CAJ | 학술논문

目的总结34例误诊为脊柱关节炎患者的异常骶髂关节影像学特点.方法回顾性分析解放军总医院风湿科收治的以臀部及下腰痛为主诉的34例患者骶髂关节X线、CT、MRI及临床、实验室检查资料.结果 34例患者均因骶髂关节影像学的异常表现误诊为脊柱关节炎,其中骶髂关节感染24例,肿瘤4例,代谢性骨病2例,骶髂关节退行性变2例,痛风1例,特发性弥漫性骨肥厚1例.24例骶髂关节感染患者中10例行骶髂关节X线检查,5例可见明显异常;22例行CT检查,7例未见异常;均行MRI检查,均可见骨髓水肿,21例出现骨侵蚀,22例周围肌肉受累.4例肿瘤患者CT上未见或仅有可疑异常;除1例室管膜瘤外,余患者骶髂关节MRI上均可见骨髓水肿及骨侵蚀,而1例尤文(Ewing)肉瘤患者可见明显的周围肌肉受累.骶髂关节退行性变、代谢性骨病、特发性弥漫性骨肥厚患者CT或X线上均可见明显的骶髂关节异常,但MRI上仅见可疑至轻度的骨侵蚀.结论骶髂关节的骨髓水肿并不是脊柱关节炎的特有表现,临床上需综合分析患者临床和实验室检查资料,才能避免误诊.
목적 총결34례오진위척주관절염환자적이상저가관절영상학특점.방법 회고성분석해방군총의원풍습과수치적이둔부급하요통위주소적34례환자저가관절X선、CT、MRI급림상、실험실검사자료.결과 34례환자균인저가관절영상학적이상표현오진위척주관절염,기중저가관절감염24례,종류4례,대사성골병2례,저가관절퇴행성변2례,통풍1례,특발성미만성골비후1례.24례저가관절감염환자중10례행저가관절X선검사,5례가견명현이상;22례행CT검사,7례미견이상;균행MRI검사,균가견골수수종,21례출현골침식,22례주위기육수루.4례종류환자CT상미견혹부유가의이상;제1례실관막류외,여환자저가관절MRI상균가견골수수종급골침식,이1례우문(Ewing)육류환자가견명현적주위기육수루.저가관절퇴행성변、대사성골병、특발성미만성골비후환자CT혹X선상균가견명현적저가관절이상,단MRI상부견가의지경도적골침식.결론 저가관절적골수수종병불시척주관절염적특유표현,림상상수종합분석환자림상화실험실검사자료,재능피면오진.
Objective To study the imaging features of sacroiliac joints(SIJ) in patients who were misdiagnosed as spondyloarthritis(SpA).Methods A total of 34 patients with chief complaint of back pain and misdiagnosed as SpA from January 2007 to April 2013 in Department of Rheumatology Chinese PLA General Hospital were enrolled.The imaging,clinical manifestations,laboratory examinations data were analyzed.Result The main reason for misdiagnosis as SpA was because of sacroiliitis presenting on imaging.The final diagnoses included 24 patients as SIJ infection,4 patients as neoplastic diseases,2 patients as metabolic bone diseases,2 patients as sacroiliac joint degeneration,1 patient as gout of sacroiliac joint,1 patient as diffuse idiopathic bone hypertrophy.For patients with infection,there were 10 patients receiving X-ray and 22 patients receiving CT of SIJ.However,5 and 7 patients had negative results respectively.These patients with infection had abnormalities in MRI including all with bone marrow edema,21 patients with erosion of bone and joint,22 patients with muscle involved.As to the patients with malignancies,SIJ CT scan appeared normal.Bone marrow edema and erosion in MRI were found in all neoplasm patients expect one as ependymoma.Adjacent muscles were involved in the patient with Ewing's sarcoma.Either X-ray or CT in other patients demonstrated obvious abnormalities,but only mild erosion of bone was found in MRI.Conclusion Bone marrow edema of SIJ in MRI represented not only in patients with SpA.Rheumatologists should analyze the clinical manifestations and laboratory examinations comprehensively in order to avoid the misdiagnoses.