MRI诊断早期强直性脊柱炎骶髂关节病变分级的临床价值
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摘要
目的分析磁共振成像(MRI)诊断早期强直性脊柱炎(AS)骶髂关节(SIJ)病变分级的临床价值。方法选取2017年4月至2018年6月我院收治的早期AS患者88例为研究对象,均行CT及MRI检查,对比两种检查方法下影像特征及在SIJ病变分级中的诊断价值。结果 CT检查发现早期AS患者SIJ关节间隙变窄且模糊,关节面见骨质破坏,呈锯齿状,多发小囊变,髂骨侧及关节中、下部受累,Ⅰ-Ⅱ级病变者MRI可见骨质关节面模糊粗糙、骨髓水肿、骨质软骨受损,T1WI、T2WI、短时反转恢复序列(STIR)多为低或等信号,Ⅲ-Ⅳ级患者MRI可见明显炎性病变、骨髓水肿、骨质软骨受损、滑膜厚度增加、脂肪沉积,T1WI、T2WI高信号,STIR信号不均匀或不完整;MRI对AS患者SIJ病变Ⅰ级、Ⅱ级的检出率高于CT(P<0.05),两种检查方法对0级、Ⅲ级、Ⅳ级的检出率比较差异无统计学意义(P>0.05);MRI检查对关节面下骨质囊变、关节侵蚀、关节面增生硬化、腰5骶1关节突病变、软组织肿胀的检出率均高于CT(P<0.05);以病理结果为准,MRI对早期SIJ病变分级(0-Ⅱ级)诊断的正确率高于CT,而在晚期SIJ病变分级(Ⅲ-Ⅳ级)诊断方面,CT、MRI的正确率比较差异无统计学意义(P>0.05)。结论 MRI在早期AS患者SIJ病变分级中有较高临床价值,可作为首选检查方法评估骶髂关节改变、脊柱及其附属结构的早期改变。
Objective To analyze the clinical value of magnetic resonance imaging(MRI in the diagnosis oflesion classification of sacroiliac joint(SIJ) in early ankylosing spondylitis.Methods 88 patients with early AS in the hospital from April 2017 to June 2018 were chosen in the study. All patients were given CT and MRI examination. The imaging characteristics and the diagnostic value in SIJ lesion classification with the two methods were compared. Results CT examination found that the SIJ space in the patients with early AS was narrow and fuzzy, the joint surface showed destroyed bone in a jagged shape and multiple small cystic lesions, the side of ilium and the middle and lower parts of the joints were involved. MRI showed that there were fuzzy and roughbone joint surface,bone marrow edema and bone cartilagein patients with grade I to II lesions. T1 WI, T2 WI and short-term inversion recovery sequence(STIR) showed low or equal signals. MRI of patients with grade IIIIV lesions showed obvious inflammatory lesions, bone marrow edema, osteocartilage damage, increased synovial thickness and fat deposition. T1 WI and T2 WI showed high signal and STIR signal was inhomogenous or incomplete. The detection rates of grade I and II SIJ lesions in AS patients by MRI were higher than CT(P<0.05). There was no significant difference in the detection rate of grade 0, grade III or grade IV lesions between the two examination methods(P>0.05). The rates of bone cystic change under articular surface, joint erosion, articular surface hyperplasia and sclerosis, facet joint lesions at the 5 th lumbar segment and the 1 st sacral segment and soft tissue swelling detected by MRI were higher thanCT(P<0.05). With pathological results as the standard,the correct rate of MRI diagnosis for early SIJ lesions(grade 0-II) was higher than that of CT while there was no significant difference in the correct rate between CT and MRI in terms of the diagnosis of advanced SIJ lesions(grade III to IV)(P>0.05). Conclusion MRI is of greatclinical value in the classification of SIJ lesions in patients with early AS. It can be used as the first choice to evaluate the changes of sacroiliac joint, the spine and its accessory structures.
