CAJ | 학술논문

目的通过与X线、CT及MRI的比较分析,探讨单光子发射计算机断层显像(SPECT)全身骨扫描在SpA诊断中的价值.方法 65例SpA患者均行SPECT全身骨扫描、骨盆X线平片、骶髂关节CT平扫,其中40例行MR增强扫描,收集所有影像学结果及其他临床资料进行比较与分析,应用x2检验、t检验进行统计学分析.结果65例SpA患者中,47例(72％)SPECT扫描提示骶髂关节炎.骨盆X线未见异常的19例患者中13例(68％)SPECT可显示骶髂关节炎(x2=19.760,P＜0.01),而X线骶髂关节炎≥Ⅱ级的34例中仅26例(76％)SPECT示骶髂关节炎(x2=9.067,P=0.003),2组间差异均有统计学意义.CT骶髂关节平扫未见异常的14例患者中8例(57％)SPECT显示骶髂关节炎(x2=11.200,P=0.001),CT显示骶髂关节炎≥Ⅱ级病变的38例患者中仅30例(79％)SPECT显示骶髂关节炎(x2=8.941,P=0.003),2组间差异均有统计学意义.40例行MRI增强扫描检查的SpA患者中,28例(70％)MRI结果显示骶髂关节炎,31例(78％)SPECT结果显示骶髂关节炎,差异无统计学意义(x2=0.239,P＞0.05).除骶髂关节炎外,SPECT可同时显示脊柱及其他关节的受累情况,其中脊柱受累最常见,其后依次为髋、膝、肩、踝、腕、股骨、肋骨、胸锁关节、肘、足跟等.结论SPECT在发现早期骶髂关节炎方面较X线片及CT有优势,而在发现中晚期骶髂关节炎的能力上不如X线及CT.SPECT发现骶髂关节炎症的敏感性与MR增强扫描相当,但除骶髂关节炎外,SPECT可同时显示脊柱及其他关节的受累情况.SPECT全身骨扫描对诊断SpA有较好的辅助价值,可以成为除X线、CT和MRI外另一种有用的补充手段.
목적 통과여X선、CT급MRI적비교분석,탐토단광자발사계산궤단층현상(SPECT)전신골소묘재SpA진단중적개치.방법 65례SpA환자균행SPECT전신골소묘、골분X선평편、저가관절CT평소,기중40례행MR증강소묘,수집소유영상학결과급기타림상자료진행비교여분석,응용x2검험、t검험진행통계학분석.결과65례SpA환자중,47례(72％)SPECT소묘제시저가관절염.골분X선미견이상적19례환자중13례(68％)SPECT가현시저가관절염(x2=19.760,P＜0.01),이X선저가관절염≥Ⅱ급적34례중부26례(76％)SPECT시저가관절염(x2=9.067,P=0.003),2조간차이균유통계학의의.CT저가관절평소미견이상적14례환자중8례(57％)SPECT현시저가관절염(x2=11.200,P=0.001),CT현시저가관절염≥Ⅱ급병변적38례환자중부30례(79％)SPECT현시저가관절염(x2=8.941,P=0.003),2조간차이균유통계학의의.40례행MRI증강소묘검사적SpA환자중,28례(70％)MRI결과현시저가관절염,31례(78％)SPECT결과현시저가관절염,차이무통계학의의(x2=0.239,P＞0.05).제저가관절염외,SPECT가동시현시척주급기타관절적수루정황,기중척주수루최상견,기후의차위관、슬、견、과、완、고골、륵골、흉쇄관절、주、족근등.결론SPECT재발현조기저가관절염방면교X선편급CT유우세,이재발현중만기저가관절염적능력상불여X선급CT.SPECT발현저가관절염증적민감성여MR증강소묘상당,단제저가관절염외,SPECT가동시현시척주급기타관절적수루정황.SPECT전신골소묘대진단SpA유교호적보조개치,가이성위제X선、CT화MRI외령일충유용적보충수단.
Objective To investigate the value of whole body bone scan with single photon emission computed tomography (SPECT) in the diagnosis of Spondyloarthropathies (SPA) by comparing with conventional X-ray,Sacroiliac joint CT and MRI contrast enhancement.Comparisons were tested by t test and Chisquare test.Methods A retrospective study on the diagnosis of sacroiliitis of SpA by SPECT was carried out at Peking University Shenzhen Hospital from October 2006 to June 2014,a total number of 65 patients with SpA (39 men and 26 women) were recruited.All patients underwent SPECT whole body scan,Pelvic conventional X-ray and sacroiliac joint CT scan,of which 40 patients underwent sacroiliac joint MRI contrast enhancement scan.Results of SPECT scan,conventional X-ray,sacroiliac joint CT scan and sacroiliac joint MRI contrast enhancement were collected and analyzed.Chi-square test and t-test were used to analyze the data.Results Forty-seven of 65 SpA patients (72％) were found to have sacroiliitis by SPECT.Thirteen of 19 SpA patients (68％) showed normal results by conventional X-ray scan were found to have sacroiliitis bySPECT scan (x2=19.760,P＜0.01),while only 26 of 34 SpA patients (76％) showed definite sacroiliitis (≥ Ⅱ grade) by X-ray were found to have sacroiliitis by SPECT (x2=9.067,P=0.003).Eight of 14 patients (57％) showed normal results by CT scan were found to have sacroiliitis by SPECT scan (x2=11.200,P=0.001),while only 30 of 38 SpA patients (79％) showed definite sacroiliitis (≥ Ⅱ grade) by CT scan were found to have sacroiliitis by SPECT scan (x2=8.941,P=0.003).Forty SpA patients underwent MRI enhancement scan,of which 28 patients (70％) were found to have sacroiliitis by MRI,31 patients (78％) were showed sacroiliitis by SPECT (x2=0.239,P＞0.05).Although the sensitivity in detecting sacroiliitis showed no significant difference between SPECT and MRI,SPECT could reveal the inflammation of spine and other joints in the same scan.Conclusion Comparing with Pelvic X-ray and Sacr-oiliac joint CT scan,SPECT has significantly higher sensitivity in the diagnosis of early sacroiliitis and sign-ificantly lower sensitivity in finding advanced stage sacroiliitis.Although the sensitivity in detecting sacroiliitis has shown no significant difference between SPECT and MRI,SPECT could reveal the inflammation of spine and other joints in the same scan.Results of this study suggest that SPECT has certain value in the diagnosis of SpA.SPECT can be used as a valuable supplementary imaging modalities in the diagnosis of SpA.