强直性脊柱炎骶髂关节病变的影像学研究

分析了43例正常骶髂关节CT表现并对30例强直性脊柱炎(AS)骶髂关节病变作了双盲X线和CT对照研究,正常成人滑膜部关节间隙宽度为2～5mm,40岁后,关节前下部间隙可出现局部狭窄,骶侧皮质厚度多小于3mm,前后均匀者占90%;髂侧中部皮质厚度小于5mm,其前部皮质厚度可大于5mm(占16%),部分正常人可出现关节面不清晰,但无明确的侵蚀改变,关节面的侵蚀是诊断早期骶髂关节炎的重要条件,AS骶髂关节病变的对照研究表明:对平片可疑的病变,CT常可排除或肯定诊断,早期病变(Ⅱ级),CT可提高一个级别;Ⅲ、Ⅳ级病变CT和平片分级相同.CT扫描可用于临床高度怀疑而平片难以确诊者;对Ⅲ、Ⅳ级病变如仅为诊断,则CT扫描似并非必需.     

强直性脊柱炎的影像学诊断

目的:研究强直性脊柱炎所致骶髂关节改变的X线及CT表现,探讨其早期征像,比较X线与CT对AS诊断的价值。方法:临床确诊的50例强直性脊柱炎患者,摄取骶髂关节正侧位平片,其中30例患者做骶髂关节CT扫描,总结其影像学表现与病理分级及临床分期的关系,并对两种检查方法所示结果进行比较分析。结果:AS早期骶髂关节改变影像学表现为:骨质侵蚀、虫蚀样破坏,囊变、周围骨硬化等,对于病变征像,X线与CT显示基本相同,X线为首选方法,但是CT对细微结构显示清楚,能更直观的反映病变的范围及关节间隙的改变,对早期病变显示优于X线平片,对Ⅲ、Ⅳ级病变,如仅满足诊断要求,CT扫描并非必需,对需观察病变及评价疗效者,CT是一种理想的检查方法。结论:骶髂关节骨质侵蚀、破坏、囊变、骨质硬化是AS的早期征像,CT对病变细节显示更清楚对早期病变更具敏感性,对疗效观察更为有利。     

MRI多序列联合应用在强直性脊柱炎相关骶髂关节病变中的诊断价值

目的：探讨M RI在强直性脊柱炎相关骶髂关节病变的诊断价值。方法对23例临床怀疑为强直性脊柱炎患者的X线平片、C T及M R检查结果进行分析。结果23例患者中X线平片检查确诊的7例共9侧;C T检查明确11例18侧骶髂关节病变;M RI多序列检查23例患者中均表现为异常,特别是X线平片及C T不能显示的骨髓水肿、滑膜病变、脂肪沉积、肌腱附着点炎、被膜炎及关节软骨破坏。结论 M RI多序列联合应用能发现X线平片及C T 不能显示的AS的早期病变表现,为临床怀疑AS病变相关性骶髂关节炎的首选检查方法。     

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。     

骶髂关节正斜位片在强直性脊柱炎（Ⅱ级以上）X线诊断中的应用价值

目的：评价骶髂关节正斜位片在强直性脊柱炎（Ⅱ级以上）X线诊断中的价值。资料和方法：根据目前常用强直性脊柱炎的纽约诊断标准，对临床上已确诊的120例强直性脊柱炎患者骶髂关节正斜位片与CT片进行对照分析。结果：X线组（60例）：阳性者49例，阴性者11例，阳性率为81．7％；CT组（60例）：阳性者55例，阴性者5例，阳性率为91．7％。结论：虽然对于强直性脊柱炎的诊断，X线组阳性率81．7％低于CT组阳性率91．7％，但二者的结果经统计学分析无显著性差异，故笔者认为X线检查中的骶髂关节正斜位片对于强直性脊柱炎（Ⅱ级以上）诊断可以达到与CT检查基本相同的阳性率。     

强直性脊柱炎的影像学诊断

目的：探讨强直性脊柱炎的影像学表现特点，分析其早期影像学表现，比较X线与CT对强直性脊柱炎的诊断价值。方法：回顾性分析临床确诊的43例强直性脊柱炎的影像学资料，总结其影像学表现特点。结果：骶髂关节炎影像学表现为骶髂关节关节面硬化、骨侵蚀、破坏，关节间隙模糊、狭窄、消失．脊椎骨质疏松、竹节样改变，外周关节间隙变窄、关节强直等。CT对早期骶髂关节病变显示明显优于X线摄影。结论：骶髂关节骨质侵蚀、破坏、囊变、骨质硬化是强直性脊柱炎的早期征象，CT检查对病变细节显示更清楚，对早期病变更具敏感性，能对强直性脊柱炎做出正确分期，对临床诊断及治疗预后有较高的准确性，优于X线平片。     

