CAJ | 학술논문

目的评价磁共振弥散加权成像诊断早期强直性脊柱炎(AS)的应用价值,探讨AS全身弥散加权成像的显示效果.方法对2011年3至10月中山大学肿瘤医院16例早期AS及18例慢性腰背痛(LBP)患者进行骶髂关节磁共振弥散加权成像,测量并比较双侧骶髂关节软骨下骶骨及髂骨骨髓的表观弥散系数(ADC值),计算AS患者病灶ADC平均值.运用独立样本t检验对AS及LBP患者ADC值进行统计学比较分析,以P＜0.05为差异有统计学意义.另外对8例确诊的AS患者进行全身弥散加权成像,运用图像工作站进行MIP、MPR后处理,结合常规MRI图像,对比分析全身弥散加权成像的显示效果.结果 16例AS患者骶髂关节两侧软骨下髂骨骨髓ADC平均值(0.51 ±0.13) ×10-3 mm2/s、骶骨(0.49±0.17)×10-3 mm2/s;LBP组患者髂骨(0.32±0.06)×10-3mm2/s、骶骨(0.31±0.08)×10-3 mm2/s.前者ADC平均值均高于后者,差异有统计学意义(P＜0.05).8例确诊的AS患者行全身弥散加权成像,显示骶髂关节软骨下骨髓水肿以及骶髂关节外的病灶,与相应区域临床症状相符.AS患者骶骨区病灶ADC平均值(1.31±0.38)×10-3 mm2/s,髂骨区(1.18±0.27) ×l0-3 mm2/s.结论通过测量骶髂关节软骨下骨髓ADC值可以鉴别AS和LBP.全身弥散加权成像能通过MIP、MPR重建对AS患者进行全身综合评价,对指导治疗,评价预后及检测疗效具有意义.
목적 평개자공진미산가권성상진단조기강직성척주염(AS)적응용개치,탐토AS전신미산가권성상적현시효과.방법 대2011년3지10월중산대학종류의원16례조기AS급18례만성요배통(LBP)환자진행저가관절자공진미산가권성상,측량병비교쌍측저가관절연골하저골급가골골수적표관미산계수(ADC치),계산AS환자병조ADC평균치.운용독립양본t검험대AS급LBP환자ADC치진행통계학비교분석,이P＜0.05위차이유통계학의의.령외대8례학진적AS환자진행전신미산가권성상,운용도상공작참진행MIP、MPR후처리,결합상규MRI도상,대비분석전신미산가권성상적현시효과.결과 16례AS환자저가관절량측연골하가골골수ADC평균치(0.51 ±0.13) ×10-3 mm2/s、저골(0.49±0.17)×10-3 mm2/s;LBP조환자가골(0.32±0.06)×10-3mm2/s、저골(0.31±0.08)×10-3 mm2/s.전자ADC평균치균고우후자,차이유통계학의의(P＜0.05).8례학진적AS환자행전신미산가권성상,현시저가관절연골하골수수종이급저가관절외적병조,여상응구역림상증상상부.AS환자저골구병조ADC평균치(1.31±0.38)×10-3 mm2/s,가골구(1.18±0.27) ×l0-3 mm2/s.결론 통과측량저가관절연골하골수ADC치가이감별AS화LBP.전신미산가권성상능통과MIP、MPR중건대AS환자진행전신종합평개,대지도치료,평개예후급검측료효구유의의.
Objective To evaluate the magnetic resonance diffusion-weighted imaging (DWI) in the detection of early ankylosing spondylitis and explore the manifestations of ankylosing spondylitis on whole body DWI (WB-DWI).Methods A total of 16 patients with early ankylosing spondylitis (AS) and 18 patients with low back pain (LBP) were recruited.Subchondral bone marrow apparent diffusion coefficient (ADC) in bilateral ilia and sacrum along sacroiliac joints were compared.An independent sample t-test (SPSS 16.0,SPSS,Chicago,Ⅲ) was utilized to analyze the ADC value differences between groups.P ＜0.05 denoted statistical significance.The mean ADC values of focal lesions in AS patients were also measured.Whole body diffusion weighted imaging was performed in additional 8 clinical confirmed AS patients and analyzed with the techniques of maximum intensity projection (MIP) and multiplanar reconstruction (MPR) in comparison with conventional MRI images to investigate the detectability of AS lesions with whole body DWI.Results Mean ADC values in 16 AS patients were (0.51 ± 0.13) × 10-3mm2/s in ilia and (0.49 ±0.17) × 10-3 mm2/s in sacrum.Mean ADC values in 18 LBP patients were (0.32 ±0.06) × 10-3 mm2/s in ilia and (0.31 ±0.08) × 10-3 mm2/s in sacrum.The ADC value in AS patients were statistically significantly greater than those in ilia and sacrum of LBP patients.Whole body DWI detected abnormalities in 8 AS patients within bilateral sacroiliac joints and other sites corresponding to the clinical symptoms of patients.The mean ADC values of focal lesions of this patient cohort were (1.31 ±0.38) × 10-3 mm2/s in sacrum and (1.18 ± 0.27) × 10-3 mm2/s in ilia.Condusion Subchondral marrow ADC values along sacroiliac joints allow the differentiation of patients with early AS from LBP patients.In conjunctions with such post-processing techniques as MIP and MPR,WB-DWI allows a comprehensive assessment of AS patients to guide treatment,evaluate prognosis and follow therapeutic responses.