摘要
目的总结强直性脊柱炎(AS)中轴骨病变的影像特征,分析AS病人脊柱骨折的损伤特点及影像表现,提高对该病的认识。方法回顾性分析88例经临床确诊的AS病人的X线、CT、MRI影像资料,观察病人骶髂关节病变、脊柱病变及合并脊柱骨折的影像征象,记录病变累及部位及数目。计算X线与CT影像对不同分级的骶髂关节病变的检出率,以及CT与MRI对骶髂关节病变的骨侵蚀、骨硬化、关节间隙变化的检出率。采用χ^(2)检验比较检出率的差异。结果88例病人中有87例(98.86%)骶髂关节受累。X线及CT表现为双侧骶髂关节面毛糙、侵蚀破坏,边缘硬化,骶髂关节间隙增宽或变窄,骶髂关节部分融合或完全骨性强直。27例病人行骶髂关节MRI检查,多数病人可见骨质侵蚀、骨髓水肿、脂肪沉积、骨质硬化,少数可见关节间隙滑膜炎、骶髂关节囊炎、附着点炎、骶髂关节强直伴间隙消失。X线对Ⅰ级病变的检出率高于CT,对Ⅱ级病变的检出率低于CT(均P<0.05)。CT对关节面下骨硬化的检出率高于MRI(P<0.05)。65例(73.86%)有脊柱受累,其中脊柱强直38例。24例病人存在脊柱椎角炎(Romanus病灶),病变以胸腰段及腰椎多见;15例病人有椎间盘炎(Andersson病变),主要累及中下胸椎及腰椎。24例(27.27%)病人合并脊柱骨折,14例合并急性骨折,以下颈椎最多见(C5-7,8例);10例为陈旧骨折,均位于胸腰椎(以T11-12多见,3例)。结论AS病人中轴骨病变影像表现具有一定特征性,其脊柱骨折常累及脊柱三柱,容易合并脊髓损伤及假关节形成,需要特别重视。
Objective To summarize the imaging features of axial bone lesions in ankylosing spondylitis(AS),analyze the injury characteristics and imaging manifestations of spinal fractures in patients with AS,and improve the understanding of the disease.Methods A retrospective analysis was conducted on the X-ray,CT,and MRI imaging data of 88 clinically diagnosed AS patients.Sacroiliac joint lesions,spinal lesions,and associated spinal fractures were observed,and the affected locations and number of lesions were recorded.The detection rates of different grades of sacroiliac joint lesions were compared between X-ray and CT imaging,and the detection rates of bone erosion,sclerosis,and joint space changes between CT and MRI were calculated.The χ^(2) test was used to compare differences in detection rates.Results Of the 88 patients,87(98.86%)had sacroiliac joint involvement.X-ray and CT images showed bilateral sacroiliac joint surface roughness,erosive destruction,marginal sclerosis,joint space widening or narrowing,and partial fusion or complete bony ankylosis of the sacroiliac joints.MRI of the sacroiliac joint was performed on 27 patients,and most showed bone erosion,bone marrow edema,fat deposition,and sclerosis.A few cases exhibited synovitis of the joint space,sacroiliac bursitis,enthesitis,or sacroiliac joint ankylosis with disappearance of the joint space.X-ray detection rates for gradeⅠlesions were higher than CT,but lower for gradeⅡlesions(both P<0.05).CT had a higher detection rate for subchondral sclerosis compared to MRI(P<0.05).Sixty-five patients(73.86%)had spinal involvement,including 38 cases of spinal ankylosis.Twenty-four patients had spondylitis at vertebral corners(Romanus lesions),predominantly in the thoracolumbar and lumbar regions.Fifteen patients had intervertebral discitis(Andersson lesions),mainly affecting the mid-lower thoracic and lumbar vertebrae.Spinal fractures were observed in 24 patients(27.27%),14 had acute fractures,most commonly in the lower cervical spine(C5-7,8 cases),while 10 had old fractures,all located in the thoracolumbar spine(most frequently T11-12,3 cases).Conclusion The imaging manifestations of axial bone lesions in AS have certain characteristics.Spinal fractures in AS patients often involve the three columns of the spine and are prone to spinal cord injury and pseudarthrosis,which requires special attention.
作者
于静红
孙瑞芬
翟伟星
焦洋
YU Jinghong;SUN Ruifen;ZHAI Weixing;JIAO Yang(Department of Radiology,The Second Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010020,China.)
出处
《国际医学放射学杂志》
2024年第5期519-526,共8页
International Journal of Medical Radiology
基金
国家自然科学基金地区项目(82360339)
内蒙古自然科学基金项目(2021MS08084)
内蒙古科技计划项目(2021GG0192)
内蒙古医科大学学科建设项目(YKD2023XK006)。