强直性脊柱炎骶髂关节核素骨显像与病理分析

Histopathologic evidence of sacroiliitis and bone scintigraphic imaging in ankylosing spondylitis

目的 探讨核素骨显像骶髂关节与骶骨放射性比值测定诊断强直性脊柱炎 (AS)的价值。方法 16例AS患者 ,共 31个骶髂关节 ,CT检查诊断为 0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期骶髂关节炎。先行全身骨显像、骶髂关节显像及放射性比值测定 ,1～ 3d后行CT引导下骶髂关节穿刺活组织检查。结果活组织检查示骶髂关节炎关节 30个 ,均有不同程度的滑膜炎、软骨及软骨下骨板血管翳侵入、骨质破坏等病变。核素骶髂关节显像示放射性比值升高关节 2 7个。 16例患者均有全身其他关节或脊柱病变。结论 核素骨显像及其放射性比值测定有利于AS骶髂关节炎的早期诊断 ,对其活动性监测有临床价值。

Objective To evaluate the value of early diagnosis and to monitor the activity of ankylosing spondylitis(AS) by using bone scintigraphic imaging and histopathologic technology. Methods Sixteen patients with AS (31 sacroiliac joint of them were involved) were divided into 5 groups:0 period, Ⅰperiod, Ⅱ period, Ⅲperiod and Ⅳ period group according to the modified New York criteria of AS. SPECT was performed on whole body skeleton as well as on the sacroiliac joint to measure the radioactivity ratio of it. After 1 to 3 days, they underwent the centesis of the sacroiliac joint under CT guidance for the histopathologic work-up. Results Histopathologic evidence showed synovitis, enthesitis, intraarticular fibrous strands, new bone formation, and bony ankylosis in 30 sacroiliac joints of AS patients. The radioactivity ratio of sacroiliac joint/sacrum increased in 27 sacroiliac joints, and 16 AS patients were found with abnormalities in joints other than sacroiliac joint. Conclusion Bone scintigraphic imaging is not only helpful to diagnosis of the AS in earlier stage, but also to monitoring of the activity of the disease.