CT检查腰间盘时附带筛查强直性脊柱炎的必要性与方法

强直性脊柱炎（ankylosing spondylitis,AS）是一种主要侵犯骶髂关节、脊柱和髋关节的慢性结缔组织病,受累脊柱有迅速发生屈曲畸形,骨性强直的趋势,致残率高。由于其临床表现不典型,且病情迁延反复,常常引起误诊。骶髂关节炎是诊断AS的一种必不可少的条件。我科从2004年开始对临床诊断为腰间盘病变申请做椎间盘扫描的患者,加做骶髂关节的扫描进行强直性脊柱炎筛查,效果明显,现报告如下。     

强直性脊柱炎的影像诊断研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是以骶髂关节炎及中轴关节病变为特征的慢性炎性脊柱关节病,属于血清阴性脊柱关节病的一个亚型.在我国其患病率在0.3%左右,多发生于青少年男性,男女比例约5:1,有明显的家族性发病倾向.     

强直性脊柱炎合并下颈椎骨折围手术期并发症的观察和预防

强直性脊柱炎（AS）是一种以骨关节及韧带骨化为特征的慢性炎症性疾病。典型的AS以骶髂关节炎为最初表现,病情逐渐向上发展。脊柱各椎间盘及周围韧带逐渐发生连续性骨化,最终导致脊柱融合。由于本病的病理特点。其颈椎骨折的发生率较正常人明显增肓,尤其是下颈椎,据统计AS患者骨折发生率是正常人群的3．5倍。     

214例强直性脊柱炎之骶髂关节与脊柱和髋关节病变的关系以及CT扫描的评估

本文分析214例强直性脊柱炎(AS)的X线表现,其中11例行骶髂关节CT扫描。病变主要累及骶髂关节(100％)、次为脊柱(74.8％)和髋关节(37.9％),其他周围关节炎仅6例,23例有附着病(10.7％)。幼年发病者(JAS)易累及髋关节(75.8％),较少侵犯腰椎(48.5％),等级相关分析和X线动态观察表明:腰椎和髋关节病变与骶髂关节炎同步发展,骶髂关节炎的活动基本上可反映腰椎和髋关节病变的活动。骶髂关节炎CT扫描比平片显示更清晰。     

强直性脊柱炎骶髂关节核素骨显像与病理分析

目的 探讨核素骨显像骶髂关节与骶骨放射性比值测定诊断强直性脊柱炎（AS）的价值。方法 16例AS患者，共31个骶髂关节，CT检查诊断为0、Ⅰ、Ⅱ、Ⅲ、Ⅳ期骶髂关节炎。先行全身骨显像、骶髂关节显像及放射性比值测定，1－3d后行CT引导下骶髂关节穿刺活组织检查。结果 活组织检查示骶髂关节炎关节30个，均有不同程度的滑膜炎、软骨及软骨下骨板血管翳侵入、骨质破坏等病变。核素骶髂关节显像示放射性比值升高关节27个。16例患者均有全身其他关节或脊柱病变。结论 核素骨显像及其放射性比值测定有利于AS骶髂关节炎搂早期诊断，对其活动性监测有临床价值。     

强直性脊柱炎

强直性脊柱炎（AnkylosingSpondylitis,AS）是一古老疾病。在近一个世纪里，人们一直将AS和类风湿关节炎混为一种疾病，称AS为类风湿关节炎的中心型，或称为类风湿关节炎的变异型，直至本世纪60年代才将AS从类风湿关节炎区分出来作为一独立疾病。AS是一种慢性、进行性、灭性疾病，主要侵犯骶髂关节、脊柱骨突关节、脊柱旁软组织及外周（四肢）关节，也可发生关节外病变。本清的特点是椎间盘纤维环和纤维环附近结缔组织的纤维化和骨化，以及受累关节的强直。由于很少病例发展为脊柱“弯曲”，故AS不是一个理想的名称。一、流行病学AS…     

