CAJ | 학술논문

目的：探讨磁共振 DWI 联合 DCE-MRI 诊断早期强直性脊柱炎的临床应用价值。方法：回顾性搜集48例临床早期活动性强直性脊柱炎患者影像资料，分析其 DWI 及 DCE 序列图像，分别测量骶侧髂侧关节面下骨髓的 ADC 值，并与21例健康志愿者的资料进行对比分析，计算增强因子 Fenh、增强斜率 Senh 和达峰时间 Tmax，并与正常组对照，绘制病例组时间-信号曲线（TIC），对 ADC 值与 Fenh、Senh 值之间关系进行统计学分析。结果：病例组髂骨侧关节面下骨髓区 ADC 平均值为（5．05±1．10）×10－4 mm2／s，骶骨侧为（4．63±0．79）×10－4 mm2／s，均较对照组增高；病例组骨髓区Fenh、Senh 高于对照组，Tmax 低于正常值；病例组 TIC 表现为Ⅱ型，Ⅲ型；病变区 ADC 值与 Fenh 值之间呈高度直线相关关系（P ＜0．05），相关系数 r＝0．705。结论：磁共振 DWI 及 DCE-MRI 对早期 AS 患者骶髂关节骨髓异常改变显示敏感；病变区 ADC 值与 Fenh 值相结合，增强了早期诊断本病的信心，提供了影像诊断的新思路。
목적：탐토자공진 DWI 연합 DCE-MRI 진단조기강직성척주염적림상응용개치。방법：회고성수집48례림상조기활동성강직성척주염환자영상자료，분석기 DWI 급 DCE 서렬도상，분별측량저측가측관절면하골수적 ADC 치，병여21례건강지원자적자료진행대비분석，계산증강인자 Fenh、증강사솔 Senh 화체봉시간 Tmax，병여정상조대조，회제병례조시간-신호곡선（TIC），대 ADC 치여 Fenh、Senh 치지간관계진행통계학분석。결과：병례조가골측관절면하골수구 ADC 평균치위（5．05±1．10）×10－4 mm2／s，저골측위（4．63±0．79）×10－4 mm2／s，균교대조조증고；병례조골수구Fenh、Senh 고우대조조，Tmax 저우정상치；병례조 TIC 표현위Ⅱ형，Ⅲ형；병변구 ADC 치여 Fenh 치지간정고도직선상관관계（P ＜0．05），상관계수 r＝0．705。결론：자공진 DWI 급 DCE-MRI 대조기 AS 환자저가관절골수이상개변현시민감；병변구 ADC 치여 Fenh 치상결합，증강료조기진단본병적신심，제공료영상진단적신사로。
Objective:To investigate the clinical application of diffusion-weighted imaging (DWI)and dynamic con-trast-enhanced MRI (DCE-MRI)in the diagnosis of early ankylosing spondylitis (AS)at sacroiliac joint.Methods:MR im-age data of 48 patients with early active AS was retrospectively reviewed.Based on DWI,the ADC values of bone marrow under the articular surface were measured and compared with those of 21 healthy volunteers (control group).In addition, the time-intensity curve (TIC)was obtained from DCE-MRI.The factor of enhancement (Fenh),slope of enhancement (Senh)and peak time (Tmax)were then calculated and compared with the control group.The relationships among ADC, Fenh and Senh were statistically analyzed.Results:In the patients'group,the mean ADC values were (5.05 ± 1.10 )× 10 -4 mm2/s on the iliac side and (4.63±0.79)×10 -4 mm2/s on the sacral side,which were higher than those in the control group.Moreover,the Fenh and Senh values of the marrow area were also higher than those in the control group;however, the Tmax was lower in the patients'group than the control group.The ADC and Fenh values in the affected area showed highly linear correlation (r=0.705,P <0.05).Conclusion:DWI and DCE-MRI are sensitive to the abnormal changes of sac-roiliac joints in the early ankylosing spondylitis.The combination of the ADC and Fenh provides us more confidence in early diagnosing AS.