骨关节闪烁显像在强直性脊柱炎早期诊断中的价值

目的：探讨放射性核素骨关节显像在强直性脊柱炎(AS)早期诊断中的价值。方法：对依“修订纽约标准”临床诊断肯定AS患者23例，符合临床标准而无确定放射学改变的可能AS病人27例，及正常对照31例进行了骨关节闪烁显像研究。经静脉注射~(99m)Tc－MDP 3小时后，所有受检者均采集1.5倍放大的骨盆后位像，分别在两侧骶髂关节(SIJ)和骶骨取相同大小的矩形感兴趣区(ROI)，计算其比值SI/S作为骶髂关节指数，进行定量分析(QSS)；全身骨关节闪烁显像(WB)进行视觉分析。结果：对照组SI/S为1.20±0.17，可能AS组与肯定AS组分别为1.58±0.36和1.44±0.22(P<0.01)。以每例有一侧SI/S大于1.5为异常，两侧均小于1.5为正常，则可能AS组与肯定AS组阳性率分别为74.07％和47.83％(P<0.55)。WB显示AS患者存在SIJ外多处关节骨质代谢活跃灶，典型椎肋关节和脊椎明显不均匀性高摄取作为诊断依据，可能AS组与肯定AS组阳性率分别为44.44％和60.87％(P<0.05)。结合QSS与WB可能AS组和肯定AS组阳性率分别达85.19％和82.16％。结论：QSS有益于早期AS的诊断，而QSS与WB结合可进一步提高诊断灵敏性，并可明确病变的进展和累及部位。

Evaluation of bone scintigraphy in early diagnosis of ankylosing spondylitis

Objective: To investigate the value of radionuclide imaging in the early diagnosis of ankylosing spondylitis (AS). Method: A posterior planar film of the pelvis was obtained to calculate sacro-iliac joint(SIJ) radioactivity index(SI/S) for quantitatively analyses (quantitative sacroiliac joint scintigraphy, QSS) in 23 patients with confirmed AS, 27 patients with possible AS, and 31 controls; and whole body scintigraphy was performed for optical analysis, three hours after injection of 99mTc - MDP. Results: The mean SI/S in patients with possible AS (1.58±0.36) was significantly higher than the patients with confirmed AS (1.44±0.22) ( P＜0.01), and that of controls(1.20±0.17)( P＜0.001). If the value of SI/S exceed 1.5 was considered as abnormal, 20 of 27 possible AS were positive (74.07% ), while 11 of 23 confirmed AS were positive(47.83%) (P＜0.05). The presence of typical uptake pattern outside SIJ, especially costovertebral and spine in 12 of 27 patients with possible AS (44.44%), and in 14 of 23 confirmed AS(60. 87% ) were useful in suggesting the diagnosis. Conclusion: The study indicates that bone scintigraphy is useful in early diagnosis of ankylosing spondylitis and screening the sites of abnormality in bones and joints.