全身MRI检查在强直性脊柱炎活动性炎症中的评估价值  

The value of whole-body magnetic resonance imaging in the evaluation of active inflammation in ankylosing spondylitis

作　　者：程艺璇 徐磊[2] 王梦悦 谈文峰[3] 徐凌霄[3] 祁良[2] CHENG Yi-xuan;XU Lei;WANG Meng-yue(Department of Imagingand Nuclear,Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学医学影像与核医学系,江苏南京210029 [2]南京医科大学第一附属医院放射科,江苏南京210029 [3]南京医科大学第一附属医院风湿免疫科,江苏南京210029

出　　处：《放射学实践》2023年第12期1587-1592,共6页Radiologic Practice

摘　　要：目的:探讨全身MRI在强直性脊柱炎(AS)活动性炎症中的评估价值。方法:对96例经临床确诊的AS患者进行全身MRI扫描,评估活动性炎症累及的部位(主要包括骶髂关节、脊柱及肩关节、髋关节等外周大关节,共计23个部位),并采用加拿大脊柱关节炎研究协会(SPARCC)评分方法对脊柱和骶髂关节炎症进行评分。采用卡方检验或Fisher精确检验(频数小于5时)比较短病程(病程<5年)组(41例)和长病程(病程≥5年)组(55例)之间各部位活动性炎症的受累率,采用t检验比较两组患者SPARCC评分的差异。采用单因素分析确定两组之间活动性炎症发生率具有差异的部位后,采用二元logistic回归分析筛选出与长病程显著相关的受累部位。结果:短病程组中活动性骶髂关节炎的发生率明显高于长病程组(44/82 vs. 37/110,P<0.05);椎角炎、椎小关节炎、肋横突关节炎、股骨大转子附着点炎、棘突附着点炎、胸肋关节炎、耻骨联合炎、髂后上棘及耻骨下支附着点炎在长病程组中的发生率均高于短病程组(P<0.05)。短病程组的骶髂关节SPARCC评分明显高于长病程组(11.220±12.817 vs. 3.854±7.327,P<0.05),脊柱SPARCC评分明显低于长病程组(7.584±7.635 vs. 16.098±13.225,P<0.05)。二元logistic回归分析结果显示骶髂关节炎(OR=0.322,P=0.002)、耻骨联合炎(OR=5.045,P=0.025)和脊柱SPARCC评分(OR=1.102,P=0.002)与长病程具有显著相关性。结论:全身磁共振成像可以全面评估强直性脊柱炎患者活动性炎症的分布情况。病程早期骶髂关节活动性炎症较明显,而慢性期更易出现脊柱、其它周围关节及肌腱附着点的活动性炎症。Objective:To explore the value of whole-body MRI(WB-MRI)in the assessment of active inflammation in ankylosing spondylitis.Methods:WB-MRI was performed in 96 clinically confirmed patients with ankylosing spondylitis(AS),the joints involved among 23 joints(including sac-roiliac joint,spinal joints and shoulder,hip or other peripheral major joints)was assessed,and inflammation of spine and sacroiliac joint was evaluated according to the SPARCC(spondyloarthritis research consortium Canada)score.The chi-square test was used to compare the incidence of inflammation in various parts between the short course(disease course<5 years)group(41 cases)and the long course(disease course≥5 years)group(55 cases).When the frequency was less than 5,Fisher's exact test was used.t-test was used to compare the differences in SPARCC scores between the two groups.After using single factor analysis to find out the joints with statistical difference in incidence of active inflammation between the two groups,binary logistic regression analysis was used to select out the joints with significant correlation with long disease course of AS.Results:The incidence of active sacroiliac arthritis in the short course group was significantly higher than that in the long course group(44/82 vs.37/110,P<0.05).The incidence rate of vertebral angle arthritis,vertebral facet arthritis,costotransverse arthritis,femoral trochanteric attachment point inflammation,spinous attachment point inflammation,thoracocostal arthritis,pubic symphysis inflammation,posterior superior iliac spine and inferior public ramus attachment point inflammation in the short course group was higher than that in the long course group(P<0.05).There were significant differences in the SPARCC scores of sacroiliac joint and spinal between the two groups of patients.Patients in the short course group in ankylosing spondylitis had significantly higher SPARCC scores of sacroiliac joint than patients in the long course group(11.220±12.817 vs.3.854±7.327,P<0.05),and patients in the long c

关 键 词：强直性脊柱炎 全身磁共振成像 脊柱关节病 骶髂关节炎 

分 类 号：R445.4[医药卫生—影像医学与核医学] R681.5[医药卫生—诊断学]