de Bruin F, Ter Horst S, Bloem J L, van den Berg R, de Hooge M, van Gaalen F, Dagfinrud H, van Oosterhout M, Landewé R, van der Heijde D, Reijnierse M
Department of Radiology, Leiden University Medical Center, 2333, ZA, Leiden, The Netherlands.
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Skeletal Radiol. 2017 May;46(5):633-639. doi: 10.1007/s00256-017-2581-1. Epub 2017 Feb 24.
To determine in a cohort of young patients with suspected axial spondyloarthritis (axSpA), the prevalence of lumbosacral transitional vertebra (LSTV), its association with local bone marrow edema (BME) and lumbar spine degeneration, and the potential relationship with MRI findings and clinical signs of axSpA.
Baseline imaging studies and clinical information of patients from the SPondyloArthritis Caught Early-cohort (back pain ≥3 months, ≤2 years, onset <45 years) were used. Two independent readers assessed all patients for LSTV on radiography, and BME-like and degenerative changes on MRI. Patients with and without LSTV were compared with regard to the prevalence of MRI findings and the results of clinical assessment using Chi-squared test or t test.
Of 273 patients (35.1% male, mean age 30.0), 68 (25%) patients showed an LSTV, without statistical significant difference between patients with and without axSpA (p = 0.327). Local sacral BME was present in 9 out of 68 (13%) patients with LSTV and absent in patients without LSTV (p < 0.001). Visual analogue scale (VAS) pain score and spinal mobility assessments were comparable.
LSTV is of low clinical relevance in the early diagnosis of axSpA. There is no difference between patients with and without LSTV regarding the prevalence of axSpA, pain and spinal mobility, and a BME-like pattern at the pseudoarticulation does not reach the SI joints.
在一组疑似轴向型脊柱关节炎（axSpA）的年轻患者中，确定腰骶部移行椎（LSTV）的患病率、其与局部骨髓水肿（BME）及腰椎退变的关联，以及与axSpA的MRI表现和临床体征的潜在关系。
使用早期发现脊柱关节炎队列（背痛≥3个月，≤2年，发病年龄<45岁）患者的基线影像学研究和临床信息。两名独立阅片者对所有患者的X线片进行LSTV评估，对MRI进行BME样改变和退变改变评估。使用卡方检验或t检验比较有和无LSTV患者的MRI表现患病率及临床评估结果。
273例患者（男性占35.1%，平均年龄30.0岁）中，68例（25%）患者有LSTV，有和无axSpA的患者之间无统计学显著差异（p = 0.327）。68例有LSTV的患者中有9例（13%）存在局部骶骨BME，无LSTV的患者中未出现（p < 0.001）。视觉模拟量表（VAS）疼痛评分和脊柱活动度评估结果相当。
LSTV在axSpA的早期诊断中临床相关性较低。有无LSTV的患者在axSpA患病率、疼痛和脊柱活动度方面无差异，假关节处的BME样表现未累及骶髂关节。
