磁共振诊断强直性脊柱炎骶髂关节病变的价值

目的评价磁共振诊断强直性脊柱炎（AS）骶髂关节病变的价值。方法对41例临床拟诊为AS的患者行MRI检查。使用Marconi超导型1.5T磁共振机型,脊柱线圈。患者仰卧位,扫描方位全部为轴位。采用常规SE（spine cho,SE）T1WI（TR 700ms,TE 12ms）序列、快速自旋回波FSE（fast spin echo,FSE）序列T2WI（TR 3000ms,TE90ms）、短时反转恢复（Short T1 Inversion-Recovery,STIR）序列（TR 4000ms,TE 90ms,TI 150ms）。层厚3mm,层间距0.8mm,采集矩阵256x256,NEX=2。结果 ASI级9例,Ⅱ级15例,Ⅲ级11例,IV级6例。侵及髂骨侧34例,侵及骶骨侧7例。I-Ⅱ级MRI主要表现为T2WI滑膜信号增高;T1WI显示软骨不规则增粗或扭曲,T2WI显示软骨信号增高,骨髓水肿信号不均匀增高。Ⅲ-Ⅳ级主要表现为：T2WI软骨信号不均匀增高或减低,骨性关节面有不同程度的破坏。骨质硬化的征象是线样的无信号带不规则增宽。骨髓水肿范围更大。结论 MRI检查方法敏感,无放射性,可以显示X线、CT观察不到的软骨异常、骨髓水肿等早期变化,应作为AS早期诊断的优选检查方法。

The Value of MRI in the Diagnosis of Ankylosing Spondylitis Sacroiliac Joint Lesions

Objective To evaluate the MRI diagnosis of ankylosing spondylitis （AS） sacro- iliac joint lesions. Methods Forty-one patients with clinical suspected AS underwent MRI scan. 1.5T MRI superconductive Marconi model with spine coil were utilized. Patient supine, scanning direction included oblique coronal, axial position. Conventional SE （spill echo, SE） T1WI （TR 700ms, TE 15ms） sequences, fast spin-echo FSE （fast spin echo, FSE） sequences T2WI （TR 3000 ms, TE 90ms）, short time inversion recovery （Short T I Inver- sion-Recovery, STIR） sequence （TR 4000ms, TE 90ms, TI 150ms） were used. Slice thick- ness were 3mm, spacing were 0.8 mm, acquisition matrix were 256x256, NEX = 2. Results AS included I grade 9 cases, II grade 15 cases, Ⅲ grade 1 1 cases, IV 6 cases. Lliac invasion were 34 cases, the sacral side invasion 7 cases. Class Ⅰ-Ⅱ mainly manifestations were T2WI MRI signal increasing in synovial; TIWI showed irregular thickening or distortion of the cartilage, T2W1 showed increased signal cartilage, bone marrow edema signal differential increased.Ⅲ - IV grade mainly manifestations were T2WI signal uneven increasing or reducing in cartilage, with different degrees of damage of bone of the articular surface. Signs of bone sclerosis was a line like no signal with irregular widened, with larger bone marrow edema. Conclusion MRI exalnination methods were more sensitive without non-radioactive, can show cartilage abnormalities, early changes of bone marrow edema that X-ray and CT cannot display. MRI should be as the preferred screening method in early diagnosis of AS.