Hong Hyun Pyo, Chung Hye Won, Choi Byeong-Kyoo, Yoon Young Cheol, Choi Sang Hee
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Acta Radiol. 2009 May;50(4):418-22. doi: 10.1080/02841850902783338.
Ankylosing spondylitis (AS) may affect peripheral joints, with the shoulder, hip, and knee being well known involved sites. However, involvement of the proximal tibiofibular (PTF) joint has not yet been investigated.
To evaluate PTF joint abnormalities in patients with AS.
From July 1997 to June 2005, 16 patients (15 male, one female; mean age 25 years), who were clinically diagnosed with AS, underwent magnetic resonance imaging (MRI) to evaluate knee pain. All patients also underwent plain radiographs of the knee, lumbar spine, and pelvis. Twenty knee MRIs (bilateral in four patients) and 16 sets of knee, lumbar spine, and pelvic radiographs were retrospectively reviewed in order to evaluate possible AS involvement. The presence of abnormalities suggesting AS involvement were recorded separately in the sacroiliac joints, lumbar spine, hip, and femorotibial and PTF joints. If the PTF joint showed any pathologic findings, the radiologic findings were recorded.
Three of 16 patients (18.7%) had pathologic features of the PTF joint observed by plain radiographs or MRI. One of these three patients showed bilateral involvement of the PTF joints on plain radiographs, while the other two patients showed unilateral involvement on MRI. Subchondral sclerosis, cartilage abnormality, erosion, and abnormal bone marrow signal intensity were identified on MRI. Plain radiographs of two patients revealed subchondral sclerosis and spur formation in the PTF joint. The frequencies of involvement of other joints in the 16 patients were as follows: lumbar spine, n=5 (31%), hip joint, n=1 (6%) (identified by plain radiographs), and femorotibial joints, n=10 (62.5%) (identified by knee MRI).
MR imaging of the PTF joint can depict synovial changes and their effect on joint structures in patients with AS. The MRI findings of AS involving the PTF joints are subchondral sclerosis, cartilage abnormality, erosion, and abnormal bone marrow signal intensity.
强直性脊柱炎（AS）可能累及外周关节，肩、髋和膝关节是众所周知的受累部位。然而，胫腓近侧（PTF）关节受累情况尚未得到研究。
评估AS患者的PTF关节异常情况。
1997年7月至2005年6月，16例临床诊断为AS的患者（15例男性，1例女性；平均年龄25岁）接受磁共振成像（MRI）检查以评估膝关节疼痛。所有患者还接受了膝关节、腰椎和骨盆的X线平片检查。对20例膝关节MRI（4例为双侧）以及16套膝关节、腰椎和骨盆X线平片进行回顾性分析，以评估可能的AS累及情况。提示AS累及的异常表现分别记录于骶髂关节、腰椎、髋关节以及股胫关节和PTF关节。若PTF关节出现任何病理表现，则记录其影像学表现。
16例患者中有3例（18.7%）通过X线平片或MRI观察到PTF关节的病理特征。这3例患者中，1例在X线平片上显示双侧PTF关节受累，另外2例在MRI上显示单侧受累。MRI检查发现软骨下硬化、软骨异常、侵蚀以及骨髓信号强度异常。2例患者的X线平片显示PTF关节软骨下硬化和骨赘形成。16例患者中其他关节的受累频率如下：腰椎，n = 5（31%）；髋关节，n = 1（6%）（通过X线平片确定）；股胫关节，n = 10（62.5%）（通过膝关节MRI确定）。
PTF关节的MRI检查能够显示AS患者的滑膜变化及其对关节结构的影响。AS累及PTF关节的MRI表现为软骨下硬化、软骨异常、侵蚀以及骨髓信号强度异常。
