低剂量斜冠状位骶髂关节CT检查诊断强直性脊柱炎的研究初探  

A preliminary exploration of low-dose semicoronal CT of the sacroiliac joints in the diagnosis of ankylosing spondylitis

作　　者：高岱[1] 李坤鹏[1] 文琼芳 朱剑[1] 张江林[1] 黄烽[1] 

机构地区：[1]解放军总医院风湿科,北京100853

出　　处：《中华内科杂志》2016年第5期355-360,共6页Chinese Journal of Internal Medicine

基　　金：国家科技部＂十二五＂支撑计划（2014BAI07B05）;国家重点基础研究发展计划（973计划）（2014CB541806）

摘　　要：目的 初步研究低剂量斜冠状位骶髂关节CT检查在强直性脊柱炎（AS）患者诊断中的潜在临床应用价值.方法 选2年内接受过骶髂关节CT检查的确诊AS患者,采集临床资料,为减少辐射剂量,采用低剂量斜冠状位骶髂关节CT检查,并与既往常规轴位骶髂关节CT检查的辐射有效剂量、图像质量比较,分析两种CT影像与1984年修订的AS纽约分类标准骶髂关节炎X线分级标准、Lee等制订的骶髂关节炎螺旋CT分级标准、因斯布鲁克骶髂关节炎高分辨率CT分级标准分级的一致性.结果 33例AS患者,低剂量斜冠状位骶髂关节CT的平均辐射有效剂量为3.37 mSv,与既往常规轴位骶髂关节CT（6.56 mSv）相比降低49％.33例AS患者低剂量斜冠状位骶髂关节CT图像质量评分为（3.24±0.87）分,32例合格,26例良好及优秀.18例BMI＜ 25 kg/m2者,图像质量评分均≥3分;15例BMI ≥25 kg/m2者平均图像质量评分为3.7分,7例图像质量评分小于3分;BMI＜25 kg/m2者与BMI≥25 kg/m2者图像质量评分差异有统计学意义（P =0.000）.对33例AS患者66个骶髂关节进行低剂量斜冠状位骶髂关节CT与既往常规轴位骶髂关节CT影像分级的一致性分析,采用1984年修订的AS纽约分类标准骶髂关节炎X线分级标准分级完全一致;采用Lee等制订的骶髂关节炎螺旋CT分级标准分级一致性高（k=0.897,P=0.000）,差异无统计学意义（P=0.564）;采用因斯布鲁克骶髂关节炎高分辨率CT分级标准分级一致性高（k=0.814,P=0.000）,差异无统计学意义（P =0.852）.图像质量与体重、BMI呈负相关（r=-0.746,P=0.000;r=-0.784,P=0.000）.因斯布鲁克骶髂关节炎高分辨率CT分级与Bath强直性脊柱炎测量指数呈正相关（r=0.578,P=0.007）,与病程、患者疾病总体评价、Bath强直性脊柱炎病情活动指数、Bath强直性脊柱炎功能指数无明显相关性（P值均＞0.05）.结论 低剂量斜冠状位骶髂关节CT在显著降低辐射剂量的Objective To evaluate the clinical value of low-dose semicoronal computerized tomography （CT） of sacroiliac joints （SIJ） in the early diagnosis of ankylosing spondylitis （AS）.Methods Patients who were diagnosed with AS and had received axial CT examination of SIJs over the past 2 years were recruited.All of them simultaneously underwent a low-dose semicoronal CT of SIJs.The clinical data were recorded.Radiation dose was compared between low-dose CT and the previous conventional axial CT.Image quality of low-dose CT was assessed and correlation between image quality and weight or body mass index （BMI） was analyzed.CT images of the two groups were graded by modified New York criteria, the Lee criteria and the Innsbruck criteria.The kappa coefficient was used to assess the consistency of grading between the two groups.Results Thirty-three patients were enrolled in this study.The effective dose （ED） of semicoronal SIJ CT was 3.37 mSv which was 49％ lower than conventional axial CT （6.56 mSv）.Lower dose had the potential protection of gonads.The quality of images in male patients with BMI ＜ 25 kg/m2 and all female patients were good or excellent.There was a significant negative correlation between image quality and BMI （r =-0.746, P =0.000;r =-0.784, P =0.000;respectively）.All patients were diagnosed as sacroiliitis by modified New York criteria and the grading of two groups was consistent.The consistency of grading between two groups was satisfactory no matter which classification criteria was used.（k =0.897 with Lee criteria;k =0.814 with Innsbruck criteria;P ＞ 0.05）.Conclusions The radiation dose of semicoronal SIJ CT is significantly lower than that of the conventional axial CT with comparable efficacy of diagnosis.

关 键 词：脊柱炎 强直性 骶髂关节 体层摄影术 X线计算机 辐射剂量 斜冠状位 

分 类 号：R816.8[医药卫生—放射医学] R593.23[医药卫生—临床医学]