磁共振成像骶髂关节病变联合在诊断中轴型脊柱关节炎患者中的效用。一项包括产后妇女、椎间盘突出症患者、清洁人员、跑步者和健康人的 204 名参与者的前瞻性研究。
The utility of magnetic resonance imaging lesion combinations in the sacroiliac joints for diagnosing patients with axial spondyloarthritis. A prospective study of 204 participants including post-partum women, patients with disc herniation, cleaning staff, runners and healthy persons.
机构信息
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
出版信息
Rheumatology (Oxford). 2020 Nov 1;59(11):3237-3249. doi: 10.1093/rheumatology/keaa096.
OBJECTIVES
To investigate the diagnostic utility of different combinations of SI joint MRI lesions for differentiating patients with axial SpA (axSpA) from other conditions with and without buttock/pelvic pain.
METHODS
A prospective cross-sectional study included patients with axSpA (n = 41), patients with lumbar disc herniation (n = 25), women with (n = 46) and without (n = 14) post-partum (birth within 4-16 months) buttock/pelvic pain and cleaning assistants (n = 26), long-distance runners (n = 23) and healthy men (n = 29) without pain. Two independent readers assessed SI joint MRI lesions according to the Spondyloarthritis Research Consortium of Canada MRI definitions and pre-defined MRI lesion combinations with bone marrow oedema (BME) and fat lesions (FAT), respectively. Statistical analyses included the proportion of participants with scores above certain thresholds, sensitivity, specificity, positive and negative predictive values and likelihood ratios.
RESULTS
BME adjacent to the joint space (BME@joint space) was most frequent in axSpA (63.4%), followed by women with post-partum pain (43.5%), but was present in nearly all groups. BME adjacent to fat lesions (BME@FAT) and BME adjacent to erosions (BME@erosion) were only present in axSpA patients and in women with post-partum pain, but scores ≥3 and ≥4, respectively, were only seen in axSpA patients. FAT@erosion was exclusively recorded in axSpA patients. FAT@joint space and FAT@sclerosis were present in most groups, but with higher scores in the axSpA group.
CONCLUSION
BME@joint space and FAT@joint space were frequent in axSpA but also in other conditions, reducing the diagnostic utility. FAT@erosion, and BME@FAT, BME@erosion and FAT@sclerosis above certain thresholds, were exclusively seen in axSpA patients and may thus have diagnostic utility in the differentiation of axSpA from other conditions.
目的
探讨不同的骶髂关节 MRI 病变组合对鉴别 axSpA 患者与伴有和不伴有臀部/骨盆疼痛的其他疾病的诊断价值。
方法
本前瞻性横断面研究纳入了 axSpA 患者（n=41）、腰椎间盘突出症患者（n=25）、产后（产后 4-16 个月）有（n=46）和无（n=14）臀部/骨盆疼痛的女性、清洁助手（n=26）、长跑运动员（n=23）和健康男性（n=29）。两位独立的阅片者根据 Spondyloarthritis Research Consortium of Canada MRI 定义以及分别针对骨髓水肿（BME）和脂肪病变（FAT）的预定义 MRI 病变组合对骶髂关节 MRI 病变进行评估。统计分析包括各评分阈值以上的参与者比例、敏感性、特异性、阳性和阴性预测值以及似然比。
结果
关节旁 BME（BME@joint space）在 axSpA 中最为常见（63.4%），其次是产后有疼痛的女性（43.5%），但几乎所有组都存在。BME 毗邻脂肪病变（BME@FAT）和 BME 毗邻侵蚀（BME@erosion）仅见于 axSpA 患者和产后有疼痛的女性，但分别只有评分≥3 和≥4 的患者才见于 axSpA 患者。FAT@erosion 仅见于 axSpA 患者。FAT@joint space 和 FAT@sclerosis 见于大多数组，但 axSpA 组的评分更高。
结论
BME@joint space 和 FAT@joint space 在 axSpA 中常见，但在其他疾病中也常见，降低了诊断价值。特定阈值以上的 FAT@erosion，以及 BME@FAT、BME@erosion 和 FAT@sclerosis，仅见于 axSpA 患者，因此可能有助于 axSpA 与其他疾病的鉴别诊断。
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