King Christian 10th Hospital for Rheumatic Diseases, Toldbodgade 3, 6300, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Claudiusstrasse 45, 44649, Herne, Germany.
Best Pract Res Clin Rheumatol. 2018 Jun;32(3):342-356. doi: 10.1016/j.berh.2018.10.009. Epub 2018 Nov 17.
Imaging is key to recognition of axial spondyloarthritis (SpA) because clinical and laboratory examinations have limited diagnostic utility. Only MRI can capture both inflammation and bone remodeling by simultaneous depiction of active and structural lesions and their anatomic location. Bone marrow edema of limited extent on the sacroiliac joint (SIJ) MRI is often nonspecific and should be interpreted along with the clinical context. Contextual interpretation of the SIJ lesion signature viewed simultaneously on fluid- and fat-sensitive MRI sequences enhances confidence in the recognition of disease. A critical re-appraisal of using pelvic radiographs in clinically suspected early spondyloarthritis is warranted because of substantial limitations. In health care settings with low threshold access to advanced imaging, MRI is the preferred modality in early SpA. CT has recently advanced spinal outcome research, but substantial radiation exposure in young patients with spondyloarthritis and limited evidence on its relevance in practice do not advocate its use in daily routine.
影像学检查对于识别中轴型脊柱关节炎（SpA）至关重要，因为临床和实验室检查的诊断效用有限。只有 MRI 可以通过同时描绘活跃性和结构性病变及其解剖位置，来捕捉炎症和骨重塑。骶髂关节 (SIJ) MRI 上有限程度的骨髓水肿通常是非特异性的，应结合临床情况进行解读。在液体和脂肪敏感 MRI 序列上同时观察到的 SIJ 病变特征的上下文解读，可以增强对疾病识别的信心。由于存在很大的局限性，有必要对在临床上疑似早期脊柱关节炎中使用骨盆 X 线摄影进行重新评估。在能够便捷获得先进影像学检查的医疗环境中，MRI 是早期 SpA 的首选检查方式。CT 最近在脊柱关节炎的研究中取得了进展，但在患有脊柱关节炎的年轻患者中存在大量辐射暴露，并且其在实践中的相关性的证据有限，这并不支持在日常实践中使用 CT。
