强直性脊柱炎髋关节改变的X线、CT和MRI对比研究

目的 探讨强直性脊柱炎(AS)髋关节受累的影像表现,比较X线平片、CT和MRI显示AS髋关节受累的敏感度.方法 对55例AS患者行骨盆X线平片和MR检查,其中29例行髋关节CT检查.MR平扫均包括冠状面T1WI、T2WI、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.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示AS髋关节受累改变的敏感度进行分析.结果 55例AS患者110侧髋关节中,X线平片和MRI显示异常分别为13侧和85侧;X线平片改变包括关节面下骨侵蚀破坏13侧、关节间隙变窄4侧、韧带骨赘5侧;MRI显示关节面下骨侵蚀破坏31侧、关节间隙变窄4侧、关节少量积液80侧、骨髓水肿32侧、脂肪沉积28侧、韧带附着点炎21侧,24例行MR增强检查患者中19例见双侧滑膜异常强化.CT检查29例共58侧髋关节,CT在显示X线平片和MRI所显示的骨破坏同时,发现X线平片未能显示的10侧骨破坏和MRI未显示的1侧骨破坏.X线平片、CT、MRI显示异常分别为10.3％ (6/58)、27.6％ (16/58)和77.6％ (45/58),MRI显示髋关节受累的敏感度优于X线平片和CT(x2值分别为53.22和29.08,P值均＜0.05).MRI除显示X线平片和CT所能显示的慢性骨结构改变外,还发现X线平片和CT未能显示的急性炎症改变.结论 MRI能显示X线平片和CT不能显示的AS髋关节受累的急性炎症改变,滑膜炎所致的少量积液和滑膜异常强化是髋关节受累最常见的MRI表现.     

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。     

HLA-B27检查结合骶髂关节影像征象评价强直性脊柱炎

目的 评估HLA-B27检查及骶髂关节影像学改变对强直性脊柱炎(ankylosing spondylitis, AS)的诊断价值.方法 回顾性分析108例AS X线平片、CT表现、MR征象及HLA-B27检查的结果.结果 平片显示单侧骶髂关节改变14例(12.9%),双侧77例(71.3%),有髋关节改变59例(54.6%).CT对临床早期或进展期检查发现率93.7%(45/48).MRI对临床早期检查发现率88.2%(15/17).81例做HLA-B27检查,抗原阳性69例,阳性率85.2%.结论 骶髂关节正位片可以作为AS筛查,CT、MR扫描能提高疾病诊断的敏感性,影像学征象和HLA-B27检查,可对AS作出早期和正确的诊断.     

影像学对强直性脊柱炎骶髂关节病变的诊断价值

目的探讨强直性脊柱炎(AS)骶髂关节改变的影像学诊断价值。方法回顾性分析98例经临床证实的AS患者的骶髂关节CR、CT及MRI表现特点,包括分级、部位和数量、钙化、关节间隙变化及关节面下骨质改变等。结果AS骶髂关节病变的CR正位及斜位片显示:骶髂关节间隙变窄67例,关节面致密硬化22例,囊变15例,关节强直17例,钙化38例;CT显示:病变主要累及骶髂关节滑膜部髂骨侧,软骨钙化55例,关节间隙变窄42例,关节面及面下骨质结构囊变43例,硬化65例,骶髂韧带钙化52例;MRI显示:关节软骨破坏40例,病变区周围水肿57例,骨内脂肪沉积15例。结论对AS骶髂关节的检查,CR为最基本的方法,CT对AS的分级较准确,而MRI对AS骶髂关节病变可做出早期诊断。     

骶骨骨巨细胞瘤X线、CT及MRI表现

目的分析骶骨骨巨细胞瘤(GCT)的X线、CT和MRI表现特点,探讨三种影像检查方法的临床应用价值。资料与方法 21例骶骨GCT均经手术病理证实,所有病例均行X线、CT和MRI检查,分析骶骨GCT的X线平片、CT、MRI表现特点,将影像学表现与手术病理结果进行对照,并经双盲法分析确认。结果 21例中,X线和CT显示囊性膨胀性骨质破坏18例,溶骨性骨质破坏15例,骨包壳不完整14例,MRI显示骨质破坏10例。X线显示侵犯骶髂关节及髂骨5例,CT显示16例,MRI显示11例。CT平扫显示软组织肿块12例,CT增强显示16例,MRI显示16例,其中巨大囊实性软组织肿块12例,10例可见液平面,病灶周围可见软组织水肿及骨髓水肿。骨质破坏在MR SE T1WI上呈等低信号,T2WI呈等信号。骨包壳在MRI上表现为低信号,X线和CT上表现为硬化环。软组织肿块实性部分在T1WI为等信号,T2WI及短时反转恢复(STIR)呈等高信号。囊性部分在T1WI为低信号,T2WI及STIR呈等高信号。软组织水肿及骨髓水肿在T2WI及STIR呈高信号。CT和MRI增强软组织肿块实性部分明显强化,囊性部分不强化。结论 X线、CT和MRI从不...     

