超声评价强直性脊柱炎患者外周肌腱端病的临床应用

目的探索强直性脊柱炎患者外周肌腱端病的病变特征。方法通过二维及彩色多普勒超声检测30例强直性脊柱炎患者外周肌腱端,观察其声像图特征和血流情况,并对检查结果进行分析。结果所有受检的强直性脊柱炎患者均发现肌腱端异常,但是各个肌腱端的肌腱端病的发病率并不相同,且各个肌腱端的肌腱端病的异常声像表现也有明显差异。结论强直性脊柱炎患者肌腱端病的发病率很高,且各个肌腱端的肌腱端病的发病率和发病特点也各不相同,而超声可较敏感地探查出AS患者肌腱端的异常。     

Pelvis-shoulder coordination during level walking in patients with ankylosing spondylitis

Pelvis-shoulder coordination while walking may, as a consequence of changes in spinal structure and posture, be susceptible to modifications in ankylosing spondylitis (AS) sufferers. We designed an explanatory, cross-sectional trial to assess whether Pelvis-shoulder coordination during walking in AS patients differs from that in healthy subjects. Seventeen AS patients and 10 healthy sex- and age-matched subjects were enrolled. Gait analysis was performed in order to define the time-distance and kinematic characteristics during walking. Pelvis-shoulder coordination was calculated in terms of the continuous estimate of relative phase (CRP) between the pelvis and shoulder girdles on the transversal plane for the whole gait cycle (GC), as well as for its sub-phases. No differences were found between patients and controls as regards mean velocity, cadence and stride length. When kinematic variables were compared with those of healthy controls, AS patients displayed greater pelvic tilt and increased hip flexion in both the loading response (LR) and pre-swing (PSw) sub-phases. The CRP mean values significantly differed between groups. Moreover, patients displayed a peculiar CRP pattern, chiefly in the LR, terminal stance and PSw sub-phases. This visual consideration was confirmed by the analysis of the CRP mean values in these sub-phases of the GC. Our results suggest that the walking pattern of AS patients is characterized by altered Pelvis-shoulder coordination during the GC.     

强直性脊柱炎骶髂关节的CT诊断价值

目的探讨强直性脊柱炎（AS）患者骶髂关节病变的CT表现,并评价其对早期诊断的意义。方法对46例经临床证实AS患者骶髂天节病变的CT表现进行了回顾性分析,并参照修订的AS纽约标准（5级分类法）对全部患者的骶髂关节病变进行了分级。结果研究证实,本组46例均有异常CT表现。其中,Ⅱ级（早期,7例）CT表现为骶髂关节受累,关节面轻度硬化、毛糙,皮质白线消失,关节面细小囊变,但关节间隙仍正常;Ⅲ级（进展期,35例）CT表现为骶髂关节面呈虫蚀状侵蚀,软骨钙化,关节面骨质增生硬化,关节间隙略增宽或不均匀变窄;Ⅳ级（晚期,4例）CT表现为关节骨性强直,关节间隙消失。结论CT能清晰显示骶髂关节的微细结构及其病理改变,极有利于诊断AS患者早期骶髂关节病变。     

反复发热的强直性脊柱炎1例报道及相关文献复习

目的报道以反复发热伴脊柱外表现的强直性脊柱炎1例,并复习相关资料,以提高对其认识。方法通过对临床资料的回顾,分析其病因、发病机制,总结强直性脊柱炎的多种临床表现。结果强直性脊柱炎的临床表现多样,尤其是较隐匿的脊柱外表现,很难做到早期诊治。结论临床工作中,对强直性脊柱炎的脊柱外表现应予重视,以提高该病的早期诊治率,降低致残率,提高生活质量。     

The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis

Objective

To investigate the changes in hip MR imaging, evaluate the frequency of hip involvement and compare the value of clinical symptoms, radiographs, and MR imaging in the detection of hip involvement in patients with ankylosing spondylitis (AS).

