动态增强MRI在评价强直性脊柱炎病情严重程度中的临床价值

Clinical value of dynamic contrast-enhanced MRI in the evaluation of the severity of ankylosing spondylitis

目的分析动态增强MRI在评价强直性脊柱炎病情严重程度中的临床价值。方法选取2019年1月至2020年10月收治的45例强直性脊柱炎患者,按病情活动性分为两组,活动组24例(病情活动)及稳定组21例(病情稳定),对其骶髂关节进行MRI动态增强扫描,分析两组间诊断差异(敏感度、特异度、准确度),比较血管至细胞、血管外间隙的渗透率(K^(trans)值)、细胞外间隙/血管内容比(Kep)、细胞外间隙容积(Ve),比较患者C反应蛋白(CRP)、红细胞沉降率,疾病活动指数(BASDAI)评分。结果动态增强MRI诊断疾病严重程度的敏感度、特异度及准确度分别为95.65%、90.91%、93.33%。活动组K^(trans)值为(1.85±0.24)mL/min,高于稳定组的(1.02±0.10)mL/min,两组比较差异有统计学意义(P<0.05),活动组Kep和Ve值高于稳定组,差异有统计学意义(P<0.05),Ktrans、Kep和Ve值与病理评分呈正相关性(r=0.801,0.751,0.634,P=0.012,0.014,0.024)。活动组CRP、红细胞沉降率及BASDAI评分均高于稳定组,差异有统计学意义(P<0.05)。结论强直性脊柱炎经动态增强MRI诊断,能够有效区分疾病的稳定期、活动期,临床价值高。

Objective To analyze the clinical value of dynamic contrast-enhanced MRI in the evaluation of the severity of ankylosing spondylitis.Methods A total of 45 patients with ankylosing spondylitis admitted and treated from January 2019 to October 2020 were selected,and they were divided into the active group(n=24,with active condition)and the stable group(n=21,with stable condition)according to disease activity.The sacroiliac joint was scanned with dynamic contrast-enhanced MRI,and the diagnostic differences(sensitivity,specificity and accuracy)between the two groups were analyzed.The permeability from blood vessel to cell and extravascular space(K^(trans) value),extracellular space/vascular content ratio(Kep)and extracellular space volume(Ve)were compared.The C reactive protein(CRP),erythrocyte sedimentation rate and Bath as disease activity index(BASDAI)scores were compared.Results The sensitivity,specificity and accuracy of dynamic contrast-enhanced MRI in the diagnosis of disease severity were 95.65%,90.91%and 93.33%,respectively.K^(trans) value in the active group was(1.85±0.24)mL/min,which was higher than(1.02±0.10)mL/min in the stable group,with statistically significant difference(P<0.05).The values of Kep and Ve in the active group were higher than those in the stable group,with statistically significant differences(P<0.05).The values of K^(trans),Kep and Ve were positively correlated with pathological score(r=0.801,0.751,0.634,P=0.012,0.014,0.024).The CRP,erythrocyte sedimentation rate and BASDAI score in the active group were all higher than those in the stable group,with statistically significant differences(P<0.05).Conclusion The diagnosis of ankylosing spondylitis by dynamic contrast-enhanced MRI can effectively distinguish the stable and active stages of the disease and has high clinical value.