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1.
国际脊柱关节炎评价协会(ASAS)2009年制订的脊柱关节炎(SpA)分类标准将骶髂关节磁共振成像(MRI)的影像学改变作为疾病的主要诊断依据之一,使SpA的诊断时间平均提前了5~7年,达到了早期诊断的目的。但随着骶髂关节MRI的广泛应用,学者们发现单纯依据MRI做出的诊断易出现过度诊断或误诊,因此许多风湿病学者对MRI判断骶髂关节炎作为早期SpA诊断的价值提出质疑。2019年ASAS MRI工作组将骶髂关节MRI影像学定义进行更新、细化并增加具有诊断特异性的MRI表现,有助于提高SpA早期诊断的准确率。MRI发现的活动性骶髂关节炎还是最具特征的客观表现,是诊断SpA的一个重要的影像学表现,较其他SpA临床特征意义更大。但新定义是否可以帮助判断疾病预后及评价治疗反应?脊柱MRI的表现对中轴SpA诊断价值是否需要评估?越来越多的挑战和待解决的问题随之而来,需要在未来的临床实践中不断探索与解决。  相似文献   

2.
目的通过了解骶髂关节炎病理特点,并以病理结果为标准,探讨病理表现与放射性核素单光子发射计算机断层成像术(single-photon emission computed tomography,SPECT)、磁共振显像(magnetic resonance imaging,MRI)、计算机断层扫描(computed tomography,CT)、X线等影像学检查的关系。方法对中轴型脊柱关节炎患者进行CT引导下骶髂关节(sacroiliac joint,SIJ)穿刺,所得组织进行病理检查,并同时行SIJ的SPECT、MRI、CT和X线检查,按组织病理结果分为SIJ炎组和无炎性反应组。结果 36例患者获得组织有软骨、软骨下骨板、关节滑膜、骨髓、肌腱或韧带附着点等。获得率以软骨为最高,继以软骨下骨板、关节滑膜、骨髓和韧带附着点,各占92%、83%、75%、72%、22%;其中28例(2836,78%)患者SIJ炎病理变化包括软骨(93%)和软骨下骨板改变(75%)、滑膜炎(64%)、骨髓炎(46%)、附着点炎(32%),8例(22%)未发现有SIJ炎改变。MRI示29例(81%)患者共56个SIJ可见不同程度的异常信号改变,软骨线改变、软骨下骨板改变、骨髓水肿、脂肪沉积、骨质硬化分别为82%、71%、65%、59%、76%;SPECT示29例(81%)共52个SIJ可见骶髂关节感兴趣区的放射性比值有不同程度的升高,23例(64%)CT阳性,19例(53%)X线阳性。以病理结果为标准,SPECT、MRI、CT、X线的阳性预测值分别为89.6%、93.1%、95.6%、94.7%,敏感性分别为92.8%、96.4%、73.3%、64.2%,特异性分别62.5%、75.0%、87.5%、87.5%。4种诊断方法的受试者工作特征曲线下面积分别为0.79、0.84、0.83、0.76。结论病理检查是诊断Sl J炎和活动性炎性反应的主要方法。MRI和SPECT的相互补充,能提高骶髂关节活动性炎症的敏感性和特异性。MRI和SPECT的诊断价值与CT和X线相当,并可通过对炎症的活动度进行量化,有利于随访和疗效的评价,是诊断SIJ炎重要的辅助手段。  相似文献   

3.
目的 提高对类风湿关节炎合并骶髂关节改变的认识。方法 收集13例合并骶髂关节改变的类风湿关节炎患者及67例不合并骶髂关节改变的类风湿关节炎患者的临床和实验室检查资料,并加以分析比较。结果合并骶髂关节改变的类风湿关节炎患者,以男性为主,多以桡腕关节炎首发,下肢关节大多呈非对称性炎症改变,人类白细胞抗原(HLA)-B27阳性,或同时伴有类风湿因子(RF)阳性。结论 类风湿关节炎患者如出现臀部和/(或)下背部症状,要考虑合并骶髂关节改变,可做HLA-B27和骶髂关节CT检查。  相似文献   