Objective To analyze the clinical value of magnetic resonance imaging(MRI in the diagnosis oflesion classification of sacroiliac joint(SIJ) in early ankylosing spondylitis.Methods 88 patients with early AS in the hospital from April 2017 to June 2018 were chosen in the study. All patients were given CT and MRI examination. The imaging characteristics and the diagnostic value in SIJ lesion classification with the two methods were compared. Results CT examination found that the SIJ space in the patients with early AS was narrow and fuzzy, the joint surface showed destroyed bone in a jagged shape and multiple small cystic lesions, the side of ilium and the middle and lower parts of the joints were involved. MRI showed that there were fuzzy and roughbone joint surface,bone marrow edema and bone cartilagein patients with grade I to II lesions. T1 WI, T2 WI and short-term inversion recovery sequence(STIR) showed low or equal signals. MRI of patients with grade IIIIV lesions showed obvious inflammatory lesions, bone marrow edema, osteocartilage damage, increased synovial thickness and fat deposition. T1 WI and T2 WI showed high signal and STIR signal was inhomogenous or incomplete. The detection rates of grade I and II SIJ lesions in AS patients by MRI were higher than CT(P<0.05). There was no significant difference in the detection rate of grade 0, grade III or grade IV lesions between the two examination methods(P>0.05). The rates of bone cystic change under articular surface, joint erosion, articular surface hyperplasia and sclerosis, facet joint lesions at the 5 th lumbar segment and the 1 st sacral segment and soft tissue swelling detected by MRI were higher thanCT(P<0.05). With pathological results as the standard,the correct rate of MRI diagnosis for early SIJ lesions(grade 0-II) was higher than that of CT while there was no significant difference in the correct rate between CT and MRI in terms of the diagnosis of advanced SIJ lesions(grade III to IV)(P>0.05). Conclusion MRI is of greatclinical value in the classification of SIJ lesions in patients with early AS. It can be used as the first choice to evaluate the changes of sacroiliac joint, the spine and its accessory structures.
引文
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[11]金明花,马湘乔,胡冰,等.CT与MRI检查强直性脊柱炎骶髂关节病变的临床分析[J].医学影像学杂志,2016, 26(11):2089-2091.
[12]周萍丽.早期强直性脊柱炎骶髂关节病变应用X线、CT和MRI的诊断价值研究[J].中国CT和MR I杂志,2016, 14(10):117-120.
[13]王雨,毛明伟,陈家飞,等.磁共振在强直性脊柱炎骶髂关节病变诊断中的价值[J].现代中西医结合杂志,2015, 24(36):4085-4087.
[14]吴晓涛,李传俊,伍鑫,等.磁共振成像对强直性脊柱炎早期骸髂关节炎诊断的临床应用价值[J].昆明医科大学学报,2017, 38(3):98-1 02.
[2]Landew e R,Braun J,Deodhar.Efficacy of certolizumab pegol on signs and symptoms of axial spondyl oar t hritis including ankylosing spon dylitis:2 4-week results of a doubleblind randomised placebo-cont rolled Phase 3 s tudy[J]. Ann Rheum Dis, 2014, 73(1):39-47.
[3]赵英华(综述),李绍林(审校).MRI检测强直性脊柱炎骸髂关节炎活动性的研究进展[J].实用放射学杂志,2016, 32(4):629-631.
[4]王保奇.对比X线、CT和MRI在诊断早期强直性脊柱炎骶髂关节病变诊断中的价值[J].中国数字医学,2017,12(3):30-31, 96.
[5]蔡长寿,冯丰全,邱波,等.CT和MRI在早期强直性脊柱炎骶髂关节病变中的诊断价值[J].医学影像学杂志,2016, 26(6):1 1 32-1 1 35.
[6]Tan S,Yao J,Flynn J A, e t a l.Quantitative measurement of syndesmophyte volume and height in ankylosing spondylitis ueing CT[J].Ann Rheum Dis,2014, 73(3):544-550.
[7]周春山,黄燕.强直性脊柱炎早期骶髂关节炎的磁共振诊断价值[J].湖南师范大学学报,2016, 36(A02):1 003-1 003.
[8]孟金丽,何万林.磁共振常规序列与3D-WATS对强直性脊柱炎骸髂关节炎分级的对比研究[J].影像诊断与介入放射学,2017, 26(3):225-229.
[9]孙冬梅.MRI诊断强直性脊柱炎骸髂关节病变价值[J].中华实用诊断与治疗杂志,2016, 30(6):609-610.
[10]马立恒,张朝晖,刘春杏,等.早期强直性脊柱炎脊柱病变的MR I征象分析[J].临床放射学杂志,2016, 35(2):258-262.
[11]金明花,马湘乔,胡冰,等.CT与MRI检查强直性脊柱炎骶髂关节病变的临床分析[J].医学影像学杂志,2016, 26(11):2089-2091.
[12]周萍丽.早期强直性脊柱炎骶髂关节病变应用X线、CT和MRI的诊断价值研究[J].中国CT和MR I杂志,2016, 14(10):117-120.
[13]王雨,毛明伟,陈家飞,等.磁共振在强直性脊柱炎骶髂关节病变诊断中的价值[J].现代中西医结合杂志,2015, 24(36):4085-4087.
[14]吴晓涛,李传俊,伍鑫,等.磁共振成像对强直性脊柱炎早期骸髂关节炎诊断的临床应用价值[J].昆明医科大学学报,2017, 38(3):98-1 02.
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