目的 研究手部类风湿关节炎患 者MRI表现。方法 选取我院2015年8月至 2017年8月93例拟诊为手部类风湿关节炎 患者为研究对象，均接受临床检查、实验 室检查、影像学检查等，以随访6周结果 为依据将患者分为类风湿关节炎组与非类 风湿关节炎组。所有患者均在就诊1周内 接受MRI扫描，以随访结果为金标准，计 算不同MRI征象诊断类风湿关节炎的灵敏 度、特异度、阳性预测值、阴性预测值、 准确性、Kappa值。结果 93例拟诊为类风 湿关节炎患者随访至确诊者85例，其中证 实为类风湿关节炎患者71例。类风湿关 节炎组滑膜增厚、血管翳强化、骨髓水 肿、关节积液、骨质破坏检出率显著高于 非类风湿关节炎组(P＜0.05)。滑膜增厚 诊断类风湿关节炎的灵敏度、特异度、 准确性分别为95.8%、78.6%、92.9%，血 管翳强化灵敏度、特异度、准确性分别 为98.6%、85.7%、96.5%，骨髓水肿灵 敏度、特异度、准确性分别为90.1%、 71.4%、87.1%，关节积液灵敏度、特 异度、准确性分别为80.3%、57.1%、 76.5%，骨质破坏灵敏度、特异度、准 确性分别为77.5%、85.7%、78.8%。结 论 MRI可以准确反映滑膜增厚、血管翳强 化、骨髓水肿、关节积液、骨质破坏等手 部类风湿关节炎征象，为手部类风湿关节 炎诊断与治疗提供重要影像学依据。

Objective To study the MRI findings of patients with hand rheumatoid arthritis. Methods 93 patients with suspected hand rheumatoid arthritis who were admitted to the hospital from August 2015 to August 2017 were selected as subjects. All of them underwent clinical examination, laboratory examination and imaging examination. According to the results of 6 weeks of follow-up, the patients were divided into rheumatoid arthritis group and non-rheumatoid arthritis group. All patients underwent MRI scanning within 1 week of treatment. With follow-up results as the golden standard, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa value of different MRI signs in the diagnosis of rheumatoid arthritis were calculated. Results Among the 93 patients with suspected rheumatoid arthritis, 85 cases were followed up till confirmed diagnosis and 71 cases were diagnosed as rheumatoid arthritis. The detection rates of synovial thickening, pannus enhancement, bone marrow edema, joint effusion and bone destruction in rheumatoid arthritis group were significantly higher than those in non-rheumatoid arthritis group (P<0.05). The sensitivity, specificity and accuracy of synovial thickening in the diagnosis of rheumatoid arthritis were 95.8%, 78.6% and 92.9%, respectively while those of pannus enhancement were 98.6%, 85.7% and 96.5%, respectively. The sensitivity, specificity and accuracy of bone marrow edema were 90.1%, 71.4% and 87.1%, respectively while those of joint effusion were 80.3%, 57.1% and 76.5%, respectively. The sensitivity, specificity and accuracy of bone destruction were 77.5%, 85.7%, 78.8%, respectively. Conclusion MRI can accurately reflect synovial thickening, pannus enhancement, bone marrow edema, joint effusion, bone destruction and other signs of hand rheumatoid arthritis, which provides important imaging evidence for the diagnosis and treatment of hand rheumatoid arthritis.