早期强直性脊柱炎骶髂关节病变的X线、CT和MRI对比研究

目的 比较X线平片、CT和MRI在早期强直性脊柱炎(AS)骶髂关节病变中的诊断价值.方法 对53例临床拟诊为AS的患者行骶髂关节X线平片和MR检查,MR平扫均包括骶髂关节斜冠状面T1WI、T2WI、短时反转恢复序列(STIR)、附加水激励的三维稳态快速梯度回波序列(3D-BTFE-WATS),其中24例同时行脂肪抑制T1WI增强检查;25例患者同时行CT检查.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示骨侵蚀破坏敏感度进行统计学分析.结果 53例患者的106侧骶髂关节中,X线平片和MRI显示关节面下骨侵蚀病变分别为16侧和63侧;25例CT检查中显示26侧骶髂关节面下存在骨侵蚀破坏.CT和MRI显示骨侵蚀敏感度相近(x2=0.16,P＞o.05),两者均优于x线平片(x2值分别为14.44和17.36,P值均＜0.05),在所应用的MR序列中,3 D-BTFE-WATS显示骨侵蚀破坏最佳.MRI除显示AS骶髂关节慢性骨结构改变外,显示骨髓水肿 32例、滑膜增厚和(或)异常强化35例,脂肪沉积16例、韧带附着点炎15例、被膜炎9例和关节软骨破坏31例.结论 MRI能发现X线平片和CT不能显示的骨髓水肿和滑膜炎等急性炎性改变,早期诊断价值优于X线平片和CT.     

小儿骶髂关节外伤的CT表现

小儿骶髂关节外伤的CT 表现以往未见报导。文内报告6例,通过骶髂关节做5mm 层厚相邻层面CT 扫描、CT 随访及常规X 线照片。成长期骶髂关节外伤性分离可合并不常见的表现:半侧骨盆成长不良,相继出现骶髂关节融合及骨盆畸形伴肢体长度不等。本组5个小儿外伤后具骶髂关节间隙增宽X 线征者中仅一侧得到CT 证实。其中3例有CT 表现,而关节间隙本身无损。第5个病例在CT 上关节间隙正常,但双侧受累的骶髂关节都不规则。第6例的骶髂关节平片完全正常,但CT 显示左骶髂关节变窄。小儿外伤后伴软骨下骨折的即时CT 扫描可显     

膝关节内骨折检查方法的选择(附142例报告)

目的　深入探讨X线平片在诊断膝关节内骨折中的地位。方法　对 1 4 2例膝关节内骨折患者的X线检查进行了分析研究 ,全组病例均摄膝关节正侧位 ,部分加摄左、右斜位 ,其中 2 4例还进行了CT检查。结果　首次检查X线正侧位平片发现骨折 1 2 7例 ,轴位及左、右斜位发现骨折 8例 ;第 2次后平片检查共检出骨折 1 39例 (另 3例可能因石膏固定骨折线观察不清 ) ;CT检查发现骨折 2 2例。结论　常规X线平片检查仍然是诊断膝关节内骨折的首选方法 ;CT检查可作为常规平片检查的补充 ,除发现少数隐匿性骨折外 ,还可进一步了解有无关节软骨及周边肌腱的损伤     

强直性脊柱炎骶髂关节病变CT扫描的诊断价值

目的 分析强直性脊柱炎(AS)之骶髂关节病变的影像学表现，评价CT对AS骶髂关节病变的诊断价值方法分析研究30例成人临床肯定的AS骶髂关节病变的影像学表现。结果 AS骶髂关节病变的早期影像学表现是首发于骶髂关节前下方滑膜处的骨质侵蚀。对此处病变的检出率CT明显高于平片。平片可疑病变CT基本可以确诊，同时分级更为精确。结论 CT能清晰显示骶髂关节的微细结构，对AS的早期征象敏感性较平片高，CT检查对早期病变的诊断有较高的价值。     

Observer variation in computed tomography of the sacroiliac joints: a retrospective analysis of 1383 cases