膝关节色素沉着绒毛结节性滑膜炎影像学表现

目的 探讨膝关节色素沉着绒毛结节性滑膜炎(PVNS)的病理与影像学表现.方法 对21例膝关节PVNS的影像学表现进行回顾性分析,并与手术病理结果对照.结果 4例X线平片表现为关节间隙增宽,关节边缘骨侵蚀伴硬化;8例CT显示关节囊肿胀、软骨下边缘骨侵蚀伴硬化;14例MR显示关节内脂肪垫受侵,10例半月板及交叉韧带受累,13例软骨或骨受侵.所有病例MRI表现均有滑膜增厚、关节内软组织结节,T1WI呈等或低信号,T2WI呈低或高低混杂信号,以及不同程度关节积液.结论 与CT、X线相比,MRI对膝关节PVNS的显示具有特征性,是诊断PVNS最理想的影像学检查方法.     

MRI和CT诊断早期强直性脊柱炎累及骶髂关节病变的应用分析

目的 探讨MRI和CT诊断强直性脊柱炎(AS)累及骶髂关节病变的临床价值。方法 选取收治的100例疑似AS骶髂关节病变患者，均行CT与MRI检查。分析CT与MRI对AS累及骶髂关节病变的诊断结果。结果 本组AS累及骶髂关节病变患者中MRI诊断阳性73例，CT诊断阳性63例。MRI诊断AS累及骶髂关节病变的敏感度、特异度、阴性预测值、阳性预测值、符合率均高于CT检查，差异有统计学意义(P<0.05)。MRI对AS累及骶髂关节面侵蚀、关节面下骨质囊变、关节软骨肿胀、骨髓水肿的诊断率高于CT检查，差异有统计学意义(P<0.05),MRI与CT检查对于骶髂关节间隙增宽或狭窄、关节面增生硬化的诊断率比较，差异无统计学意义(P>0.05)。AS累及骶髂关节患者的MRI主要表现为滑膜组织增厚，呈等长或略长T₁、长T₂信号，增强后呈中度至明显的强化，且关节软骨边缘毛糙，关节面下骨质内见片状异常信号。CT影像主要表现为关节面骨质呈锯齿状，且伴有多发小囊变，关节间隙模糊、变窄，受累处通常位于关节中下部，髂骨侧较为明显。结论 MRI早期诊断AS累...     

获得性骨肥大综合征的影像表现

目的 分析获得性骨肥大(SAPHO)综合征的影像表现.方法 回顾性分析11例SAPHO综合征的影像资料,男6例、女5例,年龄28～68岁,平均51岁,X线平片检查9例、CT检查10例、MR检查3例、核索扫描检查3例.结果 9例胸前壁X线平片表现为胸骨上部、第一前肋及锁骨增生、硬化并肥大,相互之间骨桥形成或骨性融合;10例胸前壁CT检查,9例表现为胸、肋、锁骨区骨质增生硬化伴有骨质破坏,胸锁关节和胸肋之间骨性融合,1例仅表现为胸骨柄体关节骨质硬化,2例在轴面像上胸骨柄上缘似"海鸥翅"样改变.11例患者中除1例胸骨病变仪累及胸骨柄体关节外,其余10例胸前壁均多骨受累,其中8例呈对称性,2例为偏侧性(均为右侧).除胸前壁骨病变外,伴有骶髂关节炎、髂骨骨髓炎1例,胸椎骨髓炎2例,腰椎致密骨炎1例和双手掌指关节骨关节炎1例.MR检查3例,分别是胸锁关节、胸椎和骶髂关节,MRI显示锁骨头周围软组织肥厚,胸椎病变表现为椎体内T1WI呈低信号,T2WI呈混杂信号,抑脂像以高信号为主,骶髂关节见软骨下长T1WI短T2WI信号.核素扫描3例,显示胸骨上部及锁骨区呈"T"形异常高浓聚.结论 胸前壁多骨受累是SAPHO综合征主要影像特点,可并发骶髂关节炎、脊椎及髂骨骨髓炎、腰椎致密骨炎和双手骨关节炎.     

