CAJ | 학술논문

目的：比较X线平片、CT和MRI在强直性脊柱炎（ AS）骶髂关节病变中的诊断价值。方法：60例临床拟诊为AS的患者行骶髂关节X线平片检查，其中36例行CT检查，45例行MRI检查，21例同时行CT、MRI检查。分析患者的影像资料，按临床早、中、晚期将36例同时行X线平片和CT检查的患者进行比较。并与MRI显示的骨髓水肿、关节软骨破坏、关节面下脂肪沉积、关节面硬化、关节面下骨侵蚀破坏进行比较。结果：X线检查显示处于0级的关节有10个， CT检查显示有6个关节提高了级别（4个Ⅰ级，2个Ⅱ级）；X线检查显示处于Ⅰ级的关节有10个，CT检查显示有4个提高了级别（3个Ⅱ级，1个Ⅲ级）；X线检查处于Ⅱ级的关节有25个，有5个提高了级别；对于Ⅲ和Ⅳ级的诊断，两者诊断结果偏差不大。 MRI除显示AS骶髂关节慢性骨结构改变外，同时显示X线平片和CT未能显示的骨髓水肿、关节软骨破坏和脂肪沉积。但MRI对关节面下骨侵蚀的敏感性不及CT，CT上21例显示了19例，而MRI仅显示了9例。结论：AS的骶髂关节病变影像诊断， X线平片检查最为基本，但反映的是中晚期病变情况；CT能较好地显示骨质病变情况；MRI可判断病变处于活动期与相对静止期，早期诊断价值优于X线平片和CT，并可对疗效进行评估。
목적：비교X선평편、CT화MRI재강직성척주염（ AS）저가관절병변중적진단개치。방법：60례림상의진위AS적환자행저가관절X선평편검사，기중36례행CT검사，45례행MRI검사，21례동시행CT、MRI검사。분석환자적영상자료，안림상조、중、만기장36례동시행X선평편화CT검사적환자진행비교。병여MRI현시적골수수종、관절연골파배、관절면하지방침적、관절면경화、관절면하골침식파배진행비교。결과：X선검사현시처우0급적관절유10개， CT검사현시유6개관절제고료급별（4개Ⅰ급，2개Ⅱ급）；X선검사현시처우Ⅰ급적관절유10개，CT검사현시유4개제고료급별（3개Ⅱ급，1개Ⅲ급）；X선검사처우Ⅱ급적관절유25개，유5개제고료급별；대우Ⅲ화Ⅳ급적진단，량자진단결과편차불대。 MRI제현시AS저가관절만성골결구개변외，동시현시X선평편화CT미능현시적골수수종、관절연골파배화지방침적。단MRI대관절면하골침식적민감성불급CT，CT상21례현시료19례，이MRI부현시료9례。결론：AS적저가관절병변영상진단， X선평편검사최위기본，단반영적시중만기병변정황；CT능교호지현시골질병변정황；MRI가판단병변처우활동기여상대정지기，조기진단개치우우X선평편화CT，병가대료효진행평고。
Objective:To compare the diagnostic value of either X-ray, CT or MRI in detection of abnormal sacroiliac joint changes in patients of ankylosing spondylitis(AS).Methods:Sixty patients with clinically sus-pected AS underwent X-ray scan in general,among whom 36 received CT scans,45 underwent MRI detection and 21 were detected with combined CT and MRI.The imaging information was analyzed and compared with that of 36 cases regarding X-ray and CT findings in the early ,medium and advanced stage of lesion, respectively.The imaging findings were also compared with MRI presentation relative to the bone marrow edema ,artic-ular cartilage destruction, subchondral fat deposition, articular surface hardening and subchondral bone erosion.Results:Findings of X-ray of sacroiliac joint were graded as 0(n=10),Ⅰ(n=10)and Ⅱ(n=25), yet the lesion levels were correspondingly increased on CT scans in 6 joints(grade Ⅰ in 4;gradeⅡ in 2),in 4 joints(GradeⅡ in 3,gradeⅢin 1)and in 5,respectively,whereas the estimated grade in Ⅲ and Ⅳ re-mained no significant difference on CT scans.Although MRI competently detected abnormal sacroiliac joint changes and subchondral bone marrow edema,cartilaginous disruption and fat depositions that failed to be ex-posed on X-ray examination and CT scanning,yet it was inferior to CT scans in sensitivity to exhibit the bony erosion under the articular facet(19 in CT vs.9 in MRI) .Conclusion:X-ray examination may serve as primary radiological diagnosis for and reveal sacroiliac joint lesions in medium and advanced stages in patients with established AS .CT scan can better dis-play the bone lesions,and MRI appears competent to distinguish the ac-tive and inactive disease and superior to X-ray and CT in early diagnosis and estimation of the therapeutic effects.thereauptic lesion in active stage and static stage.For early diagnosis and elvaluation of the activitie of AS , MRI may be the best choice.