CT和MRI诊断早期强直性脊柱炎骶髂关节病变的影像特点

Imaging features of CT and MRI diagnosis of sacroiliac joint lesions in early ankylosing spondylitis

目的观察CT和MRI诊断早期强直性脊柱炎(AS)骶髂关节病变的影像特点。方法选取2018年11月~2019年11月本院收治的60例早期AS骶髂关节病变患者为研究对象,其中男36例,女24例,年龄20~60岁(37.28±6.33岁),病程4月~10年(4.80±1.17年)。所有患者均经CT和MRI检查,比较两种检测方法影像学特点和敏感性。结果MRI检查Ⅰ级AS骶髂关节病变敏感性高于CT检查(P<0.05);CT、MRI检查0级、Ⅱ级、Ⅲ级及Ⅳ级AS骶髂关节病变敏感性比较差异无统计学意义(P>0.05);MRI检查关节面骨质囊变、关节面侵蚀的检出率高于CT(P<0.05),两组在关节间隙变宽和变窄、关键面下骨质硬化及关节软骨肿胀的检出率比较差异无统计学意义(P>0.05)。CT检查显示,关节面骨质示锯齿状,且见多发小囊变,关节间隙变窄、模糊,受累部位多在关节中下部,MRI检查显示,关节积液呈长T1、T2信号,关节软骨炎性水肿T1呈信号,T2呈高信号;关节软骨破坏T1呈低信号,T2呈高信号,且强度不均匀。结论MRI可清晰显示早期AS骶髂关节病变情况,且异常检出率和早期诊断率均高于CT,适用于早期诊断。

Objective To observe the imaging features of CT and MRI in the diagnosis of sacroiliac joint lesions in early ankylosing spondylitis. Methods From November 2018 to November 2019, 60 patients with early as sacroiliac joint disease in our hospital were selected, including 36 males and 24 females, with the age from 20 to 60 years old(37.28±6.33 years old). The course of disease was from 4 months to 10 years(4.80±1.17 years). All patients were examined by CT and MRI. The imaging characteristics and sensitivity of the two detection methods were compared. Results The sensitivity of level Ⅰ as sacroiliac joint lesions in MRI was higher than that in CT(P<0.05). The difference of the sensitivity of level 0, level Ⅱ, level Ⅲ and level Ⅳ as sacroiliac joint lesions in CT and MRI was not significant(P>0.05). The detection rate of articular surface osteocystic degeneration and articular surface erosion in MRI was higher than that in CT(P<0.05). The two groups had widened and narrowed joint space, osteosclerosis and osteosclerosis under key surfaces. There was no significant difference in the detection rate of articular cartilage swelling(P>0.05). CT examination showed that the articular surface was serrated, with multiple small cysts, narrowed and blurred joint space. The most of the affected parts were in the middle and lower part of the joint. The joint effusion showed long T1 and T2 signals, the arthritic edema T1 showed signals, T2 showed high signals. The destruction of articular soft bone T1 showed low signals, T2 showed high signals, and the intensity was uneven. Conclusion MRI can clearly show the early as sacroiliac joint lesions. The abnormal detection rate and early diagnosis rate are higher than CT.