X线和CT对强直性脊柱炎骶髂关节病变的诊断价值比较

Comparison of the diagnostic value between X ray and CT image in sacroiliac ankylosing spondylitis

目的:比较X线和CT对强直性脊柱炎(AS)骶髂关节病变的诊断价值。方法:收集临床上诊断为AS的患者136例,对其X线平片及CT成像诊断骶髂关节病变的敏感性及病变分级进行比较分析。结果:X线诊为0～Ⅱ级骶髂关节改变中有48.8%在CT诊断中提高了诊断级别。骶髂关节面模糊(Ⅰ级改变)在X线平片中检出率较CT高(P<0.05),而关节软骨及骨侵蚀则在CT中检出率较X线平片高(P<0.05)。X线诊断为0～Ⅱ级骶髂关节病变与CT诊断的符合率较低,分别为56.6%、36.6%、53.3%;X线诊断为Ⅲ～Ⅳ级骶髂关节病变与CT诊断的符合率较高,分别为84.6%和90.9%。结论:CT较X线片对骶髂关节轻微病变的诊断敏感性高,所以CT扫描对AS骶髂关节炎早期病变的诊断具有较高价值。X线与CT对非早期骶髂关节炎病变诊断的敏感性相同。

Objective：To compare the diagnostic value beween X ray and CT image in sacroiliac ankylosing spondylitis （AS）.Methods：One hundred and thirty-six patients diagnosted AS by clinical manifestations were candidated,their X-ray and CT features and degrees of sacroiliac joints were studied and compared.Results：48.8% of saroiliac joints with 0-Ⅱdegree changes diagnosted by X-ray were further examined with CT. Blurred joint surface（ Ⅰ degree） were detected much more frequently by X-ray than CT, but cartilage and bone erosions were detected more frequently through CT than X-ray.The coincidence ratios of 0-Ⅱ deggrees sacroiliac joint changes between X-ray and CT diagnostic degree were 56.6% ,36.6% ,52% respectively.The coincidence ratios of Ⅲ-Ⅳdeggrees sacroiliac joint changes between X-ray and CT diagnostic degree were 82.3% and 90.9% respectively.Conclusion：CT is more sensitive than X-ray in detecting small signs of sacroiliac joint changes,so CT is very useful for examining the early sacroiliac joint changes and improve early diagnosis on AS.The sensitivity of diagnosis in advanced stage sacroilitis are almost same between X-ray and CT.