强直性脊柱炎骶髂关节病变的X线、CT、MRI影像分析

目的：探讨强直性脊柱炎骶髂关节病变在X线、CT、MRI三种不同影像中改变的特点。方法：收集吉林省第四人民医院2003年6月～2008年11月诊治的79例患者影像资料，患者全部拍骨盆正位片及行骶髂关节CT扫描。其中10例患者行MR骶髂关节检查。观察分析骶髂关节骨质、滑膜、关节软骨、关节间隙及关节下骨组织的改变。结果：158个关节中X线：0级26个（16％），Ⅰ级27个（17％），Ⅱ级55个（35％），Ⅲ级36个（23％），Ⅳ级14个（9％）。CT表现：0级2个（1％），Ⅰ级37个（23％），Ⅱ级58个（37％），Ⅲ级45个（29％），Ⅳ级16个（10％）。MRI：X线、CT检查为0级患者MRI显示关节软骨间断线样高信号并伴有不同程度增厚，梯度回波序列可见骨髓腔内水肿信号。对X线CT检查后仅见轻微变化的关节可以显示关节面下T1WI低信号，T2WI高信号骨质受侵改变。结论：X线作为一种常规检查手段，具有方便经济的优势。CT对关节面骨质的侵蚀破坏、关节间隙内线样钙化较X线片清晰。MRI对早期滑膜水肿、骨髓腔内的水肿敏感特异。三者结合可准确反映早期强直性脊柱炎患者骶髂关节的改变．对患者能进行准确分级。

Analysis of X-ray,CT and MIU images for sacroiliac joint pathological changes of Ankylosing spondylitis

Objective：To discuss the different images characteristics of ankylosing spondylitis （AS） sacroiliac joints （SIJ） pathological changes in X ray, CT and MRI. Methods：Collected 79 cases of AS patients who were examined in the author＇s hospital from June 2003 to November 2008. All of them were taken X-ray at normal position of pelvis and CT scan at SIJ. 10 patients were examined SIJ by MRI. The changes of bone substance, synovial membrane, articular cartilage, joint space and bone structure under arthrosis were observed and analyzed. Results：Among the 158 SIJ images, there were 26 cases of level 0 （16%）, 27 cases of level Ⅰ （17%）, 55 cases of level Ⅱ （35%）, 36 cases of level Ⅲ（23%） and 14 cases of levelⅣ （9%） in X ray; there were 2 cases of level 0 （1%）, 37 cases of level Ⅰ （23%）, 58 cases of level Ⅱ （37%）, 45 cases of level Ⅲ （29%） and 16 cases of level Ⅳ （10%） in CT scan. The MR images of the patients who were in level 0 examined by X ray and CT showed high signal broken line, and their gradient echo sequence showed dropsy signal in medulla cavity. The eases which had slight changes of SIJ in X-ray and CT showed hypointensity on TIWI images and hyperintensity on T2WI images with ossein changing by invasion. Conclusion ：As a routine exam method, X-ray has the advantages of convenience and economy. The images of CT are clearer than X-ray in ossein corroded destruction of articular surface and line calcification inside joint space. MRI is sensitive in early dropsy of synovial membrane and dropsy in medulla cavity. The combination of X-ray, CT and MRI may reflect the early SIJ pathological changes of AS, and classify the patients into proper levels accurately.