Klang Eyal, Lidar Merav, Lidar Zvi, Aharoni Dvora, Eshed Iris
1 Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
2 Rheumatology Unit, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Acta Radiol. 2017 Apr;58(4):449-455. doi: 10.1177/0284185116656490. Epub 2016 Jul 28.
Background Computed tomography (CT) examinations of the lumbar spine are commonly performed in patients aged ≤40 years due to low back pain (LBP). Purpose To investigate the prevalence and awareness of radiologists for the presence of structural post-inflammatory/other sacroiliac joint (SIJ) alterations on lumbar spine CTs of young patients with LBP. Material and Methods A total of 484 lumbar spine CT examinations (272 men, 212 women; average age, 31 years; age range, 18-40 years) of patients with LBP in which the entire SIJs were visualized were retrospectively reviewed. SIJs were scored (consensus) by two senior radiologists (study reading) for the presence of post-inflammatory structural SIJ findings or other SIJs alterations. The original reports were compared to the study reading. Fifty CT examinations were re-evaluated for reliability assessment (intra-class correlation coefficient [ICC]). Results A total of 150 (31%) abnormal SIJ examinations were registered (ICC: r = 0.7-0.8; P < 0.0001): suspected sacroiliitis = 50 (10.2%); definite sacroiliitis = 16 (3.3%); osteitis-condensans-ilii = 38 (7.8%); diffuse idiopathic skeletal hyperostosis = 24 (5%); degenerative changes = 22 (4.5%); accessory SIJ = 22 (4.5%); and tumor = 1. The SIJs were referenced 39 times (8.0%) in the original readings: pathological findings (n = 15); and normal SIJ (n = 24). Total diagnostic accuracy for these reports only and for the entire readings were 49% and 69%, respectively, and 13% and 1.3%, respectively, for the pathological findings. Conclusion Sacroiliitis and other SIJ alterations are prevalent in young individuals with LBP, albeit, the majority of these alterations are not recognized nor reported by senior radiologists thus may delay efficacious treatment.
背景 由于腰痛（LBP），腰椎计算机断层扫描（CT）检查常用于40岁及以下的患者。目的 调查放射科医生对年轻LBP患者腰椎CT上结构性炎症后/其他骶髂关节（SIJ）改变的患病率及认知情况。材料与方法 回顾性分析484例LBP患者的腰椎CT检查（男性272例，女性212例；平均年龄31岁；年龄范围18 - 40岁），这些检查中整个SIJ均可见。由两名资深放射科医生对SIJ进行评分（达成共识），以确定是否存在炎症后结构性SIJ表现或其他SIJ改变。将原始报告与研究解读结果进行比较。对50例CT检查进行重新评估以进行可靠性评估（组内相关系数[ICC]）。结果 共记录到150例（31%）SIJ检查异常（ICC：r = 0.7 - 0.8；P < 0.0001）：疑似骶髂关节炎 = 50例（10.2%）；确诊骶髂关节炎 = 16例（3.3%）；致密性骨炎 = 38例（7.8%）；弥漫性特发性骨肥厚 = 24例（5%）；退行性改变 = 22例（4.5%）；副SIJ = 22例（4.5%）；肿瘤 = 1例。原始解读中SIJ被提及39次（8.0%）：病理结果（n = 15）；正常SIJ（n = 24）。仅这些报告以及整个解读的总诊断准确率分别为49%和69%，病理结果的诊断准确率分别为13%和1.3%。结论 骶髂关节炎和其他SIJ改变在年轻LBP患者中很常见，尽管这些改变中的大多数未被资深放射科医生识别和报告，从而可能延误有效治疗。