4.
强直性脊柱炎骶髂关节病变的X线CT磁共振成像比较分析   总被引:11,自引:0,他引:11  
强直性脊柱炎 (ankylosingspondylitis ,AS)为一种原因未明的以中轴骨、关节慢性炎症为主的全身性病变 ,属于风湿性疾病的范畴。在AS的骨关节病变中 ,骶髂关节是较早且几乎必受累及的部位 ,全面认识AS骶髂关节病变的影像学改变 ,对于AS的早期诊断具有重要意义。本文就 91例AS骶髂关节病变的X线平片、CT和磁共振成像 (MRI)影像学表现进行了分析和比较 ,同时初步探讨了AS骶髂关节病变的MRI早期影像诊断。1 资料与方法1 1 临床资料 :本组AS病例共 91例 ,男性 6 2例 ,女性 2 9例 ,年龄 17~ 37岁 ,平均 2 1 7岁 ;病程 5个月~ 9年 ,…  相似文献   

5.
总结并分析不同类型感染性骶髂关节炎的临床与影像学特点。回顾性分析40例感染性骶髂关节炎患者的临床资料,其中非布鲁菌非结核性感染性骶髂关节炎(ISI)16例,结核性骶髂关节炎(TSI)13例,布鲁菌感染性骶髂关节炎(BSI)11例。ISI者中女性11例,TSI者中女性12例。ISI者中骶髂关节单侧受累15例,TSI者中12例。与ISI者、TSI者比,BSI者男性(8例)和骶髂关节双侧受累(6例)多见。磁共振成像(MRI)见骨侵蚀ISI者6例,TSI者7例,BSI者2例;MRI见脓肿形成ISI者3例,TSI者4例,BSI者1例。40例患者经抗感染和抗结核治疗后症状多于1~2周缓解,但MRI恢复较慢,3例(2例ISI者,1例BSI者)患者治疗6(3~9)个月复查MRI基本正常,8例(4例ISI者,4例TSI者)患者治疗3.5(2~18)个月复查MRI仍异常。ISI、TSI多为骶髂关节单侧受累,女性多见,骶髂关节骨质破坏明显,周围软组织受累及脓肿形成多见。BSI较少出现骨质破坏及脓肿形成。感染性骶髂关节炎患者MRI影像学恢复滞后于临床表现。  相似文献   

6.
强直性脊柱炎的诊断和治疗进展   总被引:26,自引:0,他引:26  
强直性脊柱炎是一种常见的慢性致残性风湿病,早期诊断的关键在于早期发现骶髂关节炎。炎症性腰痛是早期诊断的重要线索。CT和MRI检测有助于早期发现骶髂关节病变。ESSG和Amor标准较纽约标准更有利于早期诊断。对治疗目前主张早期使用二线药,顽固性腰痛用NSAIDs无效者可考虑使用骶髂关节注射治疗。  相似文献   

7.
幼年强直性脊柱炎临床特点和HLA-B27亚型的相关性研究   总被引:4,自引:0,他引:4  
目的提高对幼年强直性脊柱炎(JAS)和HLA-B27亚型相关性的认识。方法分析检测55例JAS患儿HLA-B27亚型和临床特点。采用国际标准微量淋巴细胞毒实验法进行血清学分型。DNA分型采用聚合酶链反应-序列特异引物技术(PCR-SSP)检测出B2701-B2713等位基因亚型。DNA提取取受测对象外周静脉血3ml,5%乙二胺四乙酸(EDTA)抗凝,饱和醋酸钠盐析法制备基因组DNA,PCR-SSP方法扩增。详细记录病史、家族史、全面体格检查,包括临床症状、体征、关节及关节外表现,相关影像学及实验室检查,随访1~5年。结果55例JAS患儿中B2704阳性者27例,B2705阳性者25例,B2702、B2707/2708及B2705/2708各1例。B2705阳性组36%(9/25)患儿关节肿痛伴发热,其中68%(17/25)存在外周关节炎,36%(9/25)为多关节炎,71%(17/24)CT显示骶髂关节病变为2级以上改变。B2704阳性组仅表现为关节肿痛,均无发热,74%(20/27)存在外周关节炎,其中有15%(4/27)为多关节炎表现,32%(8/25)CT显示骶髂关节病变2级以上改变。经统计学分析骶髂关节病变HLA-B2704组和B2705组之间差异有显著性(P<0.005)。结论JAS临床表现因HLA-B27亚型分布不同各有特点,等位基因B2705阳性患儿除关节症状外更易同时伴有发热,预后较等位基因B2704阳性患儿差。  相似文献   