Methods

Anteroposterior radiographs of the pelvis, MR imaging of the hip and clinical evaluation were undertaken in 58 patients with definite AS. All patients were followed up 3 years. Annual radiographs and clinical evaluation were carried out. The imaging data were independently assessed by two experienced radiologists who were blinded to patient identity and clinical characteristics. Based on the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system, BASRI-hip scores ≥2 were defined as radiological hip involvement. On MR imaging, both acute and chronic inflammatory changes were considered positive signs for hip involvement. Symptomatic hip involvement was defined as current or past pain or limitation of the hip movement. The statistical analysis was performed using the χ² test for comparison of sensitivity among clinical symptoms, radiographs, and MR imaging in the detection of hip involvement and the Student's t-test for comparison of disease duration between with and without hip involvement. A P value <0.05 was considered to be statistically significant. For interpreting MRI and radiographs, the percentage of agreement between the two assessors and the kappa coefficients were calculated.

Results

On MR imaging, positive changes were detected in 86 (74.1%) hips among 116 hips in all 58 patients. Joint effusion was observed in 73 (62.9%) hips; 23 out of 27 patients who underwent fat-saturated contrast-enhanced T₁-weighted sequences had abnormal synovial enhancement in bilateral hips. The other abnormal MR findings included subchondral bone marrow edema in 35 (30.2%) hips, enthesitis in 22 (19.0%) hips, fatty accumulation of the bone marrow in 28 (24.1%) hips, bone erosive destruction in 32 (27.6%) hips, and joint-space narrowing in 4 (3.4%) hips. Based on the BASRI-hip scoring system, 68, 24, 18, 6 and 0 hips had no, suspicious, mild, moderate or severe damage on conventional radiographs of the pelvis, respectively. Thirty-five hips in 20 patients had current or past pain or limitation. The proportion of hip involvement according to MR imaging, radiographs, and clinical symptoms was 74.1% (86/116), 20.7% (24/116), and 30.2% (35/116), respectively. MR imaging yielded higher values than radiographs and clinical symptoms in the detection of hip involvement in patients with AS (χ² = 66.45 and 44.93, P <0.05). Interreader reliability for interpretation of findings was acceptable for both MRI and radiographs. During follow-up, radiological hip involvement were found in 10 hips with BASRI-hip scores ≤1 at baseline and clinical symptoms appeared in 15 sides of the original asymptomatic hip. On baseline MR imaging, inflammatory changes were seen in all hips which appeared symptoms and/or radiological involvement both at baseline and during follow-up.

Conclusion

The proportion of hip involvement is much higher than that suggested by radiographic changes and clinical symptoms. MR imaging is superior to conventional radiographs and clinical symptoms in the detection of hip involvement. Joint effusion and synovial enhancement caused by synovitis are the commonest hip findings on MR imaging in patients with AS.     

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。     

mDixon Quant脂肪定量技术对强直性脊柱炎骶髂关节炎的应用研究

目的 探讨mDIXON Quant脂肪定量技术在强直性脊柱炎骶髂关节病变中的应用价值。方法 收集诊断明确的强直性脊柱炎患者63名,20名健康志愿者。所有受试者均行双侧骶髂关节常规扫描、mDIXON Quant检查。观察患者的影像表现、BASDAI评分、实验室指标将患者分为3组：早期活动组、慢性活动组、非活动组,在mDIXON Quant序列脂肪分数映射图中测量三组骨髓水肿区、脂肪沉积区以及四组病变外区的脂肪分数,比较早期活动组、慢性活动组骨髓水肿病灶以及慢性活动组、非活动组的脂肪沉积病灶脂肪分数的差异。应用单因素方差分析比较4组间病变外区骨髓的脂肪分数的差异。结果 骨髓水肿灶的脂肪分数：慢性活动组高于早期活动组,脂肪分数分别为（30.0±10.6）％、（20.3±10.2）％,脂肪沉积区的脂肪分数：非活动组高于慢性活动组,脂肪分数分别为（89.4±1.1）％、（81.6±1.7）％,病变外区骨髓的脂肪分数,四组间脂肪分数差异无统计学意义（F=1.37,P＞0.05）。结论 mDIXON Quant技术通过测量脂肪分数,可以量化骶髂关节炎骨髓水肿区、脂肪沉积区的脂肪含量,在判断病情变化中具有价值。     

