DCE-MRI及DWI评估强直性脊柱炎骶髂关节炎的价值观察

Value of DCE-MRI and DWI in evaluating ankylosing spondylitis sacroiliitis

目的探究动态增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)及扩散加权成像(diffusion-weighted imaging,DWI)评估强直性脊柱炎(nkylosing spondylitis,AS)骶髂关节炎的临床价值。方法选取2019年9月至2021年7月台州市温岭中医院收治的113例AS骶髂关节炎患者为研究对象,根据Bath强直性脊柱炎疾病活动指数(Bath ankylosing spondylitis disease activity index,BASFI)将其分为稳定期组(n=63)及活动期组(n=50),分析其DCE-MRI、DWI检查结果。比较两组表观扩散系数(apparent diffusion coefficient,ADC)、增强因子(enhancement factor,Fenh)、增强斜率(enhancement slope,Senh)及骨髓水肿SPARCC评分;分析患者骨髓水肿SPARCC评分与ADC、Fenh、Senh值的相关性;采用受试者操作特征(receiver operator characteristic,ROC)曲线分析ADC、Fenh、Senh值联合诊断对稳定期、活动期AS骶髂关节炎的鉴别价值,并比较各诊断指标及联合诊断对稳定期、活动期AS骶髂关节炎的鉴别效能。结果活动期组ADC、Fenh、Senh值及SPARCC评分大于稳定期组,差异有统计学意义(P<0.05);患者SPARCC评分与ADC、Fenh、Senh值呈正相关(P<0.05);联合诊断鉴别稳定期、活动期AS骶髂关节炎的曲线下面积(area under the curve,AUC)高于ADC、Fenh、Senh值单独诊断,差异有统计学意义(P<0.05);联合诊断鉴别稳定期、活动期AS骶髂关节炎的敏感度高于ADC,特异度高于Fenh、Senh,差异有统计学意义(P<0.05)。结论DCE-MRI及DWI联合诊断对稳定期、活动期AS骶髂关节炎具有较高的鉴别价值,且敏感度、特异性较高。

Objective To explore the clinical value of dynamic contrast enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)in evaluating ankylosing spondylitis(AS)sacroiliitis.Methods A total of 113 patients with AS sacroiliitis who were treated in Wenling Hospital of Traditional Chinese Medicine from September 2019 to July 2021 were enrolled as the research objects.According to Bath ankylosing spondylitis disease activity index(BASFI),they were divided into the stable phase group(n=63)and the active phase group(n=50).The examination results of DCE-MRI and DWI were analyzed.The apparent diffusion coefficient(ADC),enhancement factor(Fenh),enhancement slope(Senh)and score of bone marrow edema SPARCC were compared between the two groups.The correlation between score of bone marrow edema SPARCC and ADC,Fenh,Senh was analyzed.The differential diagnosis value of ADC combined with Fenh and Senh in stable and active AS sacroiliitis was analyzed by receiver operator characteristic(ROC)curve.The differential efficiency of each index and their combination for stable and active AS sacroiliitis was compared.Results ADC,Fenh,Senh and SPARCC score in active phase group were greater than those in stable phase group(P<0.05).SPARCC score was positively correlated with ADC,Fenh and Senh(P<0.05).Area under the curve(AUC)of ADC combined with Fenh and Senh for differential diagnosis of stable and active AS sacroiliitis was higher than that of ADC,Fenh and Senh alone(P<0.05).The sensitivity of combined diagnosis was higher than that of ADC,and the specificity was higher than that of Fenh and Senh alone(P<0.05).Conclusion DCE-MRI combined with DWI is of high differential diagnosis value in stable and active AS sacroiliitis,with high sensitivity and specificity.