Gong Yao, Zheng Nan, Chen Su-Biao, Xiao Zheng-Yu, Wu Ming-Yao, Liu Yuan, Zeng Qing-Yu
The First Affiliated Hospital and Shantou University Medical College, Shantou, Guangdong, China.
Arthritis Rheum. 2012 May;64(5):1399-406. doi: 10.1002/art.33453.
To evaluate the usefulness of needle biopsy in the diagnosis of early sacroiliitis to improve the diagnostic level and outcome of ankylosing spondylitis (AS).
One hundred nine patients in whom early AS was highly suspected, but in whom only sacroiliitis of grade I or lower on radiography/computed tomography (CT) was seen, were recruited for study. CT-guided needle biopsy of the sacroiliac joints was performed, and the patients were followed up for 5-10 years.
Of the 109 patients, magnetic resonance imaging (MRI) was used to confirm the presence or absence of sacroiliitis in 77 patients. Of these, 23 patients were determined to have sacroiliitis on MRI, and 54 had no sacroiliitis on MRI. Needle biopsy was performed on all 109 patients. Features of inflammation were found in 85 patients, which included all 23 patients with MRI evidence of sacroiliitis and 38 of the 54 patients without MRI evidence of sacroiliitis. No features of inflammation were found on needle biopsy in 24 of the patients, including the remaining 16 patients who did not have sacroiliitis on MRI. The sensitivity and specificity of MRI for the early diagnosis of sacroiliitis in these patients were 37.7% and 100%, respectively. Thirty-four patients with pathologic evidence of sacroiliitis were followed up for 5-10 years. At the study end point, 16 of these 34 patients continued to show grade I or lower changes on CT, and 18 had changes of grade II or higher. These 18 patients included 7 of the 8 patients with evidence of sacroiliitis on MRI and 6 of the 20 patients confirmed not to have MRI evidence of sacroiliitis at baseline.
MRI, though of low sensitivity, is specific for the diagnosis of early sacroiliitis. Sacroiliitis can be detected earlier by needle biopsy than by MRI.
评估针吸活检在早期骶髂关节炎诊断中的作用，以提高强直性脊柱炎（AS）的诊断水平及改善其预后。
招募了109例高度怀疑早期AS但X线/计算机断层扫描（CT）仅显示I级或更低级别的骶髂关节炎的患者进行研究。对骶髂关节进行CT引导下针吸活检，并对患者进行5至10年的随访。
109例患者中，77例采用磁共振成像（MRI）来确认是否存在骶髂关节炎。其中，23例患者MRI显示有骶髂关节炎，54例患者MRI未显示骶髂关节炎。对所有109例患者均进行了针吸活检。85例患者发现有炎症特征，其中包括MRI证实有骶髂关节炎的所有23例患者以及54例MRI未证实有骶髂关节炎患者中的38例。24例患者针吸活检未发现炎症特征，包括MRI未显示骶髂关节炎的其余16例患者。这些患者中，MRI对早期骶髂关节炎诊断的敏感性和特异性分别为37.7%和100%。对34例有骶髂关节炎病理证据的患者进行了5至10年的随访。在研究终点，这34例患者中有16例CT仍显示I级或更低级别的改变，18例有II级或更高等级的改变。这18例患者包括MRI显示有骶髂关节炎的8例患者中的7例以及基线时经证实MRI未显示骶髂关节炎的20例患者中的6例。
MRI对早期骶髂关节炎的诊断虽敏感性较低，但具有特异性。针吸活检比MRI能更早检测出骶髂关节炎。
