Oostveen J, Prevo R, den Boer J, van de Laar M
Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands.
J Rheumatol. 1999 Sep;26(9):1953-8.
To investigate the diagnostic value of magnetic resonance imaging (MRI) in the detection of early sacroiliitis.
Twenty-five consecutive HLA-B27 positive patients with inflammatory low back pain and < or = grade 2 unilateral sacroiliitis on conventional radiography (modified New York criteria) were studied. Erythrocyte sedimentation rate, C-reactive protein, plain radiography (PR), and MRI of the sacroiliac (SI) joints were obtained at study entry and PR of the SI joints after 3 years. Each radiograph and MR image set was interpreted independently. SI joints were scored according to the modified New York Criteria for radiological sacroiliitis. MRI scans were also scored for the presence of subchondral marrow edema. The relationship between > or = grade 2 sacroiliitis (by modified New York criteria for radiological sacroiliitis) shown on MRI and the subsequent development of > or = grade 2 sacroiliitis on PR after 3 years was investigated.
At study entry > or = grade 2 sacroiliitis was found on MRI in 36 of 50 SI joints. Edema was found in 20 of 50 SI joints. After 3 years > or = grade 2 sacroiliitis was found on PR in 21 of 44 SI joints. The positive predictive value of > or = grade 2 sacroiliitis on MRI for the development of > or = grade 2 sacroiliitis on PR after 3 years was 60%; sensitivity was 85% and specificity 47%.
Our data suggest that MRI of the SI joints can be used to identify sacroiliitis earlier than PR.
探讨磁共振成像（MRI）在早期骶髂关节炎检测中的诊断价值。
对25例连续的HLA - B27阳性且有炎性下背痛、传统X线摄影（改良纽约标准）显示单侧骶髂关节炎≤2级的患者进行研究。在研究开始时获取红细胞沉降率、C反应蛋白、骶髂关节的X线平片（PR）及MRI，3年后获取骶髂关节的PR。每组X线片和MR图像均由独立人员解读。骶髂关节根据改良纽约标准进行放射学骶髂关节炎评分。MRI扫描还对软骨下骨髓水肿情况进行评分。研究MRI显示的≥2级骶髂关节炎（根据放射学骶髂关节炎改良纽约标准）与3年后PR显示的≥2级骶髂关节炎后续发展之间的关系。
研究开始时，50个骶髂关节中有36个在MRI上显示≥2级骶髂关节炎。50个骶髂关节中有20个发现有水肿。3年后，44个骶髂关节中有21个在PR上显示≥2级骶髂关节炎。MRI上≥2级骶髂关节炎对3年后PR显示的≥2级骶髂关节炎发展的阳性预测值为60%；敏感性为85%，特异性为47%。
我们的数据表明，骶髂关节MRI比PR能更早地识别骶髂关节炎。
