骶髂关节磁共振成像在强直性脊柱炎治疗随访中的临床应用

Follow-up study on ankylosing spondylitis with magnetic resonance imaging of sacroiliac joints

目的探讨MRI在骶髂关节强直性脊柱炎(AS)患者治疗随访中的作用。方法对临床确诊的27例AS患者行MR检查,经常规治疗半年后复查骶髂关节MRI,比较软骨线、软骨下骨板、关节旁骨髓水肿、脂肪沉积和关节异常强化的变化,并与临床、实验室检查结果相对照,计算MRI与临床疗效评分在判定AS随访中的敏感度与特异度。结果27例AS患者治疗前,24例可见软骨线增粗、扭曲、中断;20例见软骨下骨板粗细不均、中断、凹凸不平;26例见关节旁骨髓水肿;15例见脂肪沉积;增强扫描27例均见骨髓内及关节囊、滑膜、关节韧带的异常强化。治疗后20例患者骶髂关节骨髓水肿不同程度减轻;19例患者强化程度减弱或消失。治疗后临床疗效判定为:显效/有效22例,无效5例;而MRI显示治疗显效和(或)有效20例;无效7例。与临床疗效评分比较,MRI诊断AS疗效判定的敏感度为90.91%,特异度为100%。结论骶髂关节MRI能直观地显示骶髂关节病变转归,在AS治疗随访中有很高的临床应用价值。

Objective To evaluate the application value of MRI in the following-up of sacroiliac joints in patients with ankylosing spondylitis （AS） after treatment. Methods Twenty-seven patients with AS proven clinically and treated with a 6- month therapeutic regimen were enrolled in this study. All the patients underrwent MR examination before treatment and during the following-up. The main survey indexes of MRI included cartilage line, bone lamella below synovial cartilage,bone marrow edema, lipidosis and enhancement abnormalities. The findings of MRI were compared with that of clinical diagnosis. Results Before treatment, cartilage line thickening, twisting and interruption were ovserved in 24 patients, lamella below synovial cartilage erosion, interruption and uneven in 20, bone marrow edema in 26, fatty deposition in 15 and enhancement abnormalities in all 27 patients. After treatment, bone marrow edema lightened in 20 patients, while enhancement abnormalities lessened or disappeared in 19 patients. After treatment the result of clinical assessment was excellent or effective in 22 patients,while ineffective in 5; and the result of MRI assessment was excellent or effective in 20, but ineffective in 7 patients. The sensitivity and specificity of MRI was 90.91 % and 100 %, respectively. Conclusion MRI can be used as a valuable imaging modality in the evaluation of AS after treatment.