平扫CT与HRCT诊断强直性脊柱炎骶髂关节病变的对照研究

目的比较平扫CT和HRCT在强直性脊柱炎(AS)骶髂关节病变分级中的作用。方法对82例AS患者骶髂关节的平扫CT及HRCT表现进行分析。平扫CT检查使用GEHispeed型螺旋机,层厚5mm,间隔5mm。HRCT采用高分辨骨算法重建,层厚1.25mm,间隔5mm。依据纽约放射标准对病变分级,作平行对照研究,并进行统计学分析。结果对照研究表明,9个关节平扫CT可疑的病变,HRCT可以肯定诊断;22个关节平扫CT表现为早期病变(0~Ⅱ级)的患者HRCT对其分级更为准确;Ⅲ、Ⅳ级病变平扫CT和HRCT分级相仿(P>0.05)。结论HRCT对于AS骶髂关节早期病变的诊断优于平扫CT,而对于中度及重度关节炎的改变同平扫CT,诊断价值相同。     

影像学骶髂关节炎的鉴别诊断需密切结合临床特征

[目的]分析影像学骶髂关节炎的误诊病例和典型病例,提高对影像学骶髂关节炎包括强直性脊柱炎(AS)、致密性骨炎(OC)及跨专科疾病的认识.[方法](1)筛选出诊断明确,资料齐全的腰背痛或伴骶髂关节炎的误诊病例104例进行分析;(2)收集确诊的OC病例11例和AS病例50例,从临床表现、体格检查、影像学、实验室检查方面进行对比分析.[结果](1)104例误诊病例包括感染性疾病(29.81％)、骨关节疾病(26.92％)、内分泌代谢疾病(22.12％)、血液系统疾病(10.58％)和肿瘤(8.65％);(2)OC和AS的病例特点分析:OC组均为女性,均有下腰痛,大部分活动后加重,部分患者可有与AS相似的夜间痛和晨僵,Schober试验均阴性,CRP和ESR多正常,HLA-B27均阴性,骶髂关节X线和MRI显示OC的改变.AS组41例男性,9例女性,均有炎性腰痛表现,部分病人Schober试验阳性,CRP和ESR多升高,HLA-B27多阳性,骶髂关节X线和MRI显示AS的改变.[结论]影像学显示骶髂关节炎和伴有慢性腰背痛的疾病鉴别诊断需结合临床年龄、病史、症状、体征、实验室检查以及影像学检查等综合分析,注意跨专科疾病的诊断和鉴别,避免误诊.     

Infectious sacroiliitis: Retrospective analysis of 18 case patients

Introduction

Few infectious sacroiliitis reports are available in the literature. There is no standard clinical presentation, and diagnosis and treatments are therefore usually delayed. We aimed to describe this infection.

Analysis of clinical,radiological and laboratory variables in psoriatic arthritis with 25 Japanese patients

Psoriatic arthritis (PsA) has many clinical and radiological manifestations but lacks a specific laboratory marker. The aim of the present study was to identify noteworthy features in PsA patients on routine clinical examinations. The subjects were 25 PsA patients who were classified based on the Classification of Psoriatic Arthritis (CASPAR) criteria. The clinical and radiological findings and laboratory parameters were analyzed by retrospective chart review. On clinical examination, dactylitis was present in 13 (52%) of 25 patients, swollen and/or tender Achilles tendons were present in nine (36%), and sacroiliitis was present in eight (32%). Of the radiological features, juxta‐articular new bone formation (JANF) was seen in 12 (48%), extra‐articular new bone formation was seen in nine (36%) and sacroiliitis was seen in six (24%). Dactylitis and JANF had the highest prevalence rates. The Psoriasis Area and Severity Index score, swollen and/or tender joint count, erythrocyte sedimentation rate, C‐reactive protein, and matrix metalloproteinase‐3 were higher in patients with sacroiliitis than in those without sacroiliitis (P < 0.05). Dactylitis, JANF and sacroiliitis may be noteworthy manifestations in Japanese patients with PsA.     

Psoas abscess as a complication of pyogenic sacroiliitis: report of a case

A psoas abscess is, either primary or secondary, a rare entity for a general surgeon. Images by ultrasonography and computed tomography (CT) can help a general surgeon to make an accurate diagnosis when encountering the patient complaining of unilateral lower abdominal deep pain with fever. A case of pyogenic abscess of the psoas muscle as a result of sacroiliitis in a 22-year-old man is reported herein. The abdominal CT and magnetic resonance imaging scans demonstrated a large multilocular abscess extending along the iliopsoas muscle, and erosion and a widening of the left sacroiliac joint. The abscess was drained with an open surgical approach and the patient responded well to antibiotic therapy. Aggressive surgical and medical treatment is necessary in patients with psoas abscess to prevent complications. Received: March 5, 2001 / Accepted: November 20, 2001     