强直性脊柱炎髋关节病变早期影像征象探讨

目的研究强直性脊柱炎髋关节病变的X线平片、CT、MRI表现及其早期征象。方法从65例强直性脊柱炎髋关节病变中筛选出23例资料完整、临床证实的强直性脊柱炎髋关节病变的X线平片、CT及MRI资料进行分析和研究，人组标准：a）有强直性脊柱炎髋关节病变临床症状；b）符合纽约诊断标准；c）X线平片、CT及MRI三种检查资料完整；d）HLA—B27阳性；e）排除股骨头无菌性坏死等其他疾病。结果研究发现髋臼囊变出现率100％，出现在其他异常征象之前，且能独立出现，并存在于强直性脊柱炎髋关节病变全过程。在早期，本组23例中18例髋臼囊变单独存在，而无其他异常征象，在进展期，其他征象如关节间隙变窄、股骨头囊变等均与髋臼囊变并存。结论髋臼囊变是强直性脊柱炎髋关节病变的早期影像征象，且在所有征象中最具特征性，对确定强直性脊柱炎髋关节病变早期诊断有重要价值。     

骶髂关节强直性脊柱炎CT表现的再分析

目的:提高对骶髂关节强直性脊柱炎CT变化特点的认识,尤其是早期诊断中容易混淆的征象。方法:收集近期临床确诊的强直性脊柱炎88例,另设50例无症状受检者的骶髂关节作对照,均行薄层CT扫描。结果:对照组关节面光滑,关节面下骨质清晰。疾病组关节间隙、关节面下松质骨硬化等改变都具有明显的变化特点。结论:关节面的破坏是该疾病CT诊断的核心问题,CT对Ⅱ级以上的诊断才具有肯定价值。     

Current radiodiagnostic concept of ankylosing spondylitis

Nine radiodiagnostic rules are drawn from the X-rays of 2125 ankylosing spondylitis patients. The significance of early diagnosis of the multicolored sacroiliac X-ray is looked onto; the syndesmophyte, squaring-phenomenon, barrel-shaped vertebra, Romanus and Andersson lesions, and the ossification of ligaments are discussed. The changes at the apophyseal and the costovertebral joints, unimportant for early diagnosis, are explored.     

强直性脊柱炎与致密性骨炎的CT鉴别诊断(附59例报告)

目的 探讨强直性脊柱炎与致密性骨炎的临床及影像学鉴别诊断。方法 对38例强直性脊柱炎。21例致密性骨炎临床表现与影像检查进行回顾性分析对比。结果 强直性脊柱炎与致密性骨炎均好发于骶髂关节附近，二最常见的临床症状均为下腰部疼痛，而强直性脊柱炎除有下腰部疼痛外，往往伴有僵硬感，影像方面，强直性脊柱炎常损害骶髂关节，造成骶髂关节的狭窄及强直，伴新骨生成及下腰部韧带骨化。而致密性骨炎病变多只限于髂骨部，并不侵犯关节面。结论 CT检查对强直性脊柱炎与致密性骨炎的诊断及鉴别诊断价值很大。     

Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography

Objective To evaluate the relationship between power Doppler ultrasonography (PDUS) assessment and clinical variables including enthesitis index, pain threshold and disease activity parameters, and to document grey-scale US findings of the 13 entheses examined.Design and patients A total of 390 entheses were examined in thirty patients with AS, and clinical variables of the Maastricht Ankylosing Spondylitis Enthesitis Index (MASES), anthropometric measurements, disease activity and functional parameters were documented. A total MASES score by palpation (t-PS) and algometric pressure pain threshold (t-PPT) was obtained. Grey scale and PDUS examination of 13 entheses were performed. Grey-scale changes such as altered tendon echogenity, calcification, cortical reactive changes and bursitis were noted, and flow on PDUS was graded semi-quantitatively.Results Cumulative power Doppler (t-PDS) score significantly correlated with t-PS and t-PPT. Ultimate correlations were found between power Doppler scores and pain, disease activity and disability parameters. Changes in grey scale combined with PDUS were more prevalent in lower-extremity entheses. The intraobserver agreement of flow signal grading was excellent (kappa=0.82). Clinical and sonographic results were concordant for three regions, but were discordant for four regions where tenderness was accepted as the sole clinical manifestation of enthesis.Conclusion Pain or tenderness is associated with increased vascularity of entheses. Power Doppler US examination of the entheses may be useful and complementary to the clinical evaluation, and further research is needed to assess its role in diagnosis and follow-up of disease course.     

MRI and CT of ankylosing spondylitis with vertebral scalloping

Summary Three cases of cauda equina syndrome in long-standing ankylosing spondylitis are reported. In all, vertebral scalloping and dural ectasia were confirmed by magnetic resonance imaging and computed tomography. MRI showed widening of the dural sac with signal intensity corresponding to cerebrospinal fluid. CT demonstrated asymmetrical lesions of the posterior elements of the lumbar spine. Myelography was not felt necessary to confirm the findings.     

Radiological changes of the symphysis in ankylosing spondylitis

Purpose: To evaluate the symphyseal changes in patients with ankylosing spondylitis.Material and Methods: Radiological-morphological changes of the symphysis were studied in 68 patients (66 men, 2 women) with ankylosing spondylitis whose age ranged from 21 to 75 years. The duration of the disease was from 2 to 50 years.Results and Conclusion: Changes in the symphysis were found in 16 patients (23.5%) and were less prominent than findings in the sacroiliac joints. We classified these changes into four stages: minimal changes, apparent destruction, reparation and ankylosis. The third and the fourth stages of the changes in the symphsis were found more frequently in patients who suffered from the disease for more than 15 years. Radiological evaluation of symphyseal changes can be helpful in the evaluation of disease progression as well as in establishing a differential diagnosis.     

MRI demonstration of arachnoiditis in cauda equina syndrome of ankylosing spondylitis

The cauda equina syndrome is a rare but well-recognised complication of longstanding ankylosing spondylitis, usually presenting when the joint disease is quiescent. The clinical and radiological findings in a patient with only a 3-year history, in whom the onset of joint and neurological symptoms was apparently simultaneous, are presented. MRI revealed characteristic expansion of the lumbar spinal canal with scalloping of the pedicles, laminae and spinous processes, related to numerous posterior dural diverticula. The quantity and extent of such diverticula are unusual. We demonstrated adherence of individual nerve roots to the arachnoid surface of these diverticula and to each other. In a second patient, with a much longer history of both ankylosing spondylitis and cauda equina syndrome, MRI again showed florid, multilocular dural ectasia, marked irregularity and thickening of nerves, and adherence to the dural diverticula. These cases provide evidence for the role of arachnoiditis in the pathogenesis of the cauda equina syndrome of ankylosing spondylitis.     

Disco-vertebral destructive lesions (So-called Andersson Lesions) associated with ankylosing spondylitis

Radiological examination of 31 patients with established ankylosing spondylitis revealed 58 disco-vertebral destructive lesions. Careful assessment of their radiological features permitted differentiation into two main types, (1) inflammatory and (2) non-inflammatory. The inflammatory type may represent either an active inflammatory process or a late sequel to such a lesion. In this series 44 lesions were included in this category, with a marked predilection for the lumbar spine. Moreover, all were observed within the first decade following the onset of the disease.The non-inflammatory type reflects an attempt of a stress fracture in the diseased spinal column to repair by connective tissue, causing a pseudoarthrosis. Eleven such lesions were obseved in this series all occurring more than 12 years after the onset of the disease. In a much smaller group of three cases-here termed the ambivalent type — differentiation between the inflammatory and non-inflammatory types could not be established on radiological grounds alone. It is of interest that all three cases occurred within the first year after the onset of the disease.It is suggested that the term Andersson lesion should be used to include all disco-vertebral destructive lesions related to ankylosing spondylitis—be they of inflammatory or non-inflammatory pathogenesis —as the better known term Romanus lesion includes all types of circumscribed marginal destructive lesions of vertebral bodies without involvement of the disc in ankylosing spondylitis.     

