Title Uloga magnetske rezonancije u otkrivanju promjena vratne kralježnice u bolesnika s juvenilnim idiopatskim artritisom Title (english) The role of magnetic resonance imaging in detection of cervical spine changes in patients with juvenile idiopathic arthritis Author Ana Tripalo Batoš Mentor Kristina Potočki (mentor)Mentor Alenka Gagro (komentor)Committee member Gordana Ivanac (predsjednik povjerenstva)Committee member Marija Jelušić (član povjerenstva)Committee member Branimir Anić (član povjerenstva)Granter University of Zagreb Defense date and country 2020-12-07, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Juvenilni idiopatski artritis jedna je od najčešćih kroničnih bolesti dječje dobi s povišenim rizikom za smanjenje kvalitete života kao i nastanka invaliditeta. Promjene na vratnoj kralježnici uzrokovane ovom bolesti mogu biti i životno ugrožavajuće. -----
Ciljevi istraživanja: Ispitati postojanje promjena na vratnoj kralježnici MR-om uz aplikaciju kontrastnog sredstva prije nastupa promjena koje su vidljive RTG-om u djece s JIA-om u kojih simptomi vratne kralježnice traju do tri godine od postavljanja dijagnoze. Analizirati i usporediti radiološke nalaze, detektirati povezanost HLA-lokusa, ANA-e i RF-a s RTG-om i MR-om. -----
Materijali i metode: U istraživanje je bilo uključeno 62 bolesnika. Uspoređivane su promjene viđene na RTG-u i MR-u međusobno i s podacima CHAQ-a, RF-a, ANA-e i nalazom HLA-a, te s indeksom inklinacije, reklinacije i sagitalne gibljivosti. -----
Rezultati: U ispitivanoj skupini distribucija djece po spolu pokazala je dvostruku dominaciju ženskog spola. Prevladavala su djeca s ERA-om (82,2%). Vrijednosti CHAQ-a ukazale su na zadovoljavajuće opće psihofizičko stanje djece. U sedam ANA pozitivnih bolesnika statistički je značajna povezanost s kroničnim promjenama na RTG-u i MR-u. Analizom HLA-lokusa, bio je manji udio pozitivnih HLA-B27 u odnosu na podatke opisane u literaturi, ali se lokus HLA-DRB1* 08 isticao s vrlo ranim i opsežnim promjenama na MR-u. Klinički pregled s mjerenjem zadanih indeksa prepoznaje jedino kronične promjene. Ukupno je bio 21 bolesnik s pozitivnim RTG i 40 s pozitivnim MR nalazom. Na RTG-u kod svih ispitanika, osim RF+ JIA bolesnika, bolesnici su imali isključivo reverzibilne promjene, a izravnanje fiziološke lordoze izdvajalo se kao najčešći nalaz (90%). Na MR-u uz izravnanje fiziološke lordoze bile su vidljive promjene poput sinovitisa, entezitisa, koštanog edema, izljeva u zglobovima i postkontrastne imbibicije. Gotovo dvije trećine ispitanika imalo je vidljive promjene na MR-u vratne kralježnice na samom početku bolesti bez obzira na klinički opseg tegoba, koje se ovom metodom opažaju ranije u usporedbi s RTG-om. Postkontrastna imbibicija bila je prisutna u trećine pozitivnih MR nalaza. Promjene vidljive na MR-u pojavljuju se ranije nego u do sada objavljenim podacima u literaturi, bez obzira na simptome, dok se na RTG snimkama dominantno vidi samo izravnanje fiziološke lordoze. Glavno ograničenje našeg istraživanja bio je mali uzorak za svaku pojedinu podvrstu JIA-a, što je ograničilo precizniju statističku analizu. -----
Zaključak: Studija statistički nije opravdala uporabu MR-a kao prve metode izbora za dijagnosticiranje ranog artritisa vratne kralježnice. Ipak, uvjerljiva je prednost MR-a u odnosu na RTG, jer se MR-om prepoznaju reverzibilne promjene prije te u većem opsegu nego RTG-om.
Abstract (english) Juvenile idiopathic arthritis is one of the most common chronic diseases of today, increasing the risk of loss of quality of life and eventual disability. Changes in the vertebral spine caused by this disease can also be life-threatening. -----
Objectives of the study: To examine the changes in the vertebral spine by MR with contrast medium application before the change is visible on X-ray in children with JIA that have developed symptoms correlated with cervical spine pathology. The aim was to analyze and compare radiological findings, detect the association of HLA-loci, ANA, and RF with X-rays and MRIs. -----
Materials and methods: 62 patients were included in the study. The changes seen on X-ray and MR were compared with each other, as well as with CHAQ, RF, ANA and HLA findings, and with the inclination, reclination, and sagittal mobility index. -----
Results: In the examined group, the distribution by gender showed a double dominance of females. Children with ERA were predominant (82.2%). CHAQ values showed an adequate level of psychophysical condition in children. In seven ANA-positive patients, there was a statistically significant correlation with chronic changes in X-ray and MR. Analysis of the HLA-locus showed that the frequency of positive HLA-B27 is lower than in the literature, but HLA-DRB1 * 08 emerged with very early positive and extensive changes on MR. Clinical examination with mobility indexes recognizes only chronic changes. A total of 21 patients had positive X-rays and 40 had positive MR findings. On X-ray in all subjects, excluding RF + JIA patients, patients had only reversible changes, and the loss of physiological lordosis appeared as the most common finding (90%). There were also other MR changes such as synovitis, enthesitis, bone edema, joint effusion, and postcontrast imbibition. Almost two-thirds of the subjects had changes visible on MR examination of the cervical spine already at the beginning of the disease, regardless of the extent of the symptoms, and the changes were seen earlier in relation to X-rays. Postcontrast imbibition was present in one-third of positive MR findings. The changes visible on MR appeared earlier than in the data published so far in the literature regardless of the symptoms, while on X-rays only the loss of physiological lordosis is predominantly seen. The main limitation of our research is the small sample for each individual subtype of JIA, which precludes more accurate statistical analysis. ----- Conclusion: The study did not statistically justify the use of MR as the first method of choice for diagnosing early cervical arthritis. Nevertheless, the advantage of MR over X-ray is convincing, because MR recognizes reversible changes earlier and to a greater extent than X-rays.
Keywords
magnetska rezonancija
rendgenske snimke vratne kralježnice
juvenilini idiopatski artritis
vratna kralježnica
Keywords (english)
magnetic resonance imaging
X-rays of the cervical spine
juvenile idiopathic arthritis
cervical spine
Language croatian URN:NBN urn:nbn:hr:105:015351 Study programme Title: Biomedicine and Health Sciences Catalog URL https://katalog.nsk.hr/F/19IT7Y755V1NXQJPHCLYSQGPF6BLAPPF179HQ7FAXXMYBYGMV5-08687?func=find-e&request=Uloga+magnetske+rezonancije+u+otkrivanju+promjena+vratne+kralje%C5%BEnice+u+bolesnika+s+juvenilnim+idiopatskim+artritisom&find_scan_code=FIND_NAS&adjacent=N&local_base=MF_WEB&x=29&y=11&filter_code_1=WLN&filter_request_1=&filter_code_2=WYR&filter_request_2=&filter_code_3=WYR&filter_request_3=&filter_code_4=WFM&filter_request_4= Type of resource Text Extent 103 str. File origin Born digital Access conditions Open access Terms of use Repository Dr Med - University of Zagreb School of Medicine Digital Repository Created on 2021-03-22 10:09:39