骶髂关节脂肪信号的MR影像评估——18例正常人和52例强直性脊柱炎对照分析

目的对比观察正常人与强直性脊柱炎（ＡＳ）患者骶髂关节的ＭＲ影像,特别是对脂肪信号在ＡＳ骶髂关节ＭＲＩ　所见的分析。方法１８例正常人及５２例ＡＳ骶髂关节炎患者分别行骶髂关节ＭＲＩ　检查。检查序列包括ＳＥＴ１ＷＩ　、ＦＳＥＴ２ＷＩ　、ＧＥＴ２ＷＩ　,所有影像分别由两名放射科医师观察分析。结果ＭＲＩ　检查中５２．８％的正常人骶髂关节的骶骨和／或髂骨内可见对称性分布或灶状分布的脂肪信号;５２例ＡＳ患者中有３５．６％的骶髂关节表现为关节下窄条状脂肪信号,紧邻骨质侵蚀及硬化,另有２５．０％骶髂关节内的脂肪信号分布与正常人骶髂关节脂肪信号相同;有８５．６％的骶髂关节可见软骨异常的改变;且可见骨质侵蚀、骨质硬化及关节下骨髓内水肿等征象。结论伴随骨质侵蚀及硬化的软骨下脂肪浸润是骶髂关节炎的征象之一。了解骶髂关节内脂肪信号分布的特点有助于骶髂关节炎的ＭＲ影像诊断。     

高分辨CT扫描在强直性脊柱炎早期诊断的应用研究

目的探讨高分辨CT对强直性脊柱炎骶髂关节炎的早期诊断价值。方法对40例临床拟诊成人型强直性脊柱炎的患者进行常规横断CT扫描及多层螺旋CT薄层高分辨率扫描，分别对骶髂关节炎的CT表现及分级进行分析，并在CT引导下对该组病人进行骶髂关节穿刺活检，将CT结果分别与病理结果相对比。结果40例中病理诊断骶髂关节炎36例，其中常规横断CT扫描诊断骶髂关节炎的35例中，30例诊断正确，准确率85．7％，病变分级为1～2级的病例诊断准确率70．6％，3-4级准确率100％。假阳性5例，假阴性4例；多层螺旋CT薄层高分辨率扫描诊断骶髂关节炎39例中，36例诊断正确，准确率92．3％，病变分级1-2级准确率85．7％，3-4级准确率100％。假阳性2例，假阴性1例。结论多层螺旋CT薄层高分辨率扫描能清晰显示骶髂关节的细微病理变化，有助于强直性脊柱炎的早期诊断及对疾病的分级评估。     

Hidradenitis suppurativa associated with Crohn’s disease and spondyloarthropathy: response to anti-TNF therapy

An association of hidradenitis suppurativa with Crohns disease is supported by previous repent. We here report a patient with hidradenitis suppurativa who subsequently developed peripheral arthritis, sacroiliitis, and Crohns disease. A significant attenuation of bowel, cutaneous, and joint symptoms was achieved after treatment with monoclonal antibody against tumor necrosis factor (TNF). The pathogenetic aspects according to the literature and response to the various therapeutic measures applied are also presented.     

Cooled Radiofrequency System for the Treatment of Chronic Pain from Sacroiliitis: The First Case‐Series

? Abstract: Sacroiliitis and sacroiliac (SI) joint dysfunction are frequent causes of the chronic lower back pain. Therapeutic solutions include intra‐atricular injections with short‐term pain relief and surgical fusion, which appears ineffective. Radiofrequency (RF) of the joint capsule or lateral branches has been previously reported with variable successes. Cooling tissue adjacent to the electrode (cooled RF) increases the radius of lesion. We present here the first retrospective data on pain relief and changes in function after such RF denervation. We reviewed electronic records of 27 patients with chronic low back pain (median 5 years) who underwent cooled RF of S1, S2, and S3 lateral branches and of dorsal ramus (DR) L5 following two diagnostic SI joint blocks (>50% of pain relief). Patient sample consisted of 20 women and 7 men, 38 to 92 years old. Pain disability index (PDI), visual analog scale (VAS) pain scores, global patient satisfaction (GPE) and opioid use before and 3–4 months after the procedure were analyzed. One patient had an incomplete chart. Observed were improvements in function (PDI) from 32.7 ± 9.9 to 20.3 ± 12.1 (P < 0.001) and VAS pain scores 7.1 ± 1.6 to 4.2 ± 2.5 (P < 0.001) at 3–4 months after the procedure. Opioid use decreased from median 30 to 20 mg morphine equivalent. Eighteen patients rated their improvement in pain scores using GPE as improved or much improved, while eight claimed minimal or no improvement. The majority of patients with chronic SI joint pain experienced a clinically relevant degree of pain relief and improved function following cooled RF of sacral lateral branches and DR of L5 at 3–4 months follow‐up. ?