弥散加权成像联合临床炎性指标诊断早期强直性脊柱炎骶髂关节病变研究

Application of the combination of DWI and clinical inflammatory index in sacroiliac joint lesion of early AS

目的:探讨弥散加权成像(DWI)联合临床炎性指标在早期强直性脊柱炎(AS)骶髂关节病变中的应用。方法:选取医院拟诊为AS的80例患者,根据检查结果将其分为AS组(51例)和非AS组(29例),分别行磁共振成像(MRI)检查,应用加拿大脊柱骨关节研究协会评分系统(SPARCC)和Bath强直性脊柱炎病情活动指数(BASDAI)评分,测量表观弥散系数(ADC)值,探讨其ADC值与SPARCC评分、BASDAI评分的相关性,判断C反应蛋白(CRP)、红细胞沉降率(ESR)、BASDAI和SPARCC评分对AS骶髂关节病变的诊断价值,绘制受试者工作特征(ROC)曲线。结果:AS组患者ESR、CRP水平、ADC值、SPARCC和BASDAI评分均明显高于非AS组患者,差异有统计学意义(t=6.231,t=5.723,t=4.701,t=4.842,t=14.513;P<0.05)。Pearson相关性分析中,AS组患者ADC值与SPRCC评分、ESR、CR及BASDAI评分均呈正相关(r=0.524,r=0.434,r=0.693,r=0.542;P=0.000)。ADC值、SPARCC评分、BASDAI评分、CRP和ESR诊断AS的灵敏度分别为74.5%、76.5%、78.4%、72.6%和70.6%;特异度分别为65.5%、58.6%、62.1%、68.9%和72.4%;ROC曲线下面积(AUC)为0.713、0.700、0.725、0.712和0.710,联合诊断AS的灵感度和特异度分别为84.3%和55.2%,AUC为0.738。结论:DWI联合临床炎性指标、SPRCC评分和BASDAI评分的联合诊断具有较高的临床价值。

Objective:To explore the application of the combination of diffusion-weighted imaging(DWI)and clinical inflammatory indexes in sacroiliac joint lesions of early ankylosing spondylitis(AS).Methods:80 patients who were primarily confirmed as AS were selected and they were divided into AS group(n=51)and non-AS group(n=29)according to the final examination results.They underwent magnetic resonance imaging(MRI),and spondyloarthritis research consortium of Canada(SPARCC)and Bath ankylosing spondylitis functional index(BASDAI)scores were performed.Apparent diffusion coefficient(ADC)values were measured,and the correlations between ADC values,SPARCC scores and BASDAI scores were explored,and the diagnostic values of CRP,ESR,BASDAI scores and SPARCC scores for AS sacroiliac joint lesions were judged.And then,the receiver operating characteristics(ROC)curve were drawn.Results:The erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)value,ADC value,SPARCC score and BASDAI score in AS group were significantly higher than those in non-AS group(t=6.231,t=5.723,t=4.701,t=4.842,t=14.513,P<0.05).Pearson correlation analysis showed that the ADC value of AS group was positively correlated with SPRCC score(r=0.524,P=0.000),ESR(r=0.434,P=0.001),CRP(r=0.693,P=0.000)and BASDAI score(r=0.542,P=0.000).The sensitivities of ADC value,SPARCC score,BASDAI score,CRP and ESR in the diagnosis of AS were 74.5%,76.5%,78.4%,72.6%and 70.6%,respectively.And the specificities of them were 65.5%,58.6%,62.1%,68.9%and 72.4%,respectively.The AUC of ROC curve was 0.713,0.700,0.725,0.712 and 0.710.The sensitivity and the specificity of combined diagnosis of AS were 84.3%and 55.2%,and AUC of that was 0.738.Conclusion:The combined diagnosis of DWI and clinical inflammatory index,SPPCC score and BASDAI score has higher clinical value.