MR扩散加权像诊断骶髂关节早期急性炎性病变的价值  

Application of MR diffusion weighted imaging in the detection of early acute sacroilliitis

作　　者：黄振国[1] 张雪哲[1] 王国春[2] 章璐[2] 徐妍妍[1] 王武[1] 

机构地区：[1]中日友好医院放射科,北京100029 [2]中日友好医院风湿免疫科,北京100029

出　　处：《中华放射学杂志》2014年第9期750-753,共4页Chinese Journal of Radiology

摘　　要：目的 探讨MR DWI在检测脊柱关节病患者骶髂关节面下早期急性炎性病变中的价值.方法 回顾性分析临床诊断为炎性背痛、行骶髂关节X线和（或）CT检查未发现异常、扫描序列包含DWI的59例患者骶髂关节MR资料.59例均行双侧骶髂关节短时反转恢复（STIR）、DWI序列MR平扫,28例同时行增强脂肪抑制T1WI （FST1WI）序列扫描.7例患者生物制剂治疗2～6个月后行MRI平扫复查.STIR和（或）增强FST1W序列见关节面下异常高信号定义为存在急性炎症,并依此将患者分为炎症组和非炎症组.采用x2检验比较同时行STIR、增强后FST1WI及DWI序列检查的患者中,3个序列对关节面下急性炎性病变的检出率差异.应用t检验比较炎症组病变区、病变外区与非炎症组骶髂关节面下骨髓ADC值的差异,及治疗前、后病变区ADC值的差异.结果 非炎症组患者21例,炎症组38例中72侧骶髂关节关节面下有急性炎症.DWI序列图像上,35例（67侧骶髂关节）关节面下急性炎症区呈明显异常高信号.在同时行STIR、增强后FST1WI和DWI的28例患者中,20例（38侧骶髂关节）存在关节面下急性炎症.STIR、增强后FST1WI和DWI分别检出37、38和36侧关节面下急性炎症,差异无统计学意义（x2=0.16,P=0.923）.炎症组38例（72侧骶髂关节炎）,病变区和病变外区的ADC值分别为（1.087±0.207）×10-3、（0.537±0.091）×10-3mm2/s,21例非炎症组患者42侧骶髂关节面下骨髓ADC值为（0.487±0.112）×10-3mm2/s.炎症组病变区ADC值高于病变外区及非炎症组,差异均有统计学意义（t值分别为14.971和12.289,P均＜0.01）;炎症组病变外区骨髓ADC值与非炎症组差异无统计学意义（t=1.874,P=0.066）.治疗前、后病变区ADC值分别为（1.018±0.266）×10-3和（0.706±0.164）×10-3mm2/s,差异有统计学意义（t=5.312,P＜0.01）.结论 DWI是显示骶髂关节早期急性炎症病变的敏感方法,通过计算ADC值可对炎性病变�Objective To investigate the value of MR DWI in the detection of early acute sacroiliitis in patients with spondyloarthritis（SpA）.Methods The data of sacroiliac joint MRI were retrospectively analyzed in fifty-nine patients with inflammatory low back pain and negative plain radiographs and/or CT.T1WI,T2WI,short tau inversion recovery （STIR） and DWI images were obtained in all cases.Contrast-enhanced T1WI with fat suppression （FST1WI） images were obtained in 28 patients and follow-up MRI examinations were performed during treatment in 7 cases.Acute inflammatory lesion was defined as hyperintense signal located in subchondral or periarticular regions on STIR images and or on enhanced FST1WI.Cases were divided into acute inflammation group and non-inflammation group.Comparison was performed among STIR,enhanced FST1WI and DWI in the detection of acute inflammation by using Chi-square test.Mean ADC value was obtained from normal and inflammatory areas in acute inflammation group and from subchondral bone marrow in non-inflammation group,and t test was used for comparison of ADC values.Results Acute inflammation existed in 38 cases （72 sacroiliac joints） and acute inflammatory lesions displayed as high signal on DWI in 35 cases （67 sacroiliac joints）.STIR,enhanced FST1WI and DWI showed no significant difference in the detection of acute sacroilliitis （37/38,38/38,36/38,respectively;x2=0.16,P=0.923）.ADC values measured from acute inflammatory areas were significantly higher than values measured from normal area in acute inflammation group [（1.087± 0.207）× 10-3 and （0.537±0.091） × 10-3mm2/s],and values measured from subchondral bone marrow in non-inflammation group [（0.487±0.112） × 10-3mm2/s],there were significant difference （t values were 14.971 and 12.289,P＜0.01）.ADC values were similar between normal area in acute inflammation group and subchondral bone marrow in non inflammation group （t=1.874,P=0.066）.ADC values were （1.018±0.266） × 10-3 and （0.706±0.164�

关 键 词：脊柱疾病 炎症 磁共振成像 诊断 

分 类 号：R684.3[医药卫生—骨科学] R445.2[医药卫生—外科学]