8.
目的比较早期强直性脊柱炎骶髂关节病变的X线、CT和MRI的诊断价值。方法在本院确诊的168例早期强直性脊柱炎骶髂关节病变患者作为研究对象,回顾性分析患者的X线、CT和MRI检查结果。结果 X线检出率为73.2%,CT检出率为86.9%,MRI检出率为100%,组间两两比较均有显著性差异(均P<0.01),MRI检出率显著高于CT和X线检出率,CT检出率显著高于X线检出率。结论 MRI可以较好的弥补X线和CT的缺陷,不仅具有更高的诊断价值,还具有一定的治疗指导价值,对于早期强直性脊柱炎骶髂关节病变来说,可以作为优先考虑的诊断方式。  相似文献   

9.
骶髂关节穿刺及其临床应用   总被引:5,自引:1,他引:4  
放射学骶髂关节炎的确立是强直性脊柱炎诊断的关键。然而 ,由于放射学骶髂关节炎的确立必须在骶髂关节发生侵蚀、硬化、破坏等形态、结构变化以后 ,而这个过程十分缓慢。因为骶髂关节结构复杂 ,不同个体间形态差异很大 ,加之盆腔其它组织、结构的影响 ,使X线早期诊断存在不少困难。即使在CT普遍应用的今天 ,确诊时的病程也在 6年以上[1] 。近年来 ,发展的CT导引下骶髂关节穿刺技术 ,为骶髂关节炎的早期诊断和早期治疗提供了手段 ,介绍如下。1 骶髂关节的解剖和断层解剖骶髂关节位于骨盆后壁骶骨和髂骨间 ,由骶骨耳状面和髂骨耳状面构…  相似文献   

10.
目的 建立Ⅱ型胶原诱导性大鼠关节炎模型(CIA),结合病理改变研究磁共振成像(MRI)检测对早期类风湿关节炎的诊断价值.方法 用牛Ⅱ型胶原和不完全弗氏佐剂联合皮内注射免疫Wistsr大鼠,制作关节炎模型;免疫后不同时期分别采用普通X线摄片、1.5T磁共振仪进行双踝关节平扫加增强扫描以及病理组织学等方法 进行大鼠踝关节病理学特征分析.结果 CIA实验组大鼠免疫14 d后,其关节指数(AI)显著增加,28 d AI增加达到最高(3.6±1.0),抗Ⅱ型胶原抗体水平较对照组明显高(P<0.001).根据病理学分析CIA成模率为93.3%.MRI平扫加增强显示有12只出现异常征象,敏感性85.7%,特异性100%,与病理诊断呈正相关(r=0.5345,P<0.05).X线有4只出现关节软组织肿胀,MRI较X线检出率高(P=0.008).结论 MRI对早期关节滑膜炎、滑膜增生、血管翳等病理学的诊断生成方面有明显优势.  相似文献   

