脊柱关节病骶髂关节炎骨质侵蚀磁共振成像误诊、漏诊分析

Analyze of MRI Misdiagnosis and Missed Diagnosis for Spondylarthritis Sacroiliitis Bone Erosion

目的:分析磁共振成像(MRI)对脊柱关节病(SpA)骶髂关节炎骨质侵蚀(BE)的误诊、漏诊原因,旨在提高诊断水平。方法:对47例SpA患者骶髂关节行CT和MRI横断面扫描。以CT为对照、以关节面为单位,统计MRI对BE的误诊率和漏诊率,并分析其原因。结果:MRI的BE误诊率24.6%(28/114)、漏诊率27.0%(20/74)。误诊原因:BE周围局限性骨质增生硬化(n=8)、骨皮质与骨板下骨髓交界面不光整(n=12)、韧带部容积效应(n=4)以及图像噪声影响(n=4)。漏诊原因:BE病灶位置表浅(n=4)、BE周围骨质增生硬化(n=10)、化学位移伪影影响(n=4)以及未仔细辨认(n=2)。结论:SIJ骨质增生硬化是导致MRI误诊、漏诊BE的主要原因,全面认识各种误诊、漏诊原因有助于提高MRI对BE的诊断水平。

Objective： To analyze the reasons ofMRI misdiagnosis or missed diagnosis for spondyarthritis （SPA） sacroiliitis bone erosion （BE） in order to improve diagnostic level. Methods： The sacroiliac joints （SIJ） of patients （n=47） with SpA were underwent with CT and MRI. Compared with CT, the rates ofMRI misdiagnosis and missed diagnosis for BE were calculated respectively, and the reasons were analyzed. Results： The rate ofMRI misdiagnosis for BE was 24.6%（28/114）. The rate of missed diagnosis was 27.0% （20/74）. The factors of misdiagnosed included subcortex boundedness bone sclerosis （n=8）, irregular margins between cortex and subcortex bone marrow （n=12）, volume effect of ligament （n=4） and noise of image （n=4）. The factors of missed diagnosis included superficial location（n=4）, bone sclerosis（n=10）, the effect of chemical shift artifacts （n=4）and careless observation （n=2）. Conclusion： The main reason led to MRI misdiagnose and miss diagnose BE is bone sclerosis of sacroiliac joint. A comprehensive understanding of the reasons are contributed to improving the diagnostic level for MRI.