微血流成像与能量多普勒超声在显示活动性强直性脊柱炎骶髂关节血流中的对比研究

Comparison of superb microvascular imaging and power Doppler ultrasound of the sacroiliac blood flow in patients with active ankylosing spondylitis

目的比较微血流成像(SMI)技术与能量多普勒超声(PUDS)技术显示活动性强直性脊柱炎(AS)患者骶髂关节滑膜血流的丰富程度及显示率的差异,探讨SMI评估活动性AS患者骶髂关节炎的临床价值。方法分别应用SMI和PDUS两种血流模式检查30例活动性AS患者(病例组)和30例健康志愿者(对照组)左右两侧各60个骶髂关节,比较两组滑膜血流丰富程度及血流显示率的差异。应用Kappa检验分析两种模式诊断结果的一致性;绘制受试者工作特征(ROC)曲线计算两种血流模式的诊断效能。结果 SMI和PUDS对病例组的血流显示率比较差异有统计学意义(96.7%vs.86.7%,P=0.048);病例组与对照组的血流丰富程度在两种血流模式中比较差异均有统计学意义(均P<0.05)。病例组以2～3级多血流为主,而对照组以0～1级少血流为主;对照组中两种血流模式对血流分级的一致性较好(Kappa=0.761,P<0.001),病例组中的一致性一般(Kappa=0.686,P<0.001)。SMI和PDUS诊断活动性AS患者骶髂关节炎的ROC曲线下面积分别为0.783、0.775,两者比较差异无统计学意义。结论应用SMI和PDUS观测血流丰富程度均可作为诊断AS患者骶髂关节炎及评估其活动性的重要参考依据,两者诊断效能相当,但SMI能够提高骶髂关节滑膜血流的显示率,上调血流级别,血流显示更加清晰,有助于更好地评估AS患者骶髂关节炎的活动性。

Objective To compare the difference of the display rate and richness of synovial blood flow in the sacroiliac joint(SIJ) in patients with active ankylosing spondylitis(AS) by superb microvascular imaging(SMI)and power Doppler ultrasound(PDUS),and to explore the clinical value of SMI in evaluating SIJ inflammation in patients with active AS. Methods Two blood flow patterns of SMI and PDUS were used to examine 60 sacroiliac joints on both sides of 30 healthy volunteers(the control group)and 30 AS patients(the patient group)respectively in this study,the differences of the display rate of blood flow and richness of synovial blood flow were compared between the two groups.The consistency of diagnostic results of the two models was tested by Kappa. The diagnostic efficiency of the two methods was calculated by ROC curve. Results The difference of blood flow display rate in by SMI and PDUS was only statistically significant in AS patients(96.7% vs. 86.7%,P=0.048). There were significant differences in the blood flow richness of sacroiliac joint between the AS patients and healthy volunteers by SMI and PDUS(all P<0.05). Grade 2~3 blood flow was mainly observed in the patient group,while grade 0~1 blood flow was mainly observed in the control group.The consistency of blood flow classification under the two blood flow patterns was better in the control group than patient group(Kappa=0.761,0.686,both P<0.001). The area under the ROC curve of SMI and PDUS in the diagnosis of sacroiliitis in AS patients were 0.783 and 0.775,respectively.Conclusion The blood flow richness of SMI and PDUS can provide important reference for the diagnosis of sacroiliitis in AS patients and evaluation of their activity. The diagnostic efficacy of SMI and PDUS in the evaluation of sacroiliitis in AS patients is basically the display rate and elevate the classification of sacroiliac joint synovial blood flow,the blood flow display is clearer compared with PDUS. SMI has an advantage in evaluating the activity of sacroiliitis in AS patients.