Abstract:

Objective　To analyze the magnetic resonance imaging (MRI) manifestations of knee bone marrow edema in children with juvenile idiopathic arthritis. Methods　Retrospective analysis was used to analyze the MRI images of knee joint bone marrow edema in 126 children with juvenile idiopathic arthritis in Henan Children's Hospital from June 2020 to June 2022. There were 98 males and 28 females, aged (7.85±2.11) years, with a course of disease of (8.65±1.05) months, all of which were unilateral knee joint lesions. The synovial thickening and pannus, effusion and fluid accumulation of joint capsule, bone abnormalities, joint cartilage lesions, popliteal lymph node enlargement, abnormal meniscus and ligaments, and vascular shadows in joint cartilage were analyzed. Results　In the 126 children with juvenile idiopathic arthritis, multiple pannus covered the surface of the joint femur [66 cases (52.38%)], low signal was dominant on T1W [96 cases (76.19%)], and homogeneous equal signal was dominant on T2W [66 cases (52.38%)]. There was a small amount of synovial fluid in the 126 children with juvenile idiopathic arthritis, of whom 102 cases (80.95%) had suprapatellar bursa effusion. The main types of bone marrow edema in children with juvenile idiopathic arthritis were low signal on T1W [48 cases (38.10%)] and patchy fuzzy signal on T2W [41 cases (32.54%)], and multiple "flame" like bone marrow edema with epiphyseal cartilage as the base and facing back to the joint cavity were found in the metaphyseal end [81 cases (64.29%)]. The main joint cartilage lesions in children with juvenile idiopathic arthritis were superficial roughness [60 cases (47.62%)] and local thinning [36 cases (28.57%)]. Of the 126 children with juvenile idiopathic arthritis, 42 cases had enlarged lymph node shadows in the knee and popliteal fossa, with low signal on T1W, low signal/slightly low signal on T2W, and high signal on SPIR/3D/FFE. In children with juvenile idiopathic arthritis, the anterior and posterior corners of the meniscus were mainly deformed [45 cases (35.71%)], and collapsed and fragmented [15 cases (11.90%)], and there were multiple swelling/local wavy changes in the anterior and posterior cruciate ligaments of the knee joint [21 cases (16.67%)]. Of the 126 children with juvenile idiopathic arthritis, 72 cases showed radial enhanced vascular shadows arranged perpendicular to the cartilage surface of the femoral condyle in the knee joint cartilage. Conclusions　In the MRI manifestations of knee joints in children with juvenile idiopathic arthritis, there are multiple synovial thickening, joint cavity effusion, and bone marrow edema. Some children are accompanied by cartilage destruction and subchondral bone invasion.

Key words:

Juvenile idiopathic arthritis, Children, Knee joint, Bone marrow edema, Magnetic resonance imaging

摘要：

目的　分析幼年型特发性关节炎儿童膝关节骨髓水肿的磁共振成像（MRI）影像表现。方法　采用回顾性分析法，对2020年6月至2022年6月期间河南省儿童医院126例幼年型特发性关节炎儿童膝关节骨髓水肿的MRI影像进行分析，其中男性98例，女性28例，年龄（7.85±2.11）岁，病程（8.65±1.05）个月，均为单侧膝关节病变。分析滑膜增厚和血管翳情况、关节囊渗出积液情况、骨质异常情况、关节软骨病变情况、腘窝淋巴结肿大情况、半月板及韧带异常情况、关节软骨内血管影情况。结果　幼年型特发性关节炎儿童多发血管翳覆盖关节股骨表面［66例（52.38%）］，T1W以低信号为主［96例（76.19%）］，T2W以均匀等信号为主［66例（52.38%）］。126例幼年型特发性关节炎儿童均存在少量滑液，其中102例（80.95%）存在髌上囊积液；骨髓水肿以T1W低信号［48例（38.10%）］、T2W片状模糊信号［41例（32.54%）］为主要类型，多发干骺端以骺软骨为基底部的背向关节腔的“火焰”样的骨髓水肿［81例（64.29%）］；关节软骨病变以表面毛糙［60例（47.62%）］、局部变薄［36例（28.57%）］为主其中42例患儿存在膝关节腘窝肿大淋巴结影，T1W呈低信号，T2W呈低信号/略低信号，SPIR/3D/FFE呈高信号；患儿半月板以前角/后角变形［45例（35.71%）］、塌陷碎裂［15例（11.90%）］为主，且多发膝关节前后交叉韧带肿胀/局部波浪状改变［21例（16.67%）］；72例患儿膝关节软骨内可见与股骨髁关节软骨面垂直排列的辐射状强化的血管影。结论　幼年型特发性关节炎儿童的膝关节MRI表现中，多发滑膜增厚、关节腔积液、骨髓水肿，部分患儿伴随软骨破坏和软骨下骨质侵袭。

关键词:

幼年型特发性关节炎, 儿童, 膝关节, 骨髓水肿, 磁共振成像