儿童磁共振成像中炎性骶髂关节炎的检测：是否需要钆造影增强？
Detection of inflammatory sacroiliitis in children with magnetic resonance imaging: is gadolinium contrast enhancement necessary?
机构信息
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia.
出版信息
Arthritis Rheumatol. 2015 May;67(8):2250-6. doi: 10.1002/art.39159.
OBJECTIVE
In adults, gadolinium contrast enhancement does not add incremental value to fluid-sensitive sequences for evaluation of bone marrow edema. This study was undertaken to determine if magnetic resonance imaging (MRI) contrast is necessary to assess lesions consistent with inflammatory sacroiliitis in children.
METHODS
Patients with clinically suspected or diagnosed juvenile spondyloarthritis (SpA) underwent pelvic MRI consisting of multiplanar fluid-sensitive and postgadolinium T1-weighted fat-saturated sequences including dedicated sacral imaging. Three radiologists independently evaluated the fluid-sensitive sequences, and later, the complete study (including postcontrast images). With postcontrast imaging as the reference standard, we calculated the test properties of fluid-sensitive sequences for depiction of acute and chronic findings consistent with sacroiliitis.
RESULTS
The 51 patients had a median age of 15 years, and 57% were male. Nineteen patients (22 joints) were diagnosed as having sacroiliitis based on postcontrast imaging, and none had synovitis in the absence of bone marrow edema. All 22 joints demonstrated bone marrow edema on both fluid-sensitive and postgadolinium T1-weighted fat-saturated sequences. Eighteen percent of joints with sacroiliitis had capsulitis, which was observed on both noncontrast and postcontrast imaging. Fifty-nine percent of joints with sacroiliitis had synovitis on postcontrast imaging. Sensitivity, specificity, positive predictive value, and negative predictive value of fluid-sensitive sequences for the detection of acute inflammatory lesions consistent with sacroiliitis using postgadolinium imaging as the reference standard were excellent. Interrater reliability was substantial for all parameters.
CONCLUSION
Our findings indicate that fluid-sensitive sequences are sufficient to detect acute and chronic lesions consistent with inflammatory sacroiliitis in children.
目的
在成人中，钆对比剂增强对于评估骨髓水肿的液体敏感序列没有增加额外的价值。本研究旨在确定磁共振成像（MRI）对比是否有必要评估符合儿童炎症性骶髂关节炎的病变。
方法
临床怀疑或诊断为幼年特发性关节炎（SpA）的患者接受了包括多平面液体敏感序列和钆后 T1 加权脂肪饱和序列的骨盆 MRI 检查，包括专门的骶骨成像。三位放射科医生分别独立评估液体敏感序列，然后评估完整的研究（包括对比后图像）。以对比后成像作为参考标准，我们计算了液体敏感序列在描述符合骶髂关节炎的急性和慢性表现方面的测试特性。
结果
51 例患者的中位年龄为 15 岁，57%为男性。19 例（22 个关节）根据对比后成像诊断为骶髂关节炎，无一例在没有骨髓水肿的情况下出现滑膜炎。所有 22 个关节在液体敏感和钆后 T1 加权脂肪饱和序列上均显示骨髓水肿。18%的骶髂关节炎关节有囊带炎，在非对比和对比后成像上均可见。59%的骶髂关节炎关节在对比后成像上有滑膜炎。使用对比后成像作为参考标准，液体敏感序列检测符合骶髂关节炎的急性炎症性病变的敏感性、特异性、阳性预测值和阴性预测值均很高。所有参数的观察者间可靠性均较高。
结论
我们的研究结果表明，液体敏感序列足以检测符合儿童炎症性骶髂关节炎的急性和慢性病变。
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