11.
脊柱关节病患者骶髂关节细针活检的病理表现及其临床意义   总被引:15,自引:0,他引:15  
Wang QW  Zeng QY  Xiao ZY  Chen SB  Liu Y  Wu MY 《中华内科杂志》2004,43(11):832-836
目的了解骶髂关节(SIJ)炎的病理表现,提高强直性脊柱炎(AS)的早期诊断水平。方法对96例脊柱关节病(SpA)患者的SIJ进行CT导引下的细针活检,3例非SpA死亡病例为对照组。记录临床资料进行分析。结果76例SpA的SIJ存在炎症表现,包括骨髓炎、血管翳形成和炎性细胞浸润,软骨下骨板破坏,软骨变性、破坏,滑膜炎,附着点炎等。其中45例0~Ⅰ级CT下SIJ炎均存在骨髓炎、软骨下骨板炎、软骨变性等改变;0级CT下SIJ炎的滑膜无病理改变,而部分Ⅰ级和所有≥Ⅱ级SIJ炎滑膜可见炎症;软骨破坏和骨化发生率以0~Ⅰ级最低,且仅见于软骨下骨板侧,关节面侧未见破坏;骨质硬化也是0~Ⅰ级最少见;附着点炎仅见于部分≥Ⅱ级SIJ炎;炎性细胞浸润程度Ⅳ级最低。45例0~Ⅰ级CT下SIJ炎的SpA经病理检查诊断为AS;其平均病程显著短于≥Ⅱ级者。结论0级CT下SIJ炎时SIJ已可有炎症存在。SIJ炎可能自骨髓开始,继而血管翳形成,软骨下骨板破坏,软骨变性、破坏,最后纤维化、骨化而导致关节融合。滑膜炎和附着点炎不是SIJ炎的最早改变。病理检查有利于AS的早期诊断和鉴别诊断。  相似文献   

12.
OBJECTIVE: To determine the frequency and clinical predictors of sacroiliitis diagnosed by magnetic resonance imaging (MRI) in a psoriatic arthritis (PsA) population. METHODS: The studied comprised 103 patients with PsA. A careful clinical assessment for sacroiliitis was made from history and examination, and HLA-B27 testing was performed. Sixty-eight patients underwent tilted coronal fat-saturated T1-weighted and STIR MRI of the sacroiliac joints. RESULTS: Clinical features of moderate or severe sacroiliitis were found in 24/68 (35%) patients. MRI features of sacroiliitis were found in 26/68 (38%) patients. Clinical features of sacroiliitis were present in 14/42 (33%) with normal MRI scans and 10/26 (38%) with abnormal scans (normal vs abnormal scans, P = 0.7). The presence of sacroiliitis on MRI was associated with restricted spinal movements (P = 0.004) and the duration of PsA (P = 0.04). There was no correlation between HLA-B27 and sacroiliitis diagnosed by MRI. CONCLUSION: Sacroiliitis diagnosed by MRI occurs commonly in PsA but is difficult to detect clinically.  相似文献   

13.
OBJECTIVE: Clinical and magnetic resonance imaging (MRI) data of 170 consecutive patients with inflammatory back pain (IBP) and/or oligoarthritis of the lower limbs were evaluated in a retrospective study. The aim was to determine the frequency of sacroiliitis and spondyloarthropathy (SpA) in this population, and to assess the significance of HLA B27 measurements for diagnosis in early disease. METHODS: Pelvic X-rays were performed in all IBP patients and dynamic MRI of the sacroiliac joints in patients with IBP who had indefinite results on sacroiliac X-rays (n = 32). RESULTS: European Spondyloarthropathy Study Group criteria for SpA were fulfilled by 106/170 patients (62.4%); eight additional patients had symptoms suggestive of SpA (4.7%). The most frequent SpA subset was undifferentiated SpA (uSpA), diagnosed in 46/106 patients (43.4%). Sacroiliitis was detected by MRI in 21/32 patients with IBP and unclear X-rays (65.6%). Of those, 14 were diagnosed as SpA and seven females with moderate unilateral sacroiliitis, but no features of SpA, also not on follow-up (at least 1 yr), were classified as undifferentiated sacroiliitis (US). Ten of the 14 SpA (71.4%) and none of the seven US patients were HLA B27 positive. CONCLUSION: HLA B27 positivity in IBP patients with MRI-proven sacroiliitis positively predicts SpA. uSpA is a frequent SpA subset. There are HLA B27-negative non-SpA patients with moderate unilateral sacroiliitis whom we propose to be classified as US.  相似文献   

