Maksymowych Walter P, Landewé Robert
Department of Medicine, University of Alberta, 562 Heritage Medical Research Building, Edmonton, Alta., Canada T6G 2S2.
Best Pract Res Clin Rheumatol. 2006 Jun;20(3):507-19. doi: 10.1016/j.berh.2006.03.006.
The introduction of symptomatically highly effective anti-tumour necrosis factor alpha therapies for ankylosing spondylitis (AS) has generated interest in the use of imaging to evaluate the potential structure-modifying properties of these agents. Several approaches have been developed to score the plain radiographic abnormalities in AS. Of these, the modified Stoke AS Spinal Score is the most responsive to change, although responsiveness is limited and requires a minimum of 2 years before significant change becomes apparent in patients on standard therapies. Magnetic resonance imaging (MRI) is the most sensitive imaging abnormality, and the advent of fat-suppression imaging allows detection of bone marrow inflammation in the sacroiliac joints as one of the earliest abnormalities in AS. Limited studies have shown that spinal inflammation can be scored reliably using either a system that evaluates the entire spine or a system that limits evaluation to only the most severely affected spinal segments. Both methods also demonstrate excellent responsiveness. The prognostic significance of acute changes on MRI remains unclear. Reliable approaches to the evaluation of chronic changes are yet to be developed. MRI represents a major advance in the diagnostic evaluation of AS.
针对强直性脊柱炎（AS）的具有显著症状缓解效果的抗肿瘤坏死因子α疗法的引入，引发了人们对于利用影像学评估这些药物潜在结构改善特性的兴趣。已经开发出几种方法来对AS的平片放射学异常进行评分。其中，改良斯托克AS脊柱评分对变化最为敏感，尽管其反应性有限，并且在接受标准治疗的患者中，至少需要2年时间才能明显看出显著变化。磁共振成像（MRI）是最敏感的影像学检查，脂肪抑制成像的出现使得能够检测骶髂关节骨髓炎症，这是AS最早出现的异常之一。有限的研究表明，使用评估整个脊柱的系统或仅将评估限于受影响最严重的脊柱节段的系统，都可以可靠地对脊柱炎症进行评分。这两种方法也都显示出良好的反应性。MRI上急性变化的预后意义仍不清楚。评估慢性变化的可靠方法尚未开发出来。MRI代表了AS诊断评估的一项重大进展。
