寰枢关节类风湿关节炎的CT评价

Assessing the atlantoaxial joint in patients with rheumatoid arthritis using axial and three dimensional reconstruced computed tomography

目的探讨CT及三维后处理技术在诊断类风湿性关节炎累及寰枢关节中的临床价值。方法分析15例临床类风湿性关节炎确诊病例的寰枢关节CT图像,并利用工作站分别进行多平面重建(MPR)和容积再现(VR)成像等进行CT图像的三维后处理,分析寰枢关节骨质、关节间隙、是否半脱位及方向等CT表现。结果类风湿性关节炎累及寰枢关节的主要CT表现为骨质稀疏(6/15),骨质破坏(9/15),关节间隙的变窄或增宽;半脱位7例,其中前半脱位3例,侧方半脱位2例,前后脱位伴侧方脱位2例;2例出现颅底凹陷伴神经病变和椎动脉供血不足,4例因寰枢关节前半脱位引起椎管狭窄,造成脊髓压迫。结论 CT及三维后处理技术在类风湿性关节炎累及寰枢关节的诊断中发挥着重要的临床作用。

Objective To assess the CT findings of atlanto‐axial joint lesions in patients with RA using axial and three dimensional reconstruced computed tomography （CT） images .Methods Fifteen patients with Atlanto‐axial joint lesions due to RA who had undergone CT examination were included in our study .Multi‐planar reconstruction （MPR） and volume rendering （VR） CT images were reconstructed to investigate with precision the morphology of destruction of the odontoid process ,including bone and joint space lesions ,whether there were subluxation and dislocation direction .Results Atlan‐to‐axial joint lesions was due to RA ,CT characteristic included osteoporosis （6/15） ,destruction of bone （9/15） ,atlanto‐axial joint space narrowing or widening .7 cases of subluxation included anterior （3/15） ,lateral （2/15） and three directons （2/15） atlanto‐axial subluxation were analyzed .2 cases had basilar invagination with neuropathy and vertebral artery in‐sufficiency .4 cases with anterior atlantoaxial joint subluxation had spinal stenosis ,causing myelosuppression .Conclusion Axial and three dimensional reconstruced CT imaging is an important technique in the diagnosis of atlanto‐axial joint le‐sions in patients with RA .