MRI及核素骨显像对强直性脊柱炎的诊断价值

The evaluation of MRI and nuclide bone scintigraph for the diagnosis of ankylosing spondylitis

目的:探讨动态增强磁共振成像(DMRI)及核素骨显像骶髂关节与骶骨的核素比值测定对强直性脊柱炎(AS)的诊断价值.方法:将15例临床诊断为AS的患者共30个骶髂关节(CT诊断为0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期骶髂关节炎)作为实验组.同时将8例志愿者的16个骶髂关节作为对照组.对以上46个骶髂关节分别先行DMRI、核素骨显像骶髂关节与骶骨核素比值测定,1～3d后均在CT引导下行骶髂关节穿刺,取组织行病理组织学检查.结果:核素骨显像骶髂关节与骶骨核素比值测定及DMRI检查阳性率两组间比较无显著性差异(P＞0.05);诊断阳性患者的病理活检主要表现为骶髂关节均有不同程度的炎症浸润,尤其是滑膜及软骨下骨板.结论:核素骨显像骶髂关节与骶骨核素比值测定及DMRI增强检查都有利于AS的骶髂关节炎的早期诊断,且对骶髂关节炎的活动性监测具有重要的应用价值,但前者操作方便、费用较低,可作为临床筛选检查手段.

Objective:To discuss the value of dynamic MRI(DMRI) and nuclide bone scintigraph of sacroiliac joint in the detection of ankylosing spondylitis(AS) and its clinical stages. Method:15 subjects diagnosed as AS patients were put in a clinical group,in which there were all together 30 sacroiliac joints diagnosed by CT as sacroilitis respectively in the clinical stages of 0,Ⅰ,Ⅱ,Ⅲ and Ⅳ. Meanwhile 8 volunteers with 16 sacroiliac joints were organized in another group for the purpose of making a contrast with the clinical group.All the 46 subjects′ sacroiliac joints received DMRI inspection and nuclide bone scintigraph of sacroiliac joint,and the nuclide ratios were measured.After an interval of 1~3 days,all subjects in clinical group underwent CT-guided needle biopsy at their sacroiliac joints as well as histopathologic examination.Result:The positive ratios acquired by nuclide bone scintigraph of sacroiliac joint and DMRI did not present substantial difference(P>0.05), and the pathologic biopsy showed that there existed inflammatory infiltration to different degrees in all positive patient′s sacroiliac joints,especially in the place of synovum and subchondral tabula.Conclusion:Both nuclide bone scintigraph,the measurement of nuclide ratio,and DMRI inspection are not only very helpful in detecting sacroilitis of primary phase,but also very valuable in inspecting the clinical conditions of sacroilitis,the former is easier and less expensive,so it can be used as a follow-up inspection method.