Maksymowych Walter P
Alberta Heritage Foundation for Medical Research, University of Alberta, Edmonton, Alberta, Canada.
Adv Exp Med Biol. 2009;649:17-36. doi: 10.1007/978-1-4419-0298-6_2.
The role ofimagingin the evaluation and management of SpA has experienced a resurgence of interest with the introduction of MRI and more sophisticated sonographic technologies. Several approaches have been developed to score plain radiographic abnormalities in the spine and sacroiliac joints of patients with SpA and this approach remains the standard for assessment of structural damage. The modified Stoke AS Spinal Score (mSASSS) is the most responsive outcome instrument for scoring damage in the spine 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 for the detection of inflammation 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. Spinal inflammation can now be reliably scored using MRI-based outcome instruments that are highly sensitive to change and this represents a major advance in the objective evaluation of new therapeutic interventions. Moreover, MRI now allows the detection of patients at an earlier stage of their disease course with the potential for new insights into the pathogenesis of disease. Ultrasound provides a more feasible and cost-effective approach to the assessment of peripheral inflammation, especially enthesitis.
随着磁共振成像（MRI）和更先进的超声技术的引入，影像学在脊柱关节炎（SpA）评估和管理中的作用再次引起人们的关注。已经开发出几种方法来对SpA患者脊柱和骶髂关节的普通X线异常进行评分，这种方法仍然是评估结构损伤的标准。改良斯托克强直性脊柱炎脊柱评分（mSASSS）是评估脊柱损伤最敏感的结果指标，不过其敏感性有限，对于接受标准治疗的患者，至少需要2年才会出现明显的显著变化。磁共振成像（MRI）是检测炎症最敏感的影像学检查，脂肪抑制成像技术的出现使得骶髂关节骨髓炎症作为强直性脊柱炎（AS）最早出现的异常之一得以被检测出来。现在可以使用对变化高度敏感的基于MRI的结果指标对脊柱炎症进行可靠评分，这代表了在客观评估新治疗干预措施方面的一项重大进展。此外，MRI现在能够在疾病病程的早期阶段检测出患者，这有可能为疾病的发病机制带来新的见解。超声为评估外周炎症，尤其是附着点炎，提供了一种更可行且更具成本效益的方法。