DWI在强直性脊柱炎活动评估中的应用价值

目的探讨DWI在强直性脊柱炎(AS)患者骶髂关节炎活动性的评估价值;并探讨全脊柱DWI在AS活动评估中的应用价值。方法选取我院经临床确诊为AS的患者76例,根据临床AS活动评分及实验室检查将其分为稳定组(32例)及活动组(44例);选20例健康志愿者作为对照组。三组观察对象均行骶髂关节MRI检查,获得各组骶髂关节ADC值;并对所有AS患者进行SPARCC骶髂关节评分,行统计学分析。另选取34例活动期AS患者及20例健康志愿者加扫全脊柱DWI,分析AS患者骶髂关节及脊柱受累情况。结果 1)活动组骶髂关节ADC值明显高于稳定组及对照组(P 0. 01);稳定组与对照组ADC值间差异无统计学意义(P 0. 05)。ROC曲线分析显示鉴别患者活动与稳定的敏感度及特异度为84. 1%、90. 6%; AS患者骶髂关节ADC值、SPARCC评分及临床BASDAI评分三者间具有显著相关性(P0. 01); 2) 34例加扫全脊柱DWI的AS患者中,13例仅骶髂关节见炎性病变,7例仅脊柱见炎性病变,14例骶髂关节及脊柱均见炎性病变,其中胸腰椎同时受累8例。AS患者脊柱炎症椎体与对照组正常椎体ADC值差异有统计学意义(P0. 05)。结论 DWI可通过ADC值对病灶进行直观、定量分析,可判断炎症的活动性及程度;对AS患者在骶髂关节检查的基础上加扫全脊柱弥散扫描,可以更全面、可靠的评估疾病的活动性及程度。     

骶髂关节炎多模态MRI的研究进展

强直性脊柱炎(ankylosing spondylitis,AS)是一种以侵犯中轴关节为主、具有致残性的慢性、免疫性疾病.骶髂关节(sacroiliac joint,SIJ)受损是AS主要的特征性改变,放射学上的骶髂关节炎(sacroiliitis,SIS)是诊断AS的关键.1984年修订的纽约AS分类标准中,将放射学SIS作为诊断AS的必要条件.X线和CT对早期无骨质改变的SIS无法明确诊断,以放射学SIS作为必要条件诊断AS必将会延误该病的诊治.因此,2009年国际脊柱关节炎协会(Assessment of Spondylo Arthritis International Society,ASAS)制定的中轴型脊柱关节炎(spondyloarthritis,SpA)分类标准引入了MRI作为影像学标准之一[1].     

C57BL/6小鼠CIA模型的建立及其监测体系的初步筛选

目的 建立稳定的C57BL／6小鼠胶原诱导关节炎(CIA)模型,构建进一步进行类风湿关节炎(RA)发病机制及治疗研究的体系。方法 取40只雄性C57BL／6小鼠,随机分为模型组和对照组。模型组采用鸡Ⅱ型胶原与完全弗氏佐剂在尾部皮内注射,21天后同样方法加强免疫。定期观察两组小鼠的关节和关节外表现以及病理学改变;用三重免疫荧光标记、胞内细胞因子测定流式细胞术检测外周血T细胞亚群。结果 对照组小鼠均未发病。模型组小鼠在50天的发病率达70％,关节炎评分在3～8分,持续时间大约100天;病理切片显示典型的炎性细胞浸润,滑膜增生,软骨及软骨下骨破坏．外周血Th1／Th2比值升高。结论 应用Ⅱ型胶原能在C57BL／6小鼠上成功建立CIA模型,该模型是进行RA研究的良好动物模型。     

退行性相关的脊柱关节炎发病率在持续性下腰痛病人的椎体、骶髂关节中的MRI表现

正摘要目的评估脊柱、骶髂关节退行性和脊柱关节炎相关的MRI表现,并且分析其与持续性下腰痛病人性别和年龄的相关性。方法对18~40岁患有下腰痛就诊于脊柱中心病人的全椎体及骶髂关节退行性和脊柱关节炎相关的MRI表现进行评估。结果在1 037例病人中,椎间盘变性、椎间     

Spondyloarthropathies: ankylosing spondylitis and psoriatic arthritis

As advances in the treatment of ankylosing spondylitis continue, TNF-alpha blocking agents may eventually be used as a first-line treatment. MR imaging could then be used to aid in the early diagnosis of ankylosing spondylitis by identifying early sacroiliitis, followed by immediate initiation of treatment to prevent the progression of the disease with its accompanying morbidities. Currently, radiographic identification of sacroiliitis remains the mainstay in diagnosing ankylosing spondylitis. In ankylosing spondylitis and psoriasis, MR imaging can demonstrate areas that are undergoing active inflammatory changes and enthesitis, aiding in the diagnosis of a spondyloarthropathy.     

