强直性脊柱炎早期骶髂关节病变的CT特征分析

CT manifestations analysis of the earlier sacroiliac joint lesion in ankylosing spondylitis

目的研究强直性脊柱炎早期骶髂关节病变的CT特征,探讨CT对强直性脊柱炎早期的诊断价值。方法对67例早期强直性脊柱炎患者骶髂关节病变的CT征象进行了回顾性分析。结果67例强直性脊柱炎患者中119个骶髂关节受累,其中双侧52例,单侧15例,Ⅰ级35个关节,Ⅱ级84个关节。早期CT表现分级:①骶髂关节前下1/3的髂骨侧骨性关节面局限性破坏缺损,密度减低,周围局限性硬化76个关节。②骨性关节面毛糙、皮质白线中断、局限性缺损94个关节。③关节面下微小囊变106个关节,表现为骨性关节面下小囊状缺损。④骶髂关节髂骨侧关节面周围轻度带状硬化117个关节。⑤软骨钙化,关节面下骨质吸收20个关节,表现关节面下带状低密度影。⑥关节间隙基本保持正常或略增宽。结论CT能清晰显示早期强直性脊柱炎骶髂关节改变,骶髂关节炎是早期诊断强直性脊柱炎的重要依据,对强直性脊柱炎早期诊断具有重要意义。

Objective To evaluate CT manifestations and the diagnostic value of earlier sacroiliac joint lesion in ankylosing spondylities（AS）. Methods All the CT findings of the 67 cases with ankylosing spondylitis confirmed by clinical were retrospectively analyzed. Results One hundred and nineteen sacroiliac joints of all the 67 cases were involved. 52 cases were involved in both joints,and 15 cases in one joint. 35 of them were Grade Ⅰ ,and 84 were Grade Ⅱ. The CT findings of their earlier period are as followings： （1）Regional osteoporosis, the erosion, destruction of the bone, hyperosteogeny and osteosclerosis were found in the ilium at the anterior and lower 1/3 part of 76 sacroiliac joints. （2）The cortex of joint surface was hazy, and partly or all the cortex disappeared in 94 joints. （3）Cystic destruction was found in 106 joints. （4）Hyperosteogeny and osteosclerosis were found in the cortex of joint surface at ilium side in 117 joints. （5）Cartilage calcification and bone absorption under joint surface showing barred low density under joint surface were found in 20 joints.（6）No remarkable narrowed joint space or slightly widen joint space. Conclusions CT scan can not only clearly reveal the small constructions of the sacroiliac joint but also have higher sensitivity and accuracy during the early diagnosis of AS.