, and evaluated for the presence of bone erosion in each MCP joint quadrant. On CT, erosion volume was scored according to the OMERACT-RAMRIS score (bone volume loss in 10% increments of original bone volume). US erosions were scored 0-3 according to the Szkudlarek and Scoring by UltraSound Structural erosion (ScUSSe) systems, respectively.
RESULTS
Seven hundred and eighty-four MCP joint quadrants were examined. Erosions were detected by CT in 259 quadrants and by US in 142 quadrants. Sensitivity/specificity/accuracy of US was overall 44%/95%/78% compared with 71%/95%/90% in areas with good US accessibility (radial 2nd MCP, ulnar 5th MCP and all dorsal/palmar aspects). US detected 95% of erosions with bone volume loss >20%. In US accessible areas, 63% of erosions with 1-10% bone volume loss and 94% of erosions with >10% bone loss were detected. The two US scoring systems agreed well on large erosions, whereas the smallest erosions (Szkudlarek grade 1, of which 86% were confirmed by CT) were not scored by ScUSSe.
CONCLUSION
In accessible areas, US was highly accurate for detection and semiquantitative assessment of RA bone erosion. Even the smallest erosions, only detected in one plane, were generally confirmed by CT.