CAJ | 학술논문

目的探讨强直性脊柱炎(AS)髋关节受累的影像表现,比较X线平片、CT和MRI显示AS髋关节受累的敏感度.方法对55例AS患者行骨盆X线平片和MR检查,其中29例行髋关节CT检查.MR平扫均包括冠状面T1WI、T2WI、STIR、附加水激励的三维稳态快速梯度回波序列(3D-BTFE-WATS),其中24例同时行脂肪抑制T1WI增强检查.分析患者的影像资料,应用x2检验对X线平片、CT和MRI显示AS髋关节受累改变的敏感度进行分析.结果 55例AS患者110侧髋关节中,X线平片和MRI显示异常分别为13侧和85侧；X线平片改变包括关节面下骨侵蚀破坏13侧、关节间隙变窄4侧、韧带骨赘5侧；MRI显示关节面下骨侵蚀破坏31侧、关节间隙变窄4侧、关节少量积液80侧、骨髓水肿32侧、脂肪沉积28侧、韧带附着点炎21侧,24例行MR增强检查患者中19例见双侧滑膜异常强化.CT检查29例共58侧髋关节,CT在显示X线平片和MRI所显示的骨破坏同时,发现X线平片未能显示的10侧骨破坏和MRI未显示的1侧骨破坏.X线平片、CT、MRI显示异常分别为10.3％ (6/58)、27.6％ (16/58)和77.6％ (45/58),MRI显示髋关节受累的敏感度优于X线平片和CT(x2值分别为53.22和29.08,P值均＜0.05).MRI除显示X线平片和CT所能显示的慢性骨结构改变外,还发现X线平片和CT未能显示的急性炎症改变.结论 MRI能显示X线平片和CT不能显示的AS髋关节受累的急性炎症改变,滑膜炎所致的少量积液和滑膜异常强化是髋关节受累最常见的MRI表现.
목적 탐토강직성척주염(AS)관관절수루적영상표현,비교X선평편、CT화MRI현시AS관관절수루적민감도.방법 대55례AS환자행골분X선평편화MR검사,기중29례행관관절CT검사.MR평소균포괄관상면T1WI、T2WI、STIR、부가수격려적삼유은태쾌속제도회파서렬(3D-BTFE-WATS),기중24례동시행지방억제T1WI증강검사.분석환자적영상자료,응용x2검험대X선평편、CT화MRI현시AS관관절수루개변적민감도진행분석.결과 55례AS환자110측관관절중,X선평편화MRI현시이상분별위13측화85측；X선평편개변포괄관절면하골침식파배13측、관절간극변착4측、인대골췌5측；MRI현시관절면하골침식파배31측、관절간극변착4측、관절소량적액80측、골수수종32측、지방침적28측、인대부착점염21측,24례행MR증강검사환자중19례견쌍측활막이상강화.CT검사29례공58측관관절,CT재현시X선평편화MRI소현시적골파배동시,발현X선평편미능현시적10측골파배화MRI미현시적1측골파배.X선평편、CT、MRI현시이상분별위10.3％ (6/58)、27.6％ (16/58)화77.6％ (45/58),MRI현시관관절수루적민감도우우X선평편화CT(x2치분별위53.22화29.08,P치균＜0.05).MRI제현시X선평편화CT소능현시적만성골결구개변외,환발현X선평편화CT미능현시적급성염증개변.결론 MRI능현시X선평편화CT불능현시적AS관관절수루적급성염증개변,활막염소치적소량적액화활막이상강화시관관절수루최상견적MRI표현.
Objective To study the imaging findings of hip involvement and to compare the sensitivity of radiography,CT,and MRI in the identification of hip involvement in patients with ankylosing spondylitis(AS).Methods Anteroposterior radiography of the pelvis and MRI of hip were performed in 55 patients with AS.CT scan of hip was performed in 29 of 55 patients.T1-weighted,T2-weighted,short tau inversion recovery (STIR) and three dimensional balanced turbo field echo with water selective excitation (3D-BTFE-WATS) coronal sequences of hips were obtained in all patients,of which fat-saturated contrastenhanced T1-weighted sequence was performed in 24 patients.The imaging data of 55 patients were analyzed.The chi-square test was used to analyze the sensitivity in the identification of hip involvement among radiography,CT,and MRI.Results Among 110 hips in all 55 patients,abnormal changes were detected in 13 hips by radiography,85 hips by MRI.The findings of radiography included bone erosions in 13 hips,joint space narrowing in 4 hips,syndesmophytes in 5 hips.MRI revealed bone erosive destruction in 31 hips,joint space narrowing in 4 hips,joint effusion in 80 hips,subchondral bone marrow edema in 32 hips,fat accumulation of bone marrow in 28 hips,enthesitis in 21 hips.Bilateral synovial enhancement was showed in 19 of 24 patients who underwent fat-saturated contrast-enhanced T1-weighted sequence.Of the 58 hip joints in 29 patients who underwent CT examination,not only did CT show all bone erosions detected by radiography and MRI,but CT revealed bone erosive destruction that were not identified by radiography in 10 hips and by MRI in 1 hip as well.Abnormal changes were detected in 10.3％ (6/58)by radiography,27.6％ (16/58) by CT,and 77.6％ (45/58) by MRI.The sensitivity of MRI in the identification of hip involvement is higher than that of radiography and CT ( x2 =53.22 and 29.08,P ＜ 0.05 ).In addition to chronic bone structural changes,MRI depicted acute inflammatory changes which could not be detected by radiography and CT.Conclusions MRI can detect early acute inflammatory changes of hip joint that can not be showed by radiography and CT.Effusion of joint and synovial enhancement caused by synovitis are the most common MRI findings of the hip in patients with AS.