Bredella Miriam A, Steinbach Lynne S, Morgan Stephanie, Ward Michael, Davis John C
Department of Radiology, University of California, San Francisco, San Francisco, CA, USA.
AJR Am J Roentgenol. 2006 Dec;187(6):1420-6. doi: 10.2214/AJR.05.1423.
The objectives of our study were to evaluate whether MRI findings of the sacroiliac joints are able to distinguish between active and inactive disease in patients with established ankylosing spondylitis and to determine whether these findings correlate with markers of clinical activity, disease duration, severity, and degree of radiographic damage.
Eighteen patients with symptomatic moderate to severe ankylosing spondylitis were evaluated. MRI of the sacroiliac joint (1.5 T) was performed using fat-saturated T2-weighted, T1-weighted, STIR, and fat-saturated contrast-enhanced T1-weighted sequences. The sacroiliac joints were evaluated by two radiologists for enhancement, subchondral bone marrow edema, erosions, and subchondral fatty marrow infiltration. Findings on MRI were analyzed for correlation with multiple clinical characteristics and measures of disease activity, including radiographic scoring.
In 17 patients, MRI showed abnormal findings of the sacroiliac joint. Ten patients showed active disease on MRI as measured by abnormal enhancement and subchondral bone marrow edema. Disease activity detected using MRI correlated in a positive fashion with only C-reactive protein (CRP) level. There was no correlation with the other measures of disease activity or with disease duration. In 14 patients, fatty subchondral bone marrow was detected on MRI. These changes were seen in patients with active and chronic disease and correlated with higher radiographic scores but not with disease duration or markers of disease activity.
Contrast-enhanced MRI of the sacroiliac joint is sensitive in depicting sacroiliitis in patients with established ankylosing spondylitis. Subchondral edema and enhancement correlate with high CRP levels. Subchondral fatty bone marrow changes were seen in both active and chronic sacroiliitis and are correlated with higher radiographic scores; these changes may be a marker of more advanced disease.
我们研究的目的是评估骶髂关节的MRI表现是否能够区分已确诊的强直性脊柱炎患者的疾病活动期和非活动期，并确定这些表现是否与临床活动指标、疾病持续时间、严重程度及放射学损伤程度相关。
对18例有症状的中度至重度强直性脊柱炎患者进行评估。使用脂肪抑制T2加权、T1加权、短反转恢复序列（STIR）及脂肪抑制对比增强T1加权序列对骶髂关节进行1.5T MRI检查。由两名放射科医生对骶髂关节的强化、软骨下骨髓水肿、侵蚀及软骨下脂肪骨髓浸润情况进行评估。分析MRI表现与多种临床特征及疾病活动指标（包括放射学评分）之间的相关性。
17例患者的骶髂关节MRI表现异常。10例患者的MRI显示存在疾病活动，表现为强化异常及软骨下骨髓水肿。通过MRI检测到的疾病活动仅与C反应蛋白（CRP）水平呈正相关。与其他疾病活动指标及疾病持续时间均无相关性。14例患者的MRI检测到软骨下脂肪骨髓。这些改变在疾病活动期及慢性期患者中均可见，且与较高的放射学评分相关，但与疾病持续时间或疾病活动指标无关。
骶髂关节对比增强MRI对已确诊的强直性脊柱炎患者的骶髂关节炎具有较高的敏感性。软骨下水肿及强化与高CRP水平相关。软骨下脂肪骨髓改变在活动期及慢性骶髂关节炎中均可见，且与较高的放射学评分相关；这些改变可能是疾病进展更严重的一个标志。