MRI of the axial skeletal manifestations of ankylosing spondylitis

Magnetic resonance imaging (MRI) is a valuable tool in the imaging and assessment of patients with ankylosing spondylitis. MRI can demonstrate the acute and chronic changes of sacroiliitis, osteitis, discovertebral lesions, disc calcifications and ossification and arthopathic lesions, which characterize the disease, as well as the complications, which include fracture and the rare cauda equina syndrome. This article reviews the range of MRI findings commonly seen within the axial skeleton in patients with this condition.     

强直性脊柱炎致骶髂关节炎的X线与CT诊断

目的 评估X线对强直性脊柱炎患者骶髂关节炎的诊断价值。方法 对临床表现为缓慢加重的腰骶部及双髋部疼痛、压痛及活动受限者68例，进行脊柱正侧位或加摄斜位X线片。其中，6例临床怀疑骶髂并节病变者又经CT检查。结果 单侧骶髂关节改变为28例，双侧骶髂关节改变40例。怀疑骶髂关节病变6例，轻度骶髂关节炎34例，中度骶髂关节炎20例，重度骶髂关节炎8例。68例中59例HLA—B27抗原阳性。结论 X线正位加左、右斜位平片能对大部分骶髂关节炎作出诊断，尤其是左、右斜位更有利于观察骶髂关节病变。对于骶髂关节炎的早期诊断，CT优于X线平片。     

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis

Objective. To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). Design and subjects. Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. Results and conclusions. MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P<0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.     

多层螺旋CT在强直性脊柱炎骶髂关节病变中的应用价值

目的:探讨多层螺旋CT在强直性脊柱炎(AS)骶髂关节病变的应用价值。方法:56例临床确诊为强直性脊柱炎患者行骶髂关节多层螺旋CT检查,观察骶髂关节病变的CT表现及影像学特征。结果:强直性脊柱炎骶髂关节病变的多层螺旋CT表现特征为病变主要累及骶髂关节的髂骨侧,表现为关节软骨钙化、关节面毛糙、骨性关节面下多发小囊状骨质吸收、破坏伴不同程度骨质增生硬化,骶髂关节间隙狭窄、消失、关节骨性融合及骶髂韧带钙化等。结论:多层螺旋CT对强直性脊柱炎(AS)骶髂关节病变的诊断与鉴别诊断具有重要的应用价值。     

Renaissance of 224 Ra for the treatment of ankylosing spondylitis: clinical experiences.

Radium (224Ra) is commercially available again for the treatment of ankylosing spondylitis. Twenty patients suffering from ankylosing spondylitis were treated with weekly intravenous (i.v.) injections of 1 MBq 224Ra for 10 weeks. Therapeutic effect was measured by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and full blood count, as well as a completion of the Bath ankylosing spondylitis functional index (BASFI) questionnaire. Follow-up was done after three and six months. At the end of the treatment course pain and movement restrictions had improved subjectively in 12 out of 20 patients. These patients were also able to discontinue or reduce their analgesic or anti-inflammatory medications. Subjective improvement was well correlated with a reduction of CRP by 45% and BASFI by 73%. At the six-month follow-up, ten patients reported a lasting improvement, whereas two had suffered a relapse. A late therapeutic response after three months was seen in a single patient only. Patients who did not respond to radium had lower initial levels of acute-phase reactants and peripheral joint involvement. Only mild side-effects, e.g. temporary worsening of pain, were observed. Leukocytes and platelets reversibly decreased by 25%, respectively. It is concluded that 224Ra is an effective and safe treatment for ankylosing spondylitis.     

