Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
Centre for Medical Imaging, University College London, London, UK.
Rheumatology (Oxford). 2019 Nov 1;58(11):1955-1965. doi: 10.1093/rheumatology/kez172.
To summarize the evidence on the performance of MRI for the diagnosis of axial SpA.
This was a systematic literature review of all studies from January 2013 to March 2017 including adult patients with clinically suspected axial SpA undergoing MRI. Studies from a previously published systematic literature review up to January 2013 were also included.
Thirty-one studies were included. Six studies demonstrated good sensitivity and specificity for SI joint (SIJ) bone marrow oedema (BMO). Specificity was increased by the presence of other structural lesions alongside BMO, particularly erosions or fat infiltration. Four studies addressed the utility of SIJ fat infiltration, finding good sensitivity but poor specificity. SIJ erosions showed good specificity in five studies. Studies addressing high T1 signal in the SIJ, fluid signal in the SIJ, ankylosis, sclerosis, capsulitis, backfill and vacuum phenomenon reported limited diagnostic value. In the spine, four studies reported moderate sensitivity and specificity for corner inflammatory lesions, and four reported poor sensitivity and specificity for spinal fat infiltration. Five studies evaluated the added value of spinal MRI over SIJ MRI alone, with variable results depending on the cohort. Six studies addressed the effect of acquisition parameters on diagnostic accuracy: fat-saturated T2-weighted imaging and short tau inversion recovery (STIR) imaging showed comparable utility in identifying BMO. Three studies showed that gadolinium was of minimal added value in the detection of BMO.
These results confirmed the diagnostic utility of MRI in axial SpA. Performance varied according to the characteristics of the cohort and the number and combination of MRI lesions considered.
总结 MRI 对诊断中轴型脊柱关节炎的应用价值。
本研究为系统综述，检索了 2013 年 1 月至 2017 年 3 月期间所有针对成人疑似中轴型脊柱关节炎患者的 MRI 研究，同时也纳入了截至 2013 年 1 月之前的先前综述中的研究。
共纳入 31 项研究。6 项研究表明 MRI 对骶髂关节（SIJ）骨髓水肿（BMO）的诊断具有较好的敏感性和特异性。当 BMO 与其他结构病变同时存在时，特异性会增加，特别是存在侵蚀或脂肪浸润时。有 4 项研究探讨了 SIJ 脂肪浸润的应用价值，发现其具有良好的敏感性，但特异性较差。5 项研究表明，SIJ 侵蚀在诊断中具有较好的特异性。针对 SIJ 高 T1 信号、SIJ 液体信号、强直、硬化、滑膜炎、填充和真空现象的研究报告其诊断价值有限。在脊柱方面，4 项研究报告了角状炎症病变的中等敏感性和特异性，而 4 项研究报告了脊柱脂肪浸润的敏感性和特异性较差。有 5 项研究评估了脊柱 MRI 相对于单独 SIJ MRI 的附加价值，结果因队列而异。有 6 项研究探讨了采集参数对诊断准确性的影响：脂肪饱和 T2 加权成像和短 tau 反转恢复（STIR）成像在识别 BMO 方面具有相似的应用价值。有 3 项研究表明，钆增强在检测 BMO 方面的价值有限。
这些结果证实了 MRI 在中轴型脊柱关节炎中的诊断价值。其性能取决于队列的特征以及考虑的 MRI 病变的数量和组合。