14.
Pyogenic sacroiliitis is an extremely rare manifestation of invasive pneumococcal disease in childhood as only four cases have been described to date. We report and comment on a case of pneumococcal sacroiliitis in a 4-year-old boy. This patient was diagnosed promptly on account of the symptom triad of fever, buttock pain, and limping gait, along with characteristic findings in magnetic resonance imaging (MRI) and bone scans, and recovered fully after 6 weeks of antimicrobial therapy. Pyogenic sacroiliitis is an uncommon disease in which the diagnosis is often delayed because of nonspecific clinical presentation. The key to successful management is early diagnosis in which MRI and bone scan findings play a crucial role. If the diagnosis is established promptly, most patients can be managed successfully following the therapeutic principles used in other osteoarticular infections.  相似文献   

15.
BackgroundSpondyloarthropaties (SpA) are a diverse group of disorders characterized by inflammatory low backache, genetic predisposition and a variety of articular and extraarticular manifestations. Evidence of sacroiliitis in plain radiographs forms the cornerstone for establishing the diagnosis. However, it may take many years for the sacroiliitis to become visible. With the availability of biologics that have the potential to modify the course of SpAs, there is a need for early diagnosis of these disorders. Magnetic resonance imaging (MRI) and nuclear scintigraphy (radionuclide bone scan) appear promising in this context with their ability to pick up structural damage and inflammation before their presence is detected in plain radiographs.ObjectivesTo assess the role of MRI and bone scan in patients with early SpA.MethodsThis was a cross sectional study done at a tertiary care rheumatology center of the armed forces. Patients satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for Spodyloarthropathy and disease duration of less than 8 years were included. All patients underwent conventional radiography, MRI imaging and nuclear scintigraphy of the sacroiliac (SI) joints. The primary outcome assessed was the positivity rate for sacroiliitis of each of the three modalities in this group of patients. The sensitivity of each modality in contributing to the diagnosis over and above that of plain radiographs was assessed.ResultsForty-four patients (predominantly young men, n = 39) with a median disease duration of 5 years were included in the study. Most patients had ankylosing spondylitis (n = 21, 47.7%) closely followed by undifferentiated spondyloarthropathy (n = 14, 31.8%), reactive arthritis (n = 5, 11.1%) and psoriatic arthropathy (n = 4, 9.2%). Evidence of sacroiliitis was seen in 59% (26/44) patients in plain radiographs, in 73% (34/44) with bone Scan and in 77% (34/44) with MRI. There was significant discordance among the three imaging modalities, documented in 49 of the 132 observations (37%). Amongst patients with a disease duration < 2 years (17/44, 39%), the plain radiographs showed changes in less than half the patients (8/17, 47%) with the MRI scan being positive in 88% of patients and the bone scan being positive in over 80% of patients. Though MRI and bone scan continued to have a higher pickup rate with increasing disease duration, the difference was most striking at 2 years. Amongst patients with undifferentiated spondyloarthropathies (USpA), (n = 14), none of the patients had evidence of sacroiliitis on plain radiographs. However 10 (71.5%) patients each had evidence of sacroiliitis on MRI and bone scan, with 8 (57.1%) patients having both MRI and bone scan findings suggestive of sacroiliitis. Plain radiographs, MRI and bone scan, when used in combination, are able to detect sacroiliitis in almost all patients with SpA.ConclusionsMRI had the maximum sensitivity (78%) for detecting sacroiliitis closely followed by bone scan (73%). Their utility was most apparent in patients with disease duration lesser than 2 years where plain radiographs have the least sensitivity in detecting sacroiliitis. They were also very useful in the subgroup of patients with uSpA where the radiographs were universally negative. MRI and bone scan individually picked up evidence of sacroiliitis in most of the patients with USpA and in combination picked up all the cases suggesting their usefulness in this group. However, there was a significant discordance rate amongst the three modalities and bone scan seems to lack specificity. MRI may be the preferred modality in patients with USpA and in those with early disease, given the poor specificity of bone scan.  相似文献   

