探讨超微血管成像技术（SMI）评估类风湿性关节炎（RA）患者滑膜血管翳中的应用价值。

收集2014年12月至2015年5月首都医科大学附属北京朝阳医院风湿免疫科收治的类风湿关节炎患者48例。应用日本东芝Aploi500彩色多普勒超声诊断仪，对48例RA患者于入院后进行双侧腕关节、双手第1~5掌指关节进行检查，记录关节滑膜厚度、关节腔积液有/无、关节周围肌腱改变及增厚滑膜内能量多普勤（PDI）及SMI血流信号，同时对增厚滑膜内PDI/SMI血流信号进行分级，分析患者临床28个关节疾病活动度评分（DAS28）及实验室相关检查指标。

48例患者，共576个关节，其中腕关节滑膜增厚有82个关节，掌指关节滑膜增厚有78个关节。腕关节增厚滑膜内SMI探测到血流信号者占81%，PDI探测到血流信号者占59%；掌指关节增厚滑膜内SMI探测到血流信号者占87%，PDI探测到血流信号者占64%；腕关节、掌指关节增厚滑膜内血流信号显示率，2种成像方式间比较，差异具有统计学意义（χ²=9.542，0.002；χ²=11.272，0.001，P值均<0.01）；患者腕关节及掌指关节增厚滑膜内PDI及SMI血流信号分级之间比较，差异具有统计学意义（Z值=-3.835，0.001，P值均<0.01；Z值=-3.611，0.001，P值均<0.01）；48例患者DAS28评分与SMI血流信号分级之间具有一定的正相关性（r=0.82，P<0.05）。

SMI成像技术对RA患者增厚滑膜血管翳有较好的评估价值，同时，SMI技术与RA病变活动程度之间具有较好的相关性，可对病变的活动度及严重程度提供一定的辅助诊断价值。

To explore the application value of super micro-vascular imaging in the evaluation of patients with rheumatoid arthritis (RA) synovial pannus.

Totally 48 rheumatoid arthritis patients treated in Department of Rheumatology, Capital Medical University Affiliate Beijing Chaoyang Hospital from December, 2014 to May, 2015 were included. Japan's Toshiba Aploi500 color Doppler ultrasound diagnostic apparatus was applied to exam the bilateral wrist joint and 1-5 metacarpophalangeal joints of both hands of 48 RA patients after hospitalized. The thicknesses of the synovial joints were recorded. It was also recorded that if there was hydrops in the articular cavity. The change of tendons around joints, PDI and SMI blood flow signals in the thickening of the synovial membrane were also recorded. Meanwhile, the PDI and SMI blood flow signals in the thickening of the synovial membrane were graded to analyze the clinical DAS28 scores and relative laboratory examination indexes.

Within 576 joints of 48 patients, 82 synovial membranes of wrist joints and 78 of metacarpophalangeal joints thickened. The proportion of blood flow signals detected by SMI in thickened synovial membranes of wrist joints was 81%, while that of PDI was 59%. The proportion of blood flow signals detected by SMI in thickened synovial membranes of metacarpophalangeal joints was 87%, while PDI was 64%. The differences of blood flow signals rate of thickened synovial membranes between both wrist joints and metacarpophalangeal joints were statistically significant, so as the comparison of two imaging patterns (χ²=9.542, 0.002, χ²=11.272, 0.001, all P<0.01). The differences of the grading of PDI and SMI blood flow signals in the thickening of the synovial membranes between wrist joints and metacarpophalangeal joints were statistically significant (Z=-3.835, 0.001, both P<0.01; Z=-3.611, 0.001, both P<0.01). DAS28 scores and SMI blood flow signals grading were positively related (r=0.82, P<0.05).

SMI imaging provides better evaluation in thickened synovial pannus of RA patients. Meanwhile, SMI shows better correlation with RA activity degrees and can provide auxiliary diagnosis in the disease activity and severity.