磁化传递对比成像和扩散加权成像在中轴型脊柱关节病患者早期骶髂关节炎中的应用

目的：研究磁化传递对比成像（MTC）和扩散加权成像（DWI）在中轴型脊柱关节炎患者早期骶髂关节炎中的应用价值。方法：连续搜集炎性腰背痛并疑为中轴型脊柱关节炎患者84例。所有患者均进行 MRI 检查,通过添加和不添加预饱和脉冲的三维扰相梯度回波序列,两次扫描获得磁化传递对比成像。同时进行平面回波扩散加权成像,b 值选取0和600 s／mm2。结果：84例患者中16例诊断为不明原因腰背痛患者（对照组）。68例符合国际脊柱关节炎评估协会制定诊断标准为中轴型脊柱关节炎（SpA 组）。SpA 患者骶髂关节软骨的磁化传递率（MTR）较对照组明显降低（t＝4．02,P ＜0．05）。SpA 患者的骶骨 ADC 值较对照组明显升高（P ＜0．05）;SpA 患者的髂骨 ADC 值较对照组明显升高（P ＜0．05）。常规磁共振序列检出中轴型脊柱关节炎的敏感度为63．2％,而骶髂关节软骨磁化传递率在检出中轴型脊柱关节炎的敏感度为75％;骶骨和髂骨骨髓 ADC 值在检出中轴型脊柱关节炎的敏感度为62．3％和72．1％。结论：磁化传递对比成像和DWI 成像能够用于检测早期中轴型脊柱关节炎,对比常规 MRI 成像序列,磁化传递对比成像和扩散加权成像可作为反映早期骶髂关节炎性改变的半定量测量手段。     

HLA B27 and clinical features in Reiter's syndrome

Summary HLA B27 and other clinical findings were investigated in 18 Turkish patients with Reiter's syndrome (mean age 35.8±8.09). Male/female ratio was 2/1. All 18 patients were seronegative, 12 (66.6%) presenting with an asymmetrical oligoarticular arthritis. Radiological sacroliitis and enthesopathy was found in 9 (50%) and 7 (45.6%) patients respectively. HLA B27 was present in 11 (61.1%) patients.     

MRI下骶髂关节炎的临床鉴别诊断

影像学一直是诊断和评估骶髂关节炎的重要手段。核磁共振成像可早期发现并评估骶髂关节改变,在诊断骶髂关节炎相关疾病及协助临床决策方面具有重要作用。临床上引起骶髂关节炎的疾病很多,如脊柱关节炎、关节退行性改变、感染、肿瘤等。临床中误诊原因多为对影像学的误读所致,且误诊给社会及患者带来巨大精神及经济负担。本文总结了骶髂关节在脊柱关节炎及相关鉴别诊断中的MRI影像学特点,强调临床工作中,影像学提示出现骶髂关节炎可能涉及如风湿免疫科、感染科、肿瘤科、内分泌等多学科的疾病。很多病例影像学虽然提示有骶髂关节炎改变,但临床医生在诊疗过程中更应结合患者的年龄、性别、体征、症状及实验室检查等相关临床特点加以综合分析和判断,避免误诊。因此,本文对不同疾病引起的骶髂关节炎的核磁共振表现做一综述。     

An unusual case of osteoid osteoma clinically mimicking sacroiliitis

Osteoid osteoma is one of the unusual causes of musculosceletal pain. A case of a 21-year-old man who had low back and hip pain radiating to the posterior thigh for 3 years is presented. Pain was worse at night but reduced with the use of nonsteroidal anti-inflammatory drugs. Straight leg raising test was negative. Patrick–Fabere and sacroiliac compression tests were positive on the right. Neurological examination was normal. Lumbar spinal and pelvic radiographs were normal except for sclerosis at the inferior half of the iliac bone adjacent to the right sacroiliac joint. Sedimentation rate, C-reactive protein, and whole blood counts were normal. Bone scan showed nonspecific increased uptake. Computed tomography revealed the presence of diffuse sclerosis at inferior half of the right iliac bone extending to medial border of sacroiliac joint with subcortical osteolytic region and centrally hyperdense sclerotic nidus inside.     

