CAJ | 학술논문

目的：比较DWI与对比增强MRI（CE-MRI）评估强直性脊柱炎（AS）骶髂关节炎活动性的价值。方法前瞻性收集符合修订的AS纽约标准的96例连续患者作为AS患者组，21名健康志愿者作为对照组。根据AS病情活动指数调查表评分、红细胞沉降率和C反应蛋白结果判断AS患者的活动性，将AS患者分为活动期组（60例）和稳定期组（36例）。所有受试者均行双侧骶髂关节常规扫描、DWI和CE-MRI检查。观察患者的影像表现，并测量病灶ADC值和信号强度增强率（ΔSI）。采用单向方差分析比较活动期AS患者、稳定期AS患者和对照组间ΔSI和ADC值的差异，以AS病情活动指数调查表评分、实验室检查结果的综合标准为金标准，采用ROC分析ΔSI和ADC值判断AS活动性的效能，并采用配对t检验比较ΔSI、ADC值ROC下面积。结果96例AS患者中，MRI显示骶髂关节炎骨髓水肿62例（活动期57例、稳定期5例），骶髂关节表面侵蚀11例（活动期4例、稳定期7例），骶髂关节骨质硬化15例（活动期6例、稳定期9例），骶髂关节脂肪沉积58例（活动期27例、稳定期31例）。AS活动期、AS稳定期和对照组间的ΔSI分别为（2.51±1.69）%、（1.19±0.67）%、（0.75±0.21）%，ADC值分别为（1.33±0.33）×10-3、（1.00±0.43）×10-3、（0.38±0.13）×10-3mm2/s，差异均有统计学意义（F值分别为18.375、16.366，P均<0.01），且ΔSI和ADC值两两比较的差异也均有统计学意义（P均<0.05）。ΔSI与ADC鉴别AS患者活动性的ROC下面积分别为0.814和0.730，差异无统计学意义（t=1.632，P=0.103）。以ΔSI=1.44%鉴别AS患者活动性的敏感度和特异度分别为81.67%及80.00%；以ADC值=1.15×10-3/mm2鉴别AS患者活动性的敏感度和特异度分别为76.67%及71.43%。结论 DWI与CE-MRI检测AS活动性的价值相似。
목적：비교DWI여대비증강MRI（CE-MRI）평고강직성척주염（AS）저가관절염활동성적개치。방법전첨성수집부합수정적AS뉴약표준적96례련속환자작위AS환자조，21명건강지원자작위대조조。근거AS병정활동지수조사표평분、홍세포침강솔화C반응단백결과판단AS환자적활동성，장AS환자분위활동기조（60례）화은정기조（36례）。소유수시자균행쌍측저가관절상규소묘、DWI화CE-MRI검사。관찰환자적영상표현，병측량병조ADC치화신호강도증강솔（ΔSI）。채용단향방차분석비교활동기AS환자、은정기AS환자화대조조간ΔSI화ADC치적차이，이AS병정활동지수조사표평분、실험실검사결과적종합표준위금표준，채용ROC분석ΔSI화ADC치판단AS활동성적효능，병채용배대t검험비교ΔSI、ADC치ROC하면적。결과96례AS환자중，MRI현시저가관절염골수수종62례（활동기57례、은정기5례），저가관절표면침식11례（활동기4례、은정기7례），저가관절골질경화15례（활동기6례、은정기9례），저가관절지방침적58례（활동기27례、은정기31례）。AS활동기、AS은정기화대조조간적ΔSI분별위（2.51±1.69）%、（1.19±0.67）%、（0.75±0.21）%，ADC치분별위（1.33±0.33）×10-3、（1.00±0.43）×10-3、（0.38±0.13）×10-3mm2/s，차이균유통계학의의（F치분별위18.375、16.366，P균<0.01），차ΔSI화ADC치량량비교적차이야균유통계학의의（P균<0.05）。ΔSI여ADC감별AS환자활동성적ROC하면적분별위0.814화0.730，차이무통계학의의（t=1.632，P=0.103）。이ΔSI=1.44%감별AS환자활동성적민감도화특이도분별위81.67%급80.00%；이ADC치=1.15×10-3/mm2감별AS환자활동성적민감도화특이도분별위76.67%급71.43%。결론 DWI여CE-MRI검측AS활동성적개치상사。
Objective To compare the value of assessment with DWI and contrast-enhanced MRI (CE-MRI) in activity of sacroiliitis of patients with ankylosing spondylitis(AS).Methods Ninety-six patients conforming to modified New York criteria were prospectively collectedas the AS group, and twenty-one healthy volunteers were enrolled into the control group. According to the Bath AS disease activity index (BASDAI), erythrocyte sedimentation rate and C-reaction protein, AS patients were divided into the active AS group (n=60) and the chronic AS group (n=36) . All subjects were performed with conventional MRI, DWI and CE-MRI of bilateral sacroiliac joints. The MRI manifestations were reviewed and the ADC values and signal intensity enhancement rate (ΔSI) were measured.ANOVA was performed for the comparison ofΔSI and ADC values among active AS group, chronic AS group and control group with BASDAI and lab test results as the gold standards. ROC was analyzed with ΔSI and ADC values for activity of AS and paired <br> samples t test was obtained to comparethe areas under the ROC ofΔSI and ADC values.Results Among 96 cases of AS patients, MRI of sacroiliac jointsshowed that 62 cases had subchondral bone edema (57 cases of active group, 5 cases of chronic group), that 11 cases had bone surface erosion(4 cases of active group, 7 cases of chronic group), that 15 cases had bone sclerosis(6 cases of active group, 9 cases of chronic group) and that 58 cases had fat deposition on the sacroiliac joints (27 cases of active group, 31 cases of chronic group). The ΔSI values of the active group, the chronic group and control group were respectively (2.51 ± 1.69)%,(1.19 ± 0.67)%and(0.75 ± 0.21)%, and the ADCvalues were(1.33 ± 0.33)× 10-3,(1.00 ± 0.43)× 10-3 and(0.38±0.13)×10-3mm2/s. There were significant differences forΔSI and ADC values among three groups (F=18.375, 16.366. P<0.01), and statistical significance ofΔSI and ADC values were found between every two groups of three(P< 0.05).The area under the ROC between ΔSI and ADC to determine activity of AS patients were respectively 0.814 and 0.730, which had nostatistical significance(t=1.632, P=0.103). The sensitivity and specificity to determine activity of AS patients byΔSI=1.44%were 81.67%and 80.00%.The sensitivity and specificity to determine activity of AS patients by ADC=1.15 × 10-3/mm2 were 76.67% and 71.43%.Conclusion DWI and CE-MRI performed equally in detecting activity of AS patients.