弥散加权成像ADC值和SPARCC评分在强直性脊柱炎活动期评估中的价值探讨
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摘要
目的通过分析强直性脊柱炎(AS)活动期患者及骶髂关节表观扩散系数(ADC值)及加拿大脊柱关节炎评分(SPARCC),探讨弥散加权成像技术(DWI)ADC值及SPARCC评分在评估AS活动期中的价值。方法选取临床确诊为AS活动期患者17例,同时收集19例健康体检者作为正常组。对两组进行骶髂关节横断位及斜冠状位扫描。通过DWI序列及ADC图,测量患者与正常组骶髂关节(左、右髂侧及骶侧)ADC值,同时测量L5椎体中央区ADC值,比较两组骶髂关节相对ADC值(rADC)变化。同时对活动期AS患者骶髂关节行SPARCC评分,并对rADC与SPARCC评分之间的相关性进行分析。结果 DWI可显示骶髂关节炎活动期骨髓水肿情况;活动期双侧骶髂关节rADC值大于正常志愿者。活动期AS患者髂侧ADC多大于骶侧ADC,两组差异均有统计学意义(均P<0.05),活动期骶髂关节平均r ADC值与SPARCC评分呈正相关(r=0.827,P<0.05)。结论 ADC值在评价AS患者病情活动性中具有一定价值,可以对病变进行定量评估,从而可以成为判断AS活动性的重要指标。
Objective To assess the application of apparent diffusion coefficient(ADC) value in MR diffusion-weighted imaging(DWI) and Spondyloarthritis Research Consortium Canada(SPARCC) score in evaluation of activity of ankylosing spondylitis(AS).Methods Seventeen patients with clinically confirmed active AS(AS group) and 19 normal subjects(control group) were recruited in the study. Axial and oblique coronal MRI scan of sacroiliac joint was performed in two groups. And the sequences included TIWI, T_2WI fs, DWI(b=0、800 s/mm~2) and STIR. ADC values of sacroiliac joint(including right and left, iliac and sacral side) and center of L_5 of two groups were measured through DWI sequences and ADC maps, and the changes of rADC values(the ratio of ADC values of iliac or sacral side and L_5) were compared. Meanwhile, SPARCC was evaluated on the sacroiliac joints of patients with active AS, and the correlation between the average rADC value and SPARCC score of the same patient was analyzed. Results DWI showed bone marrow edema during the active stage of sacroiliitis. The rADC value of bilateral sacroiliac joints of AS group was higher than that of control group. The ADC value of iliac side of patients with active AS was higher than that of sacral side(P<0.05). The average rADC value of sacroiliac joint of AS group was positively correlated with SPARCC score(r=0.827, P<0.05). Conclusion ADC is of value in evaluation of the activity of AS, and quantitative assessment can be made on lesions through ADC value.
Objective To assess the application of apparent diffusion coefficient(ADC) value in MR diffusion-weighted imaging(DWI) and Spondyloarthritis Research Consortium Canada(SPARCC) score in evaluation of activity of ankylosing spondylitis(AS).Methods Seventeen patients with clinically confirmed active AS(AS group) and 19 normal subjects(control group) were recruited in the study. Axial and oblique coronal MRI scan of sacroiliac joint was performed in two groups. And the sequences included TIWI, T_2WI fs, DWI(b=0、800 s/mm~2) and STIR. ADC values of sacroiliac joint(including right and left, iliac and sacral side) and center of L_5 of two groups were measured through DWI sequences and ADC maps, and the changes of rADC values(the ratio of ADC values of iliac or sacral side and L_5) were compared. Meanwhile, SPARCC was evaluated on the sacroiliac joints of patients with active AS, and the correlation between the average rADC value and SPARCC score of the same patient was analyzed. Results DWI showed bone marrow edema during the active stage of sacroiliitis. The rADC value of bilateral sacroiliac joints of AS group was higher than that of control group. The ADC value of iliac side of patients with active AS was higher than that of sacral side(P<0.05). The average rADC value of sacroiliac joint of AS group was positively correlated with SPARCC score(r=0.827, P<0.05). Conclusion ADC is of value in evaluation of the activity of AS, and quantitative assessment can be made on lesions through ADC value.
引文
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[10]牛富业,箫毅,邹薇薇,等.3.0TMRI扩散加权成像对强直性脊柱炎活动性骶髂关节炎的诊断价值[J].实用放射学杂志,2015,31(4):616-620.
[11]Peschmann AL,Beer M,Ammann B,et al.Quantitative DWIpredicts event-free survival in children with neuroblastictumours:preliminary findings from a retrospective cohort study[J].European Radiology Experimental,2019,3(1):6.