获得性骨肥大综合征的影像表现

目的 分析获得性骨肥大(SAPHO)综合征的影像表现.方法 回顾性分析11例SAPHO综合征的影像资料,男6例、女5例,年龄28～68岁,平均51岁,X线平片检查9例、CT检查10例、MR检查3例、核索扫描检查3例.结果 9例胸前壁X线平片表现为胸骨上部、第一前肋及锁骨增生、硬化并肥大,相互之间骨桥形成或骨性融合;10例胸前壁CT检查,9例表现为胸、肋、锁骨区骨质增生硬化伴有骨质破坏,胸锁关节和胸肋之间骨性融合,1例仅表现为胸骨柄体关节骨质硬化,2例在轴面像上胸骨柄上缘似"海鸥翅"样改变.11例患者中除1例胸骨病变仪累及胸骨柄体关节外,其余10例胸前壁均多骨受累,其中8例呈对称性,2例为偏侧性(均为右侧).除胸前壁骨病变外,伴有骶髂关节炎、髂骨骨髓炎1例,胸椎骨髓炎2例,腰椎致密骨炎1例和双手掌指关节骨关节炎1例.MR检查3例,分别是胸锁关节、胸椎和骶髂关节,MRI显示锁骨头周围软组织肥厚,胸椎病变表现为椎体内T1WI呈低信号,T2WI呈混杂信号,抑脂像以高信号为主,骶髂关节见软骨下长T1WI短T2WI信号.核素扫描3例,显示胸骨上部及锁骨区呈"T"形异常高浓聚.结论 胸前壁多骨受累是SAPHO综合征主要影像特点,可并发骶髂关节炎、脊椎及髂骨骨髓炎、腰椎致密骨炎和双手骨关节炎.     

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。     

X线 CT和磁共振成像在早期强直性脊柱炎骶髂关节病变诊断中的应用价值对比分析

目的分析X线、CT、磁共振成像(MRI)3种检查手段诊断早期强直性脊柱炎骶髂关节病变的应用价值。方法选择我院2018年1月至2019年1月收治的46例早期强直性脊柱炎骶髂关节病变患者开展研究,所有患者均进行X线检查、MRI检查、CT检查,比较3种检查方法的疾病检出率。结果对早期强直性脊柱炎骶髂关节病变典型影像学表现(关节软骨肿胀关节面侵蚀关节面下骨质囊变)的检出率,X线分别是0、52%、39%,MRI为:9%、83%、70%;CT为4%、76%、59%;X线检出率明显低于MRI、CT,比较差异有统计学意义(P<0.05),MRI与CT检出率相差不大,比较差异无统计学意义(P>0.05)。对该病的病变分级总检出率中,X线为48%,CT为85%,MRI为96%,在早期病变(0~Ⅱ级)的检出率中,X线为26%,CT为59%,MRI为65%,X线、CT、MRI在病变分级总检出率、0~Ⅱ级病变检出率的比较差异均有统计学意义(P<0.05),但是在Ⅲ、Ⅳ级病变检出率中差异无统计学意义(P>0.05)。结论X线、CT、MRI检查手段诊断早期强直性脊柱炎骶髂关节病变都具有一定的诊断价值,但MRI的检出率最高,能够准确显示出病变情况,MRI更具诊断优势及应用价值。     

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。     

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.     

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。     

Comparison of radiography, computed tomography and magnetic resonance imaging in the detection of sacroiliitis accompanying ankylosing spondylitis

Objective. To compare magnetic resonance (MR) imaging, computed tomography (CT), and radiography in the detection of sacroiliitis accompanying ankylosing spondylitis (AS). Design and subjects. Nine volunteers and 24 patients were recruited. Radiography, CT, and MR imaging were completed within a 1-week period in 24 patients with AS. In precontrast MR examination, spin-echo T1, fast spin-echo T2, and gradient echo with rephasing T2* images were obtained without fat saturation using a 0.3-T imager for all volunteers and patients. Postcontrast MR examination was performed using the same precontrast SE T1 sequence for patients with AS. Results and conclusions. MR imaging directly showed the normal cartilage in all 16 sacroiliac joints of the 8 volunteers. In the 24 patients with AS, cartilage abnormalities were observed in 42 sacroiliac joints. More diagnoses of sacroiliitis were made using MR and CT imaging than using radiography (P<0.001). Therefore, low-field-strength MR can be useful in detecting early sacroiliitis in patients with AS. MR imaging was able to reveal early cartilage changes and bone marrow edema, which could not be found by either CT or radiography.     

