Schueller-Weidekamm C, Schueller G
Abteilung für Neuroradiologie und muskuloskelettale Radiologie, Klinik für Radiodiagnostik, AKH, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090, Wien, Österreich.
Radiologe. 2012 Feb;52(2):132-40. doi: 10.1007/s00117-011-2234-7.
CLINICAL/METHODICAL ISSUE: When the presence of seronegative spondyloarthropathy is unrecognized there can be a delay in achieving an accurate diagnosis, as the typical inflammatory low back pain is similar to that found in degenerative diseases of the lumbosacral spine and the sacroiliac joints. Thus, seronegative spondyloarthropathy is often misinterpreted as a degenerative disease. The initial radiography of the sacroiliac joints is often normal which results in a delay in diagnosis of sacroiliitis of approximately 3-7 years.
This illustrates the significance of an adequate imaging method for the early detection of sacroliliitis.
Contrast medium administration for magnetic resonance imaging (MRI) enables a differentiation between synovitis, capsulitis, enthesitis and effusion.
Sensitivity and specificity for detection of active inflammation by MRI is about 83-85%. Early active inflammation can be detected by MRI 3-7 years before structural changes are obvious by x-ray examination.
Pseudosacroiliitis can be differentiated from inflammatory sacroiliitis by the patient history, laboratory data, osteoproliferative and osteodestructive changes and the typical distribution pattern of bone marrow edema.
临床/方法学问题：当血清阴性脊柱关节病未被识别时，准确诊断可能会延迟，因为典型的炎性腰背痛与腰骶部脊柱和骶髂关节退行性疾病中的疼痛相似。因此，血清阴性脊柱关节病常被误诊为退行性疾病。骶髂关节的初始X线检查通常正常，这导致骶髂关节炎的诊断延迟约3至7年。
这说明了一种适当的成像方法对早期检测骶髂关节炎的重要性。
磁共振成像（MRI）使用造影剂能够区分滑膜炎、关节囊炎、附着点炎和积液。
MRI检测活动性炎症的敏感性和特异性约为83%-85%。在X线检查显示明显结构改变前3至7年，MRI就能检测到早期活动性炎症。
可通过患者病史、实验室数据、骨质增生和骨质破坏改变以及骨髓水肿的典型分布模式，将假性骶髂关节炎与炎性骶髂关节炎区分开来。
