磁共振在脊柱关节病足部病变中的应用价值

Clinical value of magnetic resonance in the diagnosis of foot involvement in spondyloarthropathies patients

目的探讨脊柱关节病患者足部病变的磁共振（MR）表现，比较MR与X线在诊断该病中的价值。方法46例（92足）脊柱关节病患者行足部MR扫描和X线检查，其中强直性脊柱炎37例，未分化脊柱关节病7例，炎性肠病关节炎2例；10名同年龄健康志愿者（20足）作为对照组。结果46例脊柱关节病患者中，MR检查发现足部病变41例（89％），其中29例（63％）为单侧足部病变，12例（26％）表现为双侧足部病变。MR征象表现为关节积液，肌腱炎，软组织肿胀及骨质侵蚀性改变等；X线检查发现足部病变21例（46％），其中11例（52％）为单侧足部病变，10例（48％）表现为双侧足部病变。X线主要刘骨质侵蚀性改变、关节旁骨赘形成、关节间隙变窄等改变较敏感；临床检查发现足部病变（关节疼痛、肿胀）15例（33％）。10名健康志愿者足部MR和X线检查均未发现异常征象。结论MR与X线相比能敏感发现脊柱关节病患者的足部病变，肌腱、韧带及其附着点是病变的常见解剖部位。

Objective To determine the magnetic resonance imaging （MRI） features of foot involvement in spondyloarthropathies and observe changes of foot bone, soft tissue, tendon and articulation by comparing MR with X ray. Methods MR scanning and X ray were done for 46 patients of spondyloarthropathies. Among which, 37 cases were ankylosing spondylitis patients, 7 cases were undifferentiated spondyloarthropathies, and 2 were inflammatory bowel disease associated spondyloarthropathy. Ten healthy volunteers were controls and had both MRI and X ray examination. Results Signs and symptoms that suggested foot involvement were present in 15（33%） patients. Forty-one patients were proven to have foot involvement by MRI, but 21 were proven to have foot involvement by X ray. Conclusion Foot involvement in spondyloarthropathies can be detected early by MR than by X ray. Bone erosion, achilles tendilitis, soft tissue edema and joint effusion are the most prevalent MRI features. MR is important in detecting early foot involvement in patients with soondyloarthrooathies.