低剂量CT对于强直性脊柱炎脊柱韧带骨赘的诊断价值  

Diagnostic Value of Low-dose CT for Spinal Ligamentous Osteophytes in Patients with Ankylosing Spondylitis

作　　者：刘舒 程鹏 沈逸 丁泓百 顾未未 朱丽雅 史正宏 孙红梅 朱琦 LIU Shu;CHENG Peng;SHEN Yi;DING Hongbai;GU Weiwei;ZHU Liya;SHI Zhenghong;SUN Hongmei;ZHU Qi(Guanghua Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200052,China;Shanghai University of Traditional Chinese Medicine)

机构地区：[1]上海中医药大学附属光华医院,上海200052 [2]上海中医药大学

出　　处：《中国医学计算机成像杂志》2025年第1期107-112,共6页Chinese Computed Medical Imaging

基　　金：上海市卫生健康委员会科研课题面上项目(202040396);上海市科学技术委员会医学创新研究专项项目(22Y11921900);上海市科学技术委员会科技计划项目(21ZR1454400)。

摘　　要：目的:研究低剂量CT(LDCT)对强直性脊柱炎(AS)脊柱韧带骨赘的诊断价值。方法:选取2020年10月至2021年10月间在上海中医药大学附属光华医院就诊且符合入排标准的48例AS患者为研究对象,均行全脊柱LDCT及颈腰椎的X线检查,并分别进行盲态CT韧带骨赘评分(CTSS)及改良的斯托克强直性脊柱炎脊柱评分(mSASSS)测定。采用组内相关系数(ICC)比较两种评分在不同阅片者间的一致性差异,并分析两种评分所提示的韧带骨赘/骨桥的分布情况及其与病程的相关性。结果:将颈胸腰段作为整体进行分析的结果提示,对于颈腰椎mSASSS及颈胸腰椎CTSS的总体分布情况,在两阅片者间比较,差异均无统计学意义(P>0.05)。但对评价点或椎体单元逐个进行分析后显示:两阅片者对颈椎、胸椎和腰椎CTSS测定的一致性均为极好,ICC值分别为0.998(95%CI 0.997~0.999)、0.998(95%CI 0.996~0.999)及0.997(95%CI 0.995~0.998);而对颈椎和腰椎mSASSS测定的一致性均为很好,分别为0.823(95%CI 0.705~0.897)及0.808(95%CI 0.682~0.888)。两阅片者通过全脊柱LDCT观测到的颈椎、胸椎和腰椎的韧带骨赘/骨桥总数分别为106/144 vs 84/146、492/846 vs 412/856和360/232 vs 313/228,且大部分的韧带骨赘/骨桥均集中在胸椎;而通过X线观测到的颈椎和腰椎的韧带骨赘/骨桥总数较少,分别为61/40 vs 55/36和96/46 vs85/68。通过对LDCT的数据进行分层后发现,AS患者的脊柱韧带骨赘的程度同病程密切相关,病程>5年的患者无论在CTSS水平还是在骨赘数量方面,均高于病程较短者(病程≤5年),差异有统计学意义(P<0.05)。同时,对于病程>5年的患者,LDCT对腰椎骨赘的辨识度比X线片更优(P<0.05)。结论:与X线相比较,通过LDCT可以发现AS患者更多的脊柱韧带骨赘/骨桥(尤其是胸椎的韧带骨赘/骨桥),并且对于病程>5年的患者,LDCT对腰椎骨赘的辨识度可能更优;其CTSS结果在不同阅片者之间的一致性更好,�Purpose:To study the diagnostic value of low-dose computed tomography(LDCT)in the diagnosis of spinal ligamentous osteophytes in ankylosing spondylitis(AS).Methods:Forty-eight AS patients who visited Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from October 2020 to October 2021 were recruited,and they all underwent LDCT of the whole spine and X-ray of the cervical and lumbar spine,with measurement of blinded CT syndesmophyte score(CTSS)and modified Stoke ankylosing spondylitis spine score(mSASSS),respectively.The intragroup correlation coefficient(ICC)was used to compare the difference in consistency between two readers,and the distribution of osseous capillaries/bridges shown by the two scores and their correlation with the course of the disease were also analyzed.Results:Analyzing the cervicothoracolumbar segment as a whole,the results showed that the differences were with no statistical significance between the two readers for the overall distribution of cervicolumbar mSASSS and cervicothoracolumbar CTSS(P>0.05).However,if the evaluation points or vertebral units were analyzed one by one,the agreement between the CTSS of two readers for the cervical,thoracic and lumbar spine were excellent,with ICC values of 0.998(95%CI 0.997-0.999),0.998(95%CI 0.996-0.999)and 0.997(95%CI 0.995-0.998),respectively.In contrast,the consistency of the mSASSS for cervical and lumbar spine was very good,with ICC values of 0.823(95%CI 0.705-0.897)and 0.808(95%CI 0.682-0.888),respectively.The total number of ligamentous osteophytes/bridges in the cervical,thoracic and lumbar spine observed by LDCT in both readers were 106/144 vs 84/146,492/846 vs 412/856 and 360/232 vs 313/228,respectively,and most of the ligamentous osteophytes/bridges were concentrated in the thoracic spine.In contrast,the total number of ligamentous osteophytes/bridges observed in the cervical and lumbar spine by X-ray were less:61/40 vs 55/36 and 96/46 vs 85/68,respectively.After stratifying the data from LDCT,it was found t

关 键 词：强直性脊柱炎 低剂量CT 韧带骨赘 

分 类 号：R445.3[医药卫生—影像医学与核医学]