SPECT/CT of osteitis condensans ilii: one-stop shop imaging

A 16-year-old, nonpregnant, healthy, and sportive teenager suffers from intermittent low back pain. Pelvic x-ray complemented by bone-SPECT/CT demonstrated an uncommon benign condition called osteitis condensans ilii. In the early phase, it is of paramount importance to distinguish osteitis condensans ilii from sacroiliitis or ankylosing spondylitis. This case report highlights the incremental value of performing one-stop shop hybrid SPECT/low-dose CT bone imaging in diagnosing and managing this rare benign skeletal condition.     

Sacroiliac joint imaging

The sacroiliac (SI) joint has several unique anatomical features that make it one of the more challenging joints to image. The joint is difficult to profile well on radiographic views, and therefore the radiographic findings of sacroiliitis are often equivocal. Computed tomography images can usually show the findings of sacroiliitis and osteoarthritis earlier than radiographs. Magnetic resonance imaging performed with proper sequences is excellent for diagnosing even very early sacroiliitis and for following treatment response. The SI joint is often involved in patients with osteoarthritis or one of the inflammatory spondyloarthritides, most notably ankylosing spondylitis. Ankylosing spondylitis often presents with sacroiliitis, which appears as erosions, sclerosis, and joint space narrowing, eventually leading to ankylosis. Several disorders can cause sacroiliitis-like changes of the joint, including hyperparathyroidism and repetitive shear-stress injuries in athletes. The joint can become painful during pregnancy as it widens and develops increased motion, and some postpartum women develop iliac sclerosis adjacent to the joint termed osteitis condensans ilii. Another cause of SI joint pain is a disorder called sacroiliac joint dysfunction, which typically has few abnormal imaging findings. Patients with SI joint dysfunction, as well as sacroiliitis, often get relief from image-guided SI joint therapeutic injections.     

Fracture of the cervical spine in ankylosing spondylitis

The radiological features, clinical findings and mortality rates of patients with ankylosing spondylitis complicated by cervical trauma have been reviewed. All patients had long-standing disease and half had sustained their fractures as a result of trivial accidents. There were 19 cervical fractures in 18 patients, which were chalkstick in type and occurred predominantly at the 6th and 7th cervical levels. Ten fractures passed through the upper part of the vertebral body, one through the mid-vertebral body and the final eight were through the disc space. The site of the fracture line was related to neurological outcome. Those patients whose fracture line ran through the disc space had significantly less neurological injury and a much better prognosis. Distraction at the fracture site had some relation to prognosis but horizontal displacement and angulation were not found to be of importance. This study confirms that cervical fracture with neurological complications may follow minor trauma in ankylosing spondylitis. The site of the fracture in relation to the vertebral bodies and discs appears to be of some prognostic relevance and careful radiological assessment of all patients with ankylosing spondylitis and cervical injury should be undertaken.     

Sacroiliac joint uptake ratios in inflammatory bowel disease: relationship to back pain and to activity of bowel disease

Sacroiliac uptake ratios based on 99Tcm methylene diphosphonate images were calculated in 14 patients with ankylosing spondylitis, 23 patients with non-specific backache, 33 patients with inflammatory bowel disease (ulcerative colitis 19, Crohn's disease 14) and 33 control subjects. Twenty-eight of the control subjects were patients referred from a breast cancer clinic. In the control subjects, and in 20 patients with inflammatory bowel disease who did not have back pain, sacroiliac ratios decreased significantly with increasing age (p less than 0.001 and p less than 0.01 respectively). Sacroiliac uptake ratios were significantly higher in ankylosing spondylitis than in patients with non-specific backache. Seven of the 14 patients with ankylosing spondylitis had higher sacroiliac ratios than any recorded in the control subjects. Eleven patients with inflammatory bowel disease had abnormally high sacroiliac uptake ratios; ten of these patients had back pain. Increased sacroiliac joint uptake in such patients may reflect early sacroiliitis. No relationship was detected between sacroiliac uptake and the activity of the bowel disease. Sacroiliac uptake ratios were significantly higher in the inflammatory bowel disease patients suffering from back pain than in age and sex matched patients with (a) inflammatory bowel disease but no back pain or (b) non-specific backache.