强直性脊柱炎骶髂关节MRI及临床应用研究

Research into the clinical application of MRI in the evaluation of sacroiliac joint accompanying ankylosing spondylitis

目的研究强直性脊柱炎(ankylosing spondylitis,AS)骶髂关节MRI表现及其临床应用价值。方法收集符合1984年修订的纽约标准的强直性脊柱炎患者23例,男19例,女4例,行双侧骶髂关节MR平扫及增强扫描。均采用SE、短时反转恢复(STIR)序列。同时收集患者的临床症状、体征、化验指标与MRI对比分析。结果23例患者,骨髓水肿11例,骨质侵蚀16例,脂肪沉积20例。骨髓水肿组、骨质侵蚀组、脂肪沉积组分别与无相应表现组在血沉(ESR)、血小板计数(PLTC)、Bath强直性脊柱炎疾病活动指数(BASDAI评分)、患者的整体评估方面差异有显著意义,P值均小于0.05。骨髓水肿组与无骨髓水肿组的骨质破坏差异有显著性。结论MRI能够显示强直性脊柱炎的早期病理改变,并且MRI表现在评价疾病预后方面有一定临床价值。

Objective To study the MRI findings of sacroiliac joint accompanying ankylosing spendylitis（AS） and to evaluate their clinic usefulness. Methods Twenty- three patients（ 19 men and 4 women） with AS which was coincident with 1984 modified New York criteria underwent MR scans without and with contrast enhancement of bilateral sacroiliac joints. All MR imaging was performed by using spin echo（SE）and short time inversion recovery（STIR）sequences. Simultaneously, the clinical data which comprised clinical symptoms, signs and laboratory tests such as erythroeyte sedimentation rate（ESR）, platelet count（PLTC）, bath ankylosing spondylitis activity index（BASDAI）and patients global assessment （PGA） were collected for each case and comparatively analyzed with their MRI findings, Results On MR images of 23 cases, bone marrow edema was found in 11, bone erosion in 16, and fatty sedimentation in 20. All patients could be divided into two groups according to preSence and absence of bone marrow edema, bone erosion and fatty sedimentation. ESR, PTLC, BASDAI and PGA between above two groups were significant differences（ P〈 0. 05）. Conclusion MRI can reveal the early lesions of AS, thus it is helpful to identify the prognosis.