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。

Application research on high-resolution computed tomography in early diagnosis of ankylosing apondylitis

Objective] To explore the early diagnostic value of using high-resolution computed tomography in ankylosing spondyhtis and sacroiliitis. Methods] 40 cases of imitated adult patients with ankylosing spondylitis underwent routine intersect CT scan and high-resolution lamellar multislice spiral CT scan. The CT images and ranking of sacroiliitis were analyzed respectively, following the CT-guided piqure biopsy on cacroiliac joint. CT result was contrasted with pathology result. Results] 36 of 40 cases were pathologically diagnosed as sacroiliitis, among them, 30 of 35 cases underwent routine intersect CT scan were correctly diagnosied, accurate rate reached 85.7%. Accurate diagnosis rate of affection ranking 1-2 was 68% while that of ranking 3-4 hit 100%. 5 cases were false positive, 4 cases were false negative; 32 of 34 cases underwent high-resolution lamellar multislice spiral CT scan were correctly diagnosied as sacroiliitis, accurate rate reached 94.1%. Accurate diagnosis rate of affection ranking 1- 2 was 80.7% wihle that of ranking 3-4 hit 100%. 2 cases were false positive, 1 case was false negative. Conclusions] High-resolution lamellar multislice spiral CT scan can clearly display tiny pathological change of cacroiliac joint, which greatly conduces to early diagnosis of ankylosing spondylitis and ranking evaluation on disease.