改良髋关节磁共振成像扫描方法在发现骶髂关节病变中的应用价值

目的：通过对髋关节磁共振成像（MRI）冠状位扫描的改良,从而发现骶髂关节病变,弥补临床医生判断失误,提高疾病的检出率。方法对265例申请髋关节MRI检查的患者增加冠状位扫描层数,使每例患者双侧骶髂关节均能大部分显示。结果发现骶髂关节病变的共计20例,发现率为7．5％,年龄11-65岁,其中强直性脊柱炎16例,退行性骨关节炎2例,骶髂关节结核1例,外伤导致骨挫伤1例。结论骶髂关节病变,尤其是强直性脊柱炎是一种以危害年轻人为主的慢性炎性疾病,起病隐匿,临床部分患者以髋关节为主述症状,引起误诊,MRI在检查髋关节时适当在冠状位上增加扫描层数,能发现7．5％的遗漏病变,方法简便易行,值得推广。     

MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions

The aim of this study was to assess the ability of MRI determined synovial volumes and bone marrow oedema to predict progressions in bone erosions after 1 year in patients with different types of inflammatory joint diseases. Eighty-four patients underwent MRI, laboratory and clinical examination at baseline and 1 year later. Magnetic resonance imaging of the wrist and finger joints was performed in 22 patients with rheumatoid arthritis less than 3 years (group 1) who fulfilled the American College of Rheumatology (ACR) criteria for rheumatoid arthritis, 18 patients with reactive arthritis or psoriatic arthritis (group 2), 22 patients with more than 3 years duration of rheumatoid arthritis, who fulfilled the ACR criteria for rheumatoid arthritis (group 3), and 20 patients with arthralgia (group 4). The volume of the synovial membrane was outlined manually before and after gadodiamide injection on the T1-weighted sequences in the finger joints. Bones with marrow oedema were summed up in the wrist and fingers on short-tau inversion recovery sequences. These MRI features was compared with the number of bone erosions 1 year later. The MR images were scored independently under masked conditions. The synovial volumes in the finger joints assessed on pre-contrast images was highly predictive of bone erosions 1 year later in patients with rheumatoid arthritis (groups 1 and 3). The strongest individual predictor of bone erosions at 1-year follow-up was bone marrow oedema, if present at the wrist at baseline. Bone erosions on baseline MRI were in few cases reversible at follow-up MRI. The total synovial volume in the finger joints, and the presence of bone oedema in the wrist bones, seems to be predictive for the number of bone erosions 1 year later and may be used in screening. The importance of very early bone changes on MRI and the importance of the reversibility of these findings remain to be clarified.     

MR distribution of active inflammatory and chronic structural sacroiliac joint changes in axial spondyloarthropathy: Challenging conventional wisdom

ObjectiveEvaluate the MR distribution of inflammatory sacroiliac joint changes in axial spondyloarthritis phenotypes, including Ankylosing Spondylitis (AS) and non-radiographic Axial Spondyloarthritis (nrAxSpA).MethodsA retrospective review of 94 patients seen for treatment of axial spondyloarthritis (SpA) who underwent sacroiliac joint MRI between January 2011 and December 2015 was performed. MR images from 68 patients (20 with AS and 48 with nrAxSpA) were reviewed independently by two radiologists. Images were scored on presence of active inflammatory and chronic structural lesions. These lesions were further categorized as unilateral, bilateral and asymmetric, or bilateral and symmetric.ResultsNo statistically significant difference was found in the distribution (laterality or symmetry) of bone marrow edema or sclerosis between the AS and nr-axSpA groups. Osseous erosions were more commonly bilateral symmetric in AS than nr-axSpA (11/20 vs. 8/48, p = 0.01). No statistically significant difference was noted between bone marrow edema scores in the AS and nr-axSpA subgroups (2.6 vs 3.3, p = 0.514). Patients with AS had a significantly higher fat metaplasia score compared to patients with nr-axSpA (7.3 vs 1.1, p = 0.001). Patients with nr-axSpA had a higher mean score for erosions (11.6 vs 4.2, p = 0.001). Only patients classified as AS were found to have bony ankylosis. Inter-observer reliability was strong to excellent.ConclusionAnkylosing spondylitis findings at the sacroiliac joints are classically described as bilateral and symmetric on radiographs. Our study demonstrates that distribution on MRI at an individual time point is variable. The variable distribution should be considered when radiologists evaluate MRI exams of AS patients.