Subclinical Sacroiliitis in Inflammatory Bowel Disease: A Clinical and Follow-up Study

The aim of this study was to evaluate the clinical features, evolution and reliability of spondyloarthropathy criteria in a subset of patients with subclinical sacroiliitis and inflammatory bowel disease (IBD). All patients with IBD (n 62) attending a gastroenterology clinic from a referral centre were included to assess the prevalence of articular involvement. Patients were evaluated according to a specific protocol designed for the study, which included epidemiological and clinical variables, physical examination and radiological assessment. Only those with subclinical sacroiliitis were followed prospectively for 4 years. This group was visited every 6 months with the same initial protocol. Sacroiliac joints were studied using frontal and oblique X-ray views and graded according to New York criteria. HLA B27 typing was performed by serological methods in all patients and in 80 healthy controls. The reliability of Amor and ESSG criteria for spondyloarthropathy was evaluated. Fifteen patients (24%) presented with isolated subclinical sacroiliitis. In this group a higher frequency of peripheral arthritis and erythema nodosum was observed (p= NS compared to those without sacroiliitis). Most cases (60%) were grade II unilateral sacroiliitis. Three patients were HLA B27+ (p>0.05 compared to healthy controls). The resultant sensitivity of Amor’s and ESSG criteria ranged from 40% to 46%. An unexpectedly high freuqency (9.5%) of psoriasis was observed in the whole group. There is a high prevalence of isolated subclinical sacroiliitis in IBD. This may represent a forme fruste of enteropathic ankylosing spondylitis, a stunted form of axial involvement because of therapy, or a third category of rheumatic disease associated with IBD. It may also represent a common characteristic of spondyloarthropathies, rather than a specific finding of IBD. The recently developed spondyloarthropathy criteria are not particularly helpful for the diagnosis of this milder form of spondyloarthropathy. Received: 17 November 1999 / Accepted: 22 March 2000     

Spondyloarthropathy presenting at a young age: case report and review

The diagnosis of juvenile spondyloarthritis (JSA) is rarely entertained in young children who present with back and leg pain. We present a case of a 6-year-old male who presented with a 3-year history of severe back and leg pain and a positive Gower’s sign, and was given a presumed diagnosis of muscular dystrophy. Presenting serologic evaluation included a mildly elevated sedimentation rate and C-reactive protein (CRP). Computed tomography of the pelvis demonstrated large erosions affecting both sacro-iliac joints. Despite the unusually young age of this patient, ankylosing spondylitis seemed the most plausible diagnosis. Following rheumatological evaluation and treatment for JSA, he showed significant clinical improvement. His disease, however, has not entirely remitted with signs of enthesitis at the Achilles tendon and knees. We present this case to illustrate that JSA could account for symptoms at an early age and not considering it could lead to multiple medical visits and diagnoses. To our knowledge, based on a search of the World literature, this would appear to be the youngest case of JSA reported with demonstrable severe sacroiliitis. Presented at the 31st Annual members Meeting of the International Skeletal Society in Malta, September 2004.     

骶髂关节炎MRI研究概况

骶髂关节炎常见于脊柱关节病。传统X线平片、CT不利于早期诊断。磁共振成像(MRI)可检出骶髂关节软骨、骨板、关节旁骨髓、关节间隙、韧带及其附着点、腹背侧关节囊的异常。其优势为早于X线平片或CT发现骶髂关节炎,其关节区或关节旁的水肿及异常增强可评价炎症活动性。在临床药物治疗试验中,骶髂关节炎的MRI评分系统可量化影像的变化,监测疗效。MRI无电离辐射危害,适应于筛查和随访,是值得临床推广运用的影像检查。本文对骶髂关节炎的MRI表现和分级、早期诊断、活动性评价、临床药物试验应用及评分系统研究概况予以综述。     

强直性脊柱炎早期CT表现——白边征

目的 探讨强直性脊柱炎患者中骶髂关节白边征的形态学表现及临床意义。 方法 收集92例强直性脊柱炎患者,均接受骶髂关节CT检查,分析其影像学表现,并进行统计学分析。 结果 白边征表现为CT图像上骶髂关节髂骨关节面骨皮质带状、不均匀骨质致密区,骨缘不光滑。92例中,双侧骶髂关节受累84例(84/92,91.30%),单侧骶髂关节受累8例(8/92,8.70%);单纯髂骨面受累73例(73/92,79.35%)。骶髂关节炎Ⅰ级19例(19/92,20.65%),其中白边征9例(9/19,47.37%);Ⅱ级24例(24/92,26.09%),其中白边征13例(13/24,54.17%);Ⅲ级35例(35/92,38.04%),Ⅳ级14例(14/92,15.22%),均未见白边征。Ⅰ级、Ⅱ级及Ⅲ级以上骶髂关节炎中白边征出现率的差异有统计学意义(χ²=33.218,P<0.001)。 结论 骶髂关节白边征是AS的早期CT征象,可以考虑将其作为骶髂关节炎分级的参考指标。