[12]Seeger A,Schulze M,Schuettauf F,et al.Advanc ed diffusionweighted imaging in patients with optic neuritis deficit-value of reduced field of view DWI and readout-segmented DWI[J].Neuroradiol J,2018,31(2):126-132.
[13]Slobodin G,Rosner I.Indemonstrable axial spondyloarthritis:does it exist?[J].Isr Med Assoc J,2013,15(12):780-781.
[14]赵英华,韩新爱,胡绍勇,等.强直性脊柱炎骶髂关节ADC值、T1强化率与炎性活动指标的相关性[J].中华医学杂志,2014,94(35):2750-2753.
[15]Sun HT,Liu K,Liu H,et al.Comparison of bi-exponential and mono-exponential models of diffusion-weighted imaging for detecting active sacroiliitis in ankylosing spondylitis[J].Acta Radiologica,2018,59(4):468-477.
[16]Qin J,Zhu J Z,Zhang Y,et al.DWI and SPARCC scoring assess curative effect of early ankylosing spondylitis[J].Open Medicine,2016,11(1):52-58.
[2]Zhao YH,Li SL,Liu ZY,et al.Detection of active saeroiliitis with ankylosing spondylitis through intravoxel incoherent motion diffusionweighted MR imaging[J].Eur Radiol,2015,25(9):2754-2763.
[3]Bradbury LA,Hollis KA,BenoIt Gautier,et al.Diffusion-weighted imaging is a sensitive and specific magnetic resonance sequence in the diagnosis of ankylosing spondylitis[J].The Journal of Rheumatology,2018,45(6):170312.
[4]Sieper J,Rudwaleit M,Baraliakos X,et al.TheAssessmentofspondylo arthritisinternational society(ASAS)handbook:aguidetoassessspondyloarthritis[J].AnnRheum Dis,2009,68(Suppl2):ii1-ii44.
[5]Maksymowwych WP,Inman RD,Salonen D,et al.Spondyloarthritisresearch consortium of canada magnetic resonance imagingindex for assessment of sacroiliac joint inflammation in ankylosingspondylitis[J].Arthritis Rtheum,2005,53(5):703-709.
[6]Braun J,Baraliakos X,Hermann KG,et al.Golimumab reducesspinal inflammation in ankylosing spondylitis:MRI results of therandomised,placebocontrolled GO-RAISE study[J].Ann RheumDis,2012,71(6):878-884.
[7]赵英华,孙尔维,韩新爱,等.扩散加权成像与对比增强MRI评估强直性脊柱炎活动性的对比研究[J].中华放射学杂志,2015,49(9):665-669.
[8]Kwee TC,Takahara T,OchiaiR,et al.Whole-body diffusion-weightedmagnetic resonance imaging[J].Eur J Radioal,2009,70(3):409-417.
[9]李筱倩,朱建忠,赵鲁平,等.磁共振DWI联合DCE序列诊断早期强直性脊柱炎骶髂关节改变[J].放射学实践,2015,30(6):679-682.
[10]牛富业,箫毅,邹薇薇,等.3.0TMRI扩散加权成像对强直性脊柱炎活动性骶髂关节炎的诊断价值[J].实用放射学杂志,2015,31(4):616-620.
[11]Peschmann AL,Beer M,Ammann B,et al.Quantitative DWIpredicts event-free survival in children with neuroblastictumours:preliminary findings from a retrospective cohort study[J].European Radiology Experimental,2019,3(1):6.
[12]Seeger A,Schulze M,Schuettauf F,et al.Advanc ed diffusionweighted imaging in patients with optic neuritis deficit-value of reduced field of view DWI and readout-segmented DWI[J].Neuroradiol J,2018,31(2):126-132.
[13]Slobodin G,Rosner I.Indemonstrable axial spondyloarthritis:does it exist?[J].Isr Med Assoc J,2013,15(12):780-781.
[14]赵英华,韩新爱,胡绍勇,等.强直性脊柱炎骶髂关节ADC值、T1强化率与炎性活动指标的相关性[J].中华医学杂志,2014,94(35):2750-2753.
[15]Sun HT,Liu K,Liu H,et al.Comparison of bi-exponential and mono-exponential models of diffusion-weighted imaging for detecting active sacroiliitis in ankylosing spondylitis[J].Acta Radiologica,2018,59(4):468-477.
[16]Qin J,Zhu J Z,Zhang Y,et al.DWI and SPARCC scoring assess curative effect of early ankylosing spondylitis[J].Open Medicine,2016,11(1):52-58.