BACKGROUND: Computed tomography (CT) for evaluation of sacroiliitis has a higher diagnostic accuracy than radiography. There is a high degree of interobserver variation in evaluating sacroiliitis on radiographs. PURPOSE: To evaluate interobserver variation in CT of the sacroiliac joints for evaluation of sacroiliitis in a large number of patients. MATERIAL AND METHODS: 1383 CT examinations of the sacroiliac joints were reviewed by two observers. The outcomes as originally reported and the findings from the reviews were classified as no sacroiliitis, equivocal, unilateral sacroiliitis, or bilateral sacroiliitis. The unweighted kappa statistic was used for assessment of observer agreement. RESULTS: The interobserver agreement between the two reviewers was good (kappa = 0.6724), with excellent agreement on cases of bilateral sacroiliitis and moderate agreement on cases of unilateral sacroiliitis. Excellent agreement was also reached in normal cases. Compared to the original reports, there were moderate interobserver agreements between both reviewers' findings and the original reports (kappa = 0.4651 and kappa = 0.4481, respectively). CONCLUSION: The interobserver variation for the diagnosis of sacroiliitis on CT between two reviewers in a study setting showed good agreement, with moderate agreement between each of the observers and the original clinical reports. CT is a reliable method for evaluating the sacroiliac joints for changes of sacroiliitis.     

Technical note: CT scout views of the cervical spine in severely head-injured patients

 The objective of this study was the validation of a CT multiprojection scout view method for the evaluation of cervical spine integrity in severely head-injured patients. Following brain CT, 130 consecutive patients underwent anteroposterior, laterolateral, and 45° right and left oblique scout views of the cervical spine. The method allowed direct and prompt detection of traumatic lesions of the cervical spine in ten cases without moving the patients from the scanner table.     

Radiological and scintigraphic findings in patients with a clinical history of chronic inflammatory back pain

The prevalence of radiological abnormalities of the sacroiliac joints, the manubriosternal joint, and the lumbar spine were assessed, and quantitative sacroiliac scintigraphy was performed in 151 patients with a history of chronic inflammatory back pain and in 31 controls with non-inflammatory back pain. Sacroiliitis was found in 124 patients (82%), manubriosternal lesions in 84 patients (56%), and lesions of the lumbar spine in 58 patients (38%). In 19 patients (13%), manubriosternal lesions provided the sole radiological abnormality and in five patients (3%) no radiological abnormality could be demonstrated at any of these sites. Quantitative sacroiliac scintigraphy showed increased values in 69 of 137 patients examined (50%), but also in 10 out of 12 control patients with disc degeneration (83%) and is, therefore, nonspecific for inflammatory lesions. Radiological examination of the manubriosternal joint is recommended in patients with inflammatory back pain without radiographic evidence of sacroiliitis.     

Sacroiliitis: MR imaging findings

Magnetic resonance (MR) imaging was performed in seven asymptomatic volunteers and 17 patients with clinical and radiologic evidence of sacroiliitis. MR imaging findings were compared with those at computed tomography (CT) to determine the MR imaging appearance of the sacroiliac joint when normal and in sacroiliitis. The normal articulation was well depicted with MR imaging. Findings of sacroiliitis were identified in 20 sacroiliac joints (12 patients). MR imaging findings characteristic of sacroiliitis included abnormal cartilage signal intensity (95% of joints) and erosions (75% of joints) on T1-weighted images. Areas of increased intensity in the articulation (80% of joints) or in erosions (60% of joints) were seen on T2-weighted images. MR imaging was superior to CT for evaluation of cartilage and detection of erosions. Four sacroiliac joints (20%) and two patients (17%) with MR imaging findings of sacroiliitis were negative at CT. The authors conclude that MR imaging is a valuable method for detecting sacroiliitis, particularly when results of other imaging techniques are inconclusive.     

MR imaging of septic sacroiliitis

Septic sacroiliitis is difficult to diagnose, causing delayed treatment and increased morbidity. The traditional imaging techniques for diagnosis have been CT and nuclear medicine. Our purpose was to determine the ability of MR imaging to detect septic sacroiliitis, to evaluate the features of septic sacroiliitis with MR, and to compare the relative detection rate of MR, CT, and nuclear medicine. All patients with a discharge diagnosis of septic sacroiliitis who were evaluated by MR imaging of the pelvis were retrospectively evaluated. Five patients were collected with six septic sacroiliac joints, which were also evaluated with CT, 99mTc-methylene diphosphonate bone scans, and 67Ga-citrate scans. Abnormalities consistent with sacroiliitis were seen in all sacroiliac joints both prospectively (impression from the initial report) and retrospectively on MR. In addition to the nonspecific MR findings of inflammation and/or fluid in the sacroiliac joint space, bone marrow of the sacrum and/or ilium, and iliopsoas muscle, fluid/inflammation was uniquely identified tracking posterior to the iliopsoas muscle in each of these patients with septic sacroiliitis. Even in retrospect, a definite diagnosis of sacroiliitis could be made in only five of six joints by 67Ga-citrate scans, three of six joints by CT scans, and one of six joints by 99mTc-methylene diphosphonate bone scans. These results suggest MR imaging may be a sensitive modality in the early diagnosis of septic sacroiliitis.     