16.
强直性脊柱炎骶髂关节内皮质激素注射疗效观察   总被引:7,自引:1,他引:6  
目的了解强直性脊柱炎(AS)骶髂关节(SIJ)内皮质激素注射的疗效.方法患者取俯卧位,在CT导引下穿刺SIJ滑膜部,取组织标本后,在CT导引下原路进入SIJ,每侧注入丙酮缩去炎舒松15mg.记录分析病人术前、术后临床资料.结果28例中22例(78.6%)疼痛明显减轻,晨僵、夜间痛、SIJ压痛、"4”征、ESR升高及需使用NSAIDs的例数均较术前明显减少.所有SIJ标本均有炎症表现.结论SIJ关节内注射长效激素,可作为对NSAIDs不耐受或无效的AS和uSpA病人的一种有效的缓解腰背痛手段,同时uSpA病人SIJ病理标本的获得,有助于早期诊断.  相似文献   

17.
OBJECTIVE: To investigate the diagnostic value of magnetic resonance imaging (MRI) in the detection of early sacroiliitis. METHODS: Twenty-five consecutive HLA-B27 positive patients with inflammatory low back pain and < or = grade 2 unilateral sacroiliitis on conventional radiography (modified New York criteria) were studied. Erythrocyte sedimentation rate, C-reactive protein, plain radiography (PR), and MRI of the sacroiliac (SI) joints were obtained at study entry and PR of the SI joints after 3 years. Each radiograph and MR image set was interpreted independently. SI joints were scored according to the modified New York Criteria for radiological sacroiliitis. MRI scans were also scored for the presence of subchondral marrow edema. The relationship between > or = grade 2 sacroiliitis (by modified New York criteria for radiological sacroiliitis) shown on MRI and the subsequent development of > or = grade 2 sacroiliitis on PR after 3 years was investigated. RESULTS: At study entry > or = grade 2 sacroiliitis was found on MRI in 36 of 50 SI joints. Edema was found in 20 of 50 SI joints. After 3 years > or = grade 2 sacroiliitis was found on PR in 21 of 44 SI joints. The positive predictive value of > or = grade 2 sacroiliitis on MRI for the development of > or = grade 2 sacroiliitis on PR after 3 years was 60%; sensitivity was 85% and specificity 47%. CONCLUSION: Our data suggest that MRI of the SI joints can be used to identify sacroiliitis earlier than PR.  相似文献   

18.
IntroductionSpondyloarthropathy (SpA) comprises a small percentage of low backache (LBA) and presents with inflammatory pain. Sacroiliitis in SpAs forms the basis of diagnosis, and may take 7–8 years to become visible in plain radiographs. In order to achieve significant modification of the course of the disease it is imperative to make an early diagnosis, identify risk factors for aggressive disease and initiate the therapy right at outset. Magnetic resonance imaging (MRI) is a promising modality to pick up inflammation and structural damage early in the course of the disease.ObjectiveTo assess the role of MRI and radionuclide bone scan in patients with early SpA of less than 2 years.MethodsPatients with inflammatory LBA, defined according to the Calin criteria and satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for SpA of less than 2 years duration, were included. Controls had mechanical LBA. A detailed clinical assessment and assessment of disease activity and functional impairment was done with validated measures. Radiological assessment included conventional radiograph of the pelvis, radionuclide scan and MRI of sacroiliac joints (SI joints). The sensitivity, specificity and predictive value of each modality in contributing to the diagnosis of SpA were assessed.ResultsAssessment of 132 SI joints in 33 patients (Age 31 ± 6.14 years, M:F 24:9) and 33 controls (Age 31.8 ± 7.21 years, M:F 27:5) was done. The mean disease duration of cases was 10.7 (± 6.97) months. Conventional radiograph failed to pick up sacroiliitis in any of the cases. Positive bone scan was present in 27 patients (21 bilateral sacroiliitis, 6 unilateral sacroiliitis). Bone scan had a sensitivity of 81.8% and a specificity of 88%. MRI abnormality was present in 29 patients (50 joints, bilateral in 21 and unilateral in 8) and in none of the controls. This accounted for a sensitivity of 87.9% and a specificity of 100%. The MRI changes included bone marrow oedema (89%), synovial enhancement (55%), subchondral oedema (41%), erosions (51%) and sclerosis (28%). Both inflammatory and structural changes in MRI showed positive correlation with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (P = 0.034, 0.02) and erythrocyte sedimentation rate (ESR) (P = 0.02, 0.001).ConclusionsIn patients with early SpA of less than 2 years duration, conventional radiographs did not pick up sacroiliitis; however, both the radionuclide scan and MRI were useful.  相似文献   

