骶髂关节病变病理学与影像学诊断的相关性  

Relationship between Pathological Features and Image Changes of Sacroiliitis

作　　者：崔阳[1] 张晓[1] 赵振军[2] 刘艳辉[3] 郑锦萍[1] 

机构地区：[1]广东省人民医院风湿科,广州510030 [2]广东省人民医院影像中心,广州510030 [3]广东省人民医院病理医学部,广州510030

出　　处：《中华临床免疫和变态反应杂志》2014年第4期283-288,I0004,共7页Chinese Journal of Allergy & Clinical Immunology

摘　　要：目的通过了解骶髂关节炎病理特点,并以病理结果为标准,探讨病理表现与放射性核素单光子发射计算机断层成像术(single-photon emission computed tomography,SPECT)、磁共振显像(magnetic resonance imaging,MRI)、计算机断层扫描(computed tomography,CT)、X线等影像学检查的关系。方法对中轴型脊柱关节炎患者进行CT引导下骶髂关节(sacroiliac joint,SIJ)穿刺,所得组织进行病理检查,并同时行SIJ的SPECT、MRI、CT和X线检查,按组织病理结果分为SIJ炎组和无炎性反应组。结果 36例患者获得组织有软骨、软骨下骨板、关节滑膜、骨髓、肌腱或韧带附着点等。获得率以软骨为最高,继以软骨下骨板、关节滑膜、骨髓和韧带附着点,各占92%、83%、75%、72%、22%;其中28例(2836,78%)患者SIJ炎病理变化包括软骨(93%)和软骨下骨板改变(75%)、滑膜炎(64%)、骨髓炎(46%)、附着点炎(32%),8例(22%)未发现有SIJ炎改变。MRI示29例(81%)患者共56个SIJ可见不同程度的异常信号改变,软骨线改变、软骨下骨板改变、骨髓水肿、脂肪沉积、骨质硬化分别为82%、71%、65%、59%、76%;SPECT示29例(81%)共52个SIJ可见骶髂关节感兴趣区的放射性比值有不同程度的升高,23例(64%)CT阳性,19例(53%)X线阳性。以病理结果为标准,SPECT、MRI、CT、X线的阳性预测值分别为89.6%、93.1%、95.6%、94.7%,敏感性分别为92.8%、96.4%、73.3%、64.2%,特异性分别62.5%、75.0%、87.5%、87.5%。4种诊断方法的受试者工作特征曲线下面积分别为0.79、0.84、0.83、0.76。结论病理检查是诊断Sl J炎和活动性炎性反应的主要方法。MRI和SPECT的相互补充,能提高骶髂关节活动性炎症的敏感性和特异性。MRI和SPECT的诊断价值与CT和X线相当,并可通过对炎症的活动度进行量化,有利于随访和疗效的评价,是诊断SIJ炎重要的辅助手段。Objective By observing the pathological features of sacroiliitis through the CT-guided needle biopsy in sacroiliac joint,the relationship between pathology and image including single-photon emission computed tomography（SPECT）,magnetic resonance imaging（MRI）,computed tomography（CT） and X ray were analyzed.Methods Thirty-six patients with spondyloarthritis were performed CT-guided biopsy of the sacroiliac joint （SIJ）.Pathological features of sacroiliitis were observed with light microscope.Image changes of sacroiliitis were shown by the technique of SPECT、MRI、CT and X ray.Results Cartilage,subchondral bony plate,synovium,bone marrow,tendon and enthesis were taken from 36 sacroiliac joints.The cartilage had the highest frequency,followed by subchondral bony plate,synovium,bone marrow and enthesis：92％,83％,75％,72％,22％ respectively.The pathological features of 28 patients（28/36,78％） with SIJ biopsies were shown：cartilage （93％） and subchondral bone plate change （75％）,synovitis （64％）,osteomyelitis （46％）,enthesitis （32％） and 8 cases （22％） did not find any changes of sacroiliitis.Varying degrees of abnormal signal changes could be seen from 56 SIJ of 29 patients（81％,29/36）,such as 82％ of cartilage degeneration,71％ of subchondral bony plate destruction,65％ of bone marrow edema,59％ of fat deposition and 76％ of osteosclerosis; 29 cases（81％,29/36） showed different increases of SIJ ROI radioactivity ratio,and 23 cases （64％） showed positive sacroiliitis changes in CT examination,while 19 cases （53％） were found to be sacroiliitis in X ray.Defining sacroiliitis by pathological findings,we had positive predictive values of SPECT,MRI,CT and X ray were 89.6％,93.1％,95.6％,94.7％,and their sensitivities were 92.8％,96.4％,73.3％,64.2％,the specificities were 62.5％,75.0％,87.5％,87.5％ respectively.The area under the receiver operating characteristic curve of these four diagnostic methods were 0.79,0.84,0.83,0.76

关 键 词：骶髂关节炎 病理学 影像学 

分 类 号：R593.2[医药卫生—内科学] R445[医药卫生—临床医学]