扩散加权成像与对比增强MRI评估强直性脊柱炎活动性的对比研究  

Comparative study between diffusion weighted imaging and contrast-enhanced MRI in assessment of the activity of ankylosing spondylitis

作　　者：赵英华[1] 孙尔维[2] 韩新爱[2] 赵银霞[3] 石星亮[2] 胡绍勇[1] 赵祥成[3] 梅颖洁 李绍林[1] 

机构地区：[1]南方医科大学第三附属医院医学影像科,广州510630 [2]南方医科大学第三附属医院风湿免疫科,广州510630 [3]南方医科大学第三附属医院介入科,广州510630 [4]飞利浦医疗保健事业部

出　　处：《中华放射学杂志》2015年第9期665-669,共5页Chinese Journal of Radiology

基　　金：广州市医药卫生科技项目（20121A011181）;南方医科大学第三附属医院科技项目院长基金（B2011011）

摘　　要：目的比较DWI与对比增强MRI（CE—MRI）评估强直性脊柱炎（AS）骶髂关节炎活动性的价值。方法前瞻性收集符合修订的AS纽约标准的96例连续患者作为AS患者组，21名健康志愿者作为对照组。根据AS病情活动指数调查表评分、红细胞沉降率和C反应蛋白结果判断AS患者的活动性，将AS患者分为活动期组（60例）和稳定期组（36例）。所有受试者均行双侧骶髂关节常规扫描、DWI和CE-MRI检查。观察患者的影像表现，并测量病灶ADC值和信号强度增强率（△SI）。采用单向方差分析比较活动期AS患者、稳定期AS患者和对照组间ASI和ADC值的差异，以AS病情活动指数调查表评分、实验室检查结果的综合标准为金标准，采用ROC分析ASI和ADC值判断AS活动性的效能，并采用配对t检验比较ASI、ADC值ROC下面积。结果96例AS患者中，MRI显示骶髂关节炎骨髓水肿62例（活动期57例、稳定期5例），骶髂关节表面侵蚀11例（活动期4例、稳定期7例），骶髂关节骨质硬化15例（活动期6例、稳定期9例），骶髂关节脂肪沉积58例（活动期27例、稳定期31例）。AS活动期、AS稳定期和对照组间的ASI分别为（2．51±1．69）％、（1．19±0．67）％、（0．75±0．21）％，ADC值分别为（1．33±0．33）×10^-3、（1．00±0．43）×10^-3、（0．38±0．13）×10^-3mm^2／s，差异均有统计学意义（F值分别为18．375、16．366，P均〈0．01），且ASI和ADC值两两比较的差异也均有统计学意义（P均〈0．05）。ASI与ADC鉴别AS患者活动性的ROC下面积分别为0．814和0．730，差异无统计学意义（t=1．632，P=0．103）。以ASI=I．44％鉴别AS患者活动性的敏感度和特异度分别为81．67％及80．00％；以ADC值=1．15×10^-3／mm^2鉴别AS患者活动性的敏感度和特异度分别为76．67％及71．43％。结论DWI与CE．MRI检测AS活动性的价值相似。Objective To compare the value of assessment with DWI and contrast-enhanced MRI （CE-MRI） in activity of sacroiliitis of patients with ankylosing spondylitis（AS）.Methods Ninety-six patients conforming to modified New York criteria were prospectively collectedas the AS group, and twenty-one healthy volunteers were enrolled into the control group. According to the Bath AS disease activity index （BASDAI）, erythrocyte sedimentation rate and C-reaction protein, AS patients were divided into the active AS group （n=60） and the chronic AS group （n=36） . All subjects were performed with conventional MRI, DWI and CE-MRI of bilateral sacroiliac joints. The MRI manifestations were reviewed and the ADC values and signal intensity enhancement rate （ASI） were measured.ANOVA was performed for the comparison of ASI and ADC values among active AS group, chronic AS group and control group with BASDAI and lab test results as the gold standards. ROC was analyzed with ASI and ADC values for activity of AS and paired samples t test was obtained to comparethe areas under the ROC of ASI and ADC values.Results Among 96 cases of AS patients, MRI of sacroiliac jointsshowed that 62 cases had subchondral bone edema （57 cases of active group, 5 cases of chronic group）, that 11 cases had bone surface erosion（4 cases of active group, 7 cases of chronic group）, that 15 cases had bone sclerosis（6 cases of active group, 9 cases of chronic group） and that 58 cases had fat deposition on the sacroiliac joints （27 cases of active group, 31 cases of chronic group）. The ASI values of the active group, the chronic group and control group were respectively （2.51 ± 1.69） %, （ 1.19±0.67）% and （0.75±0.21）%, and the ADCvalues were （1.33±0.33） × 10^-3, （1.00±0.43） × 10^-3 and （0.38±0.13） × 10^-3mm^2/s. There were significant differences for △SI and ADC values among three groups （F=18.375, 16.366. P〈 0.01）, and statistical significance of △SI and ADC values were found between every

关 键 词：强直性脊柱炎 磁共振成像 对比研究 

分 类 号：R593.23[医药卫生—内科学] R445.2[医药卫生—临床医学]