摘要：在近20年，MRI在炎症性关节炎的研究和临床治疗中起到了重要的作用，特别是SpA、RA和OA。MRI被认为是对有炎性腰背痛的年轻人且骶髂关节X线正常的早期SpA最特异的诊断手段。最近ASAS发布的中轴型SpA的诊断标准及包括第一时间MRI显示骶髂关节炎，作为一条影像学标准合并至少一项临床表现即可诊断SpA。近期研究数据显示对骶髂关节MRI的评估有更大的实用价值，并更好地提示了早期关节结构破坏。在RA中，MRI对新发的未分化关节炎有预测疾病进展的作用，且在疾病发病时的MR病理对疾病的影像学破坏有预测作用。因此，MRI在ACR/EULAR 2010RA分类标准中有重要地位。在OA中，骨髓水肿和滑膜炎被认为是介入治疗的生物标记。在MRI存在炎性关节炎时，针对骨髓水肿和滑膜炎的治疗可以缓解疾病病情，并使关节结构的破坏得到逆转。研究的重点应关注MRI有预兆性损伤的大型队列研究，以及是否把MRI作为有炎性关节炎的患者临床好影像学随访的常规检查。

附原文 Abstract In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

引自Weber U, Ostergaard M, Lambert RG, Maksymowych WP The impact of MRI on the clinical management of inflammatory arthritides. Skeletal Radiol. 2011 Sep;40(9):1153-73. Epub 2011 Aug 17