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.     

Adhesive arachnoiditis causing cauda equina syndrome in ankylosing spondylitis: CT and MRI demonstration of dural calcification and a dorsal dural diverticulum

We present the radiological features of a 42-year-old man with long-standing inactive ankylosing spondylitis (AS), demonstrating that arachnoiditis is a cause of a cauda equina syndrome (CES) in this disease. CT showed a dorsal arachnoid diverticulum causing scalloped erosion of the laminae, and punctate and curvilinear dural calcification. MRI revealed adhesion and convergence of the cauda equina dorsally into the arachnoid pouch, causing the dural sac to appear empty canal. To the best of our knowledge, dural calcification on CT is a new finding in AS, which may be related to the CES. Our findings support the hypothesis that chronic adhesive arachnoiditis with subsequent loss of meningeal elasticity may be the main cause of CES in AS. Received: 24 August 1998 Accepted: 2 December 1998     

Diagnostic value of diffusion weighted magnetic resonance image in early ankylosing spondylitis

Background

Diffusion-weighted MRI (DW-MRI) shows the early changes in microscopical movement of water molecules, hence diagnosis of early sacroiliitis which is one of the diagnostic criteria of seronegative spondyloarthropathies.

Objective

To determine the value of DW-MRI in detection of signal characteristics of the sacroiliac joints in patients with early ankylosing spondylitis (AS).

Patients and methods

Fifteen patients with clinically suspected AS, 20 patients with mechanical low back pain and 20 healthy controls underwent conventional MRI and DWI. Apparent diffusion coefficient (ADC) was measured. In addition ten clinically confirmed AS patients underwent whole body-DWI.

Results

Mean ADC values of both sacroiliac joints in AS patients were (0.523 ± 0.15) × 10⁻³ mm²/s in the ilium and (0.502 ± 0.15) × 10⁻³ mm²/s in the sacrum. There was no significant difference between mechanical LBP and healthy controls. But there was a significant difference between AS and LBP patients. Mean ADC value of focal lesions of clinically confirmed AS was 0.965 ± 0.25 × 10⁻³ mm²/s in the sacrum and 0.932 ± 0.31 × 10⁻³ mm²/s in the ilium.

Conclusion

Subchondral bone marrow ADC values of sacroiliac joints allow differentiation between inflammatory and mechanical LBP. Furthermore, it may be helpful in evaluating the efficacy of the treatment and determine disease prognosis.     

BMP-2和bFGF在强直性脊柱炎活动期病理性表达及意义

目的：探讨骨形态发生蛋白2（BMP-2）和碱性成纤维细胞生长因子（bFGF）在强直性脊柱炎（AS）活动期的病理性表达及意义。方法：通过原位杂交技术检测活动期AS患者与对照组（骨盆骨折患者）骶髂关节滑膜组织中BMP-2、bFGF的表达,用图像分析系统检测阳性细胞与阴性细胞灰度值。结果：在活动期AS患者骶髂关节滑膜组织中BMP-2和bFGF阳性表达,而对照组骶髂关节滑膜组织中BMP-2和bFGF阴性表达,图像灰度值比较有统计学差异（P（0.01）。结论：BMP-2和bFGF均为强直性脊柱炎病理性成骨过程中重要的成骨因子,它们与强直性脊柱炎骶髂关节成骨硬化过程密切相关。控制BMP-2、bFGF的表达可能阻断AS的病理性成骨硬化,为治疗强直性脊柱炎提供新的思路。