Computed tomography evaluation of the sacroiliac joints in Crohn disease

Computed tomography (CT) was used in a prospective study of the sacroiliac joints in 86 patients with Crohn disease to determine the type and frequency of sacroiliac joint abnormalities present in this population. The CT findings were correlated with review of the clinical history in 64 patients. Computed tomography demonstrated changes of sacroiliitis in 29% of the study group. This high prevalence of sacroiliac joint abnormality was found even in those under 30 years of age. It exceeds the 11–19% previously reported from plain film examination, reflecting the greater sensitivity of CT. In the subgroup of 64 patients studied clinically, 19 (30%) had abnormal sacroiliac joints on CT, but only 2 (3%) reported symptoms related to the sacroiliac joints.     

强直性脊柱炎骶髂关节病变早期的CT特征研究

目的：研究强直性脊柱炎（AS）骶髂关节病变早期的CT特征。方法：对23例AS患骶髂关节病变的CT征象进行了分析。结果：23例AS患中，骶髂关节双侧受累18例，单侧受累5例；14例为早期病变的CT表现，其中4例为可疑病变，10例CT表现为骨皮质限局性硬化， 关节面模糊不清或斑点状脱钙，软骨下微小囊变，这些表现多见于骶髂关节中下部髂骨面，关节间隙基本保持正常或略增宽。结论：CT能清晰地显示早期AS骶髂关节病变并作出早期诊断。     

强直性脊柱炎骶髂关节影像学分析(附24例骶髂关节平片、CT和MR影像对比观察)

目的：旨在评估强直性脊柱炎（ＡＳ）患者骶髂关节炎的ＭＲ影像特征，并比较Ｘ线平片、ＣＴ和ＭＲ影像在诊断骶髂关节炎中的作用。材料与方法：搜集２４例ＡＳ患者，分别行Ｘ线平片、ＣＴ和ＭＲＩ检查。增强前ＭＲ扫描序列包括ＳＥＴ１ＷＩ、ＦＳＥＴ２ＷＩ和梯度回波的准Ｔ２ＷＩ（ＧＲＴ２＊ＷＩ）。增强后ＭＲ扫描序列参数与增强前ＳＥＴ１ＷＩ相同。另选９例志愿者，行ＭＲ平扫检查。结果：８例志愿者１６个骶髂关节的Ｔ１ＷＩ和Ｔ２ＷＩ可直接显示正常骶髂关节软骨，表现为线形或点样的中等信号影。９例志愿者１１个骶髂关节的骨髓内可见局灶性脂肪沉积。２４例ＡＳ患者的４２个骶髂关节可见软骨异常，表现为Ｔ１ＷＩ和Ｔ２ＷＩ上正常线形中等信号的软骨影像消失，代之以不规则增粗或扭曲样中等信号。分析表明：在骶髂关节炎的诊断方面，ＭＲ和ＣＴ明显优于Ｘ线平片（Ｐ＜０．００１）。结论：同Ｘ线片比较，虽ＣＴ和ＭＲＩ均有助于ＡＳ骶髂关节炎的诊断，但ＭＲ影像可显示ＣＴ和Ｘ线所不能显示的软骨异常和骨髓内水肿改变；骨髓内脂肪沉积可属正常变异；扭曲样中等强度信号应视为软骨的异常征象。     

多层螺旋CT与磁共振成像在细微及隐匿性骨折诊断中的应用

目的探讨多层螺旋CT(MSCT)与磁共振成像(MRI)在细微及隐匿性骨折中的诊断价值。方法对69例车祸伤后,常规X线、普通CT检查阴性,但怀疑有骨折或临床症状明显者行MSCT和MRI检查。结果 MSCT检查发现52例细微骨折,其中鼻骨骨折8例,颅底骨折9例,脊柱骨折6例,肋骨骨折10例、骨关节骨折19例;另17例MSCT检查未见骨折征象,再行MRI检查并诊断为隐匿性骨折,其中脊柱骨折5例,骨关节骨折12例。结论 MSCT检查能发现常规X线与普通CT未能发现的细微骨折,对特殊部位,如颅底、肋骨骨折诊断有明显优势,对骨折的类型、骨折线涉及范围有较准确的诊断;而MRI检查可显示不能被MSCT所发现的骨挫伤及隐匿性骨折。MSCT与MRI联合应用,可为骨折患者的临床治疗及交通事故的医疗鉴定提供可靠的依据。