超声与CT融合成像在定位强直性脊柱炎骶髂关节炎性血流信号中的价值

目的应用超声与CT融合成像对强直性脊柱炎(AS)患者骶髂关节区探及异常低阻血流信号的位置进行判断,探讨其临床应用价值。方法对84例AS患者实施经骶髂关节3对骶骨后孔层面(level)的超声与CT图像融合,并对图像融合成功者行多普勒超声检查。对两具骨盆标本实施骶髂关节系统解剖及断层解剖,根据其解剖学特点,对AS患者3个level层面处探及的低阻血流信号的位置进行分类,以此判断其组织来源。结果成功实施图像融合的AS患者中,level 1~3层面探及低阻血流信号的关节数分别为128个、105个和61个。3个level层面间炎性血流信号位置按关节内及周围定位的分布情况比较,差异有统计学意义(χ^2=9.101,P=0.011)。结合融合图像及解剖学研究结果,level 1和level 2层面探及低阻血流信号多定位于关节韧带部(128/128、98/105);而level 3层面血流信号多定为于滑膜部(39/61);仅少数位于level 2(2个)及level 3(10个)层面处于滑膜部及韧带部交界处的血流信号在融合图像下无法精确定位。3个level层面间炎性血流信号根据解剖学类型定位情况比较,差异有统计学意义(χ^2=174.607,P<0.01)。结论大多骶髂关节后部超声测得的异常血流信号可通过超声与CT融合成像准确地定位于关节韧带部或滑膜部,提示为不同的炎症类型;该低阻血流信号可作为评价AS的可靠指标之一。

The value of US and CT fusion imaging in locating inflammatory blood flow signals detected by CDUS in sacroiliac joint of ankylosing spondylitis patients

ObjectiveTo evaluate the effect of ultrasound and CT fusion imaging in locating inflammatory blood flow signals in sacroiliac joint(SIJ)of ankylosing spondylitis patients,and to explore its clinical application value.MethodsUS-CT image fusion of SIJs were performed on 84 patients at levels of 3 posterior sacral foramens,color Doppler ultrasound(CDUS)was performed on the successful image fusion.Two pelvic specimens were dissected with SIJ system and sectional anatomy.According to their anatomical characteristics,the positions of low-impedance blood flow signals detected at 3 levels of AS patients were classified to determine their tissue origin.Results Among the successfully performed image fusion of the AS patients,CDUS revealed abnormal low-impedance blood flow signals were 128 SIJs at level 1,105 at level 2,and 61 at level 3,respectively.The position of inflammatory blood flow signals among the three levels was compared according to the distribution of localization in and around the joints,the differences were statistically significant(χ^2=9.101,P=0.011).Combined with the fusion image and anatomical study of SIJ,the locations of abnormal low-impedance blood flow signals were initially confirmed:almost all the cases at level 1 and level 2 were located at joint ligament part(128/128,98/105).However,the majority of signals at level 3 were located at synovial part(39/61).Only a few signals located at the junction of synovium and ligament at level 2(2)and level3(10)were cannot be accurately located in the fusion image.The inflammatory blood flow signals between the 3 levels were compared according to the location of the anatomical type,and the differences were statistically significant(χ^2=174.607,P<0.01).ConclusionUS-CT fusion imaging can be used to locate abnormal low-impedance blood flow signals in the SIJs accurately in the joint ligament or synovial region.The signals at different levels indicate the different types of inflammation.The lowimpedance blood flow signal is a reliable index to evaluate AS.