19.
Ankylosing spondylitis (AS) is the most common clinical subgroup of sero-negative spondyloarthropathies. Radiographic and clinical signs of bilateral inflammatory involvement of sacroiliac joints are the gold standard for the diagnosis of juvenile AS. Although radiographic evidence of sacroiliitis is included in the definition, it is not mandatory for the diagnosis of juvenile AS. The aim of this study is to describe pelvic enthesitis–osteitis MRI findings accompanying sacroiliitis in a group of juvenile AS. Eleven patients suffering from low back pain underwent MRI of the pelvis and were enrolled in this retrospective study. The mean duration of symptoms was 12 months. The mean age of the 11 cases in our study was 12.18 years (range, 6–19). There were eight boys and three girls. Anteroposterior radiographs of the pelvis were obtained in all patients. Sacroiliac joint involvement was detected in all of the cases by pelvic MRI. Pathologic signal changes were detected in the pubic symphisis (osteitis pubis) in ten cases, trochanteric bursitis in six cases, coxofemoral joint in five cases, crista iliaca in three cases, and ischion pubis in three cases. There was increased T2 signal intensity in eight of the 11 cases (72.7%) relevant with soft tissue edema/inflammation. This high correlation between sacroiliitis and enthesitis suggests that enthesitis could be an important finding in juvenile AS.  相似文献   

20.
Detection of preradiographic sacroiliitis is important for early diagnosis of ankylosing spondylitis (AS) and related spondyloarthropathies. Magnetic resonance imaging (MRI) is a valuable tool for the diagnosis of sacroiliitis in the early and active stages. The aim of this study is to assess the value of pain provocation tests in detecting early active sacroiliitis. Chronic low-back pain (LBP) patients were recruited and examined by blinded assessors for pain provocation tests: compression, distraction, Gaenslen, Mennel, Patrick, thigh thrust and sacral thrust tests. Patients underwent lumbar and sacroiliac MRI. The percentage of agreement for each pain provocation tests was between 72-95%, and the inter-rater reliability was from moderate to good (kappa, 0.43-0.87). Kappa values ranged from 0.43 to 0.60 with an agreement of 80-95% for clusters of pain provocation tests. As separately evaluated, pain provocation tests did not have favorable accuracy. When evaluated in clusters (out of three and five provocation tests) four positive over five tests on the left side reached an area under the curve 0.693 (95% CI 0.489-0.897), and two positive over three tests reached an AUC 0.697 (95% CI 0.484-0.910). Sacroiliac pain provocation tests had acceptable reliability in early active sacroiliitis; however, the discriminating capacity of these tests is poor. A multi-test regimen of three or five sacroiliac pain provocation tests may improve the accuracy of these tests discriminating sacroiliitis from LBP of mechanical origin. Four out of five selected tests or any of the two out of three selected tests have the highest predictive value.  相似文献   

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