彩色多普勒超声评估炎症性下腰痛患者骶髂关节的价值。
Value of Color Doppler Ultrasound Assessment of Sacroiliac Joints in Patients with Inflammatory Low Back Pain.
机构信息
From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.
J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología.
出版信息
J Rheumatol. 2019 Jul;46(7):694-700. doi: 10.3899/jrheum.180550. Epub 2018 Dec 15.
OBJECTIVE
To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP).
METHODS
Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard.
RESULTS
There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%).
CONCLUSION
CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.
目的
评估彩色多普勒超声（CDUS）检测炎症性背痛（IBP）患者中骶髂关节炎（SIJ）的诊断价值。
方法
纳入了连续患有 IBP 且疑似中轴型脊柱关节炎（SpA）但尚未明确诊断的患者。纳入了连续患有明确的 SpA 且有中轴受累的患者作为对照组。所有患者在同一周内进行临床评估、磁共振成像（MRI）和 SIJ 的 CDUS 检查。使用 MRI 作为金标准，计算 CDUS 对 SIJ 炎的诊断的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
共评估了 99 例患者的 198 个 SIJ（36 例既往患有 SpA），其中 61 例为男性（61.6%），平均年龄 39.8 岁（标准差 11.3），中位病程 24 个月（IQR 12-84）。在患者水平，CDUS 的灵敏度为 63%（95%CI 48.7-75.7%），特异性为 89%（95%CI 76-96%）。PPV 为 87.2%（95%CI 72.6-95.7%），NPV 为 66.7%（95%CI 53.3-78.3%）。在关节水平，CDUS 的灵敏度为 60%（95%CI 49-70%），特异性为 93%（95%CI 88-98%）。PPV 为 83%（95%CI 78-95%），NPV 为 43%（95%CI 33-56%）。CDUS 诊断中轴型 SpA 的灵敏度为 54%（95%CI 36.6-71.2%），特异性为 82%（95%CI 63.1-93.9%），PPV 为 79%（95%CI 57.8-92.9%），NPV 为 59%（95%CI 42.1-74.4%）。
结论
CDUS 对骶髂关节炎的检测具有足够的诊断价值，是 IBP 患者的有用工具。
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