SAPHO综合征患者脊柱及骶髂关节病变的影像学表现及临床应用

发布时间：2018-02-24 12:23

本文关键词： SAPHO综合征脊柱骶髂关节 CT MRI SPARCC评分疾病活动性　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：第一部分SAPHO综合征患者脊柱病变的CT表现目的分析SAPHO综合征患者脊柱病变的CT表现,以提高各科医师对此疾病的认识。方法分析69例SAPHO综合征患者的全脊柱CT图像。对于每位患者,共评估25个椎体。观察指标:受累椎体所在的脊柱节段、病变的CT图像表现、病变在椎体上分布的对称性及部位、椎体的受累方式、椎间隙高度的异常、椎旁韧带附着点钙化、椎小关节及胸肋关节的异常。结果69例患者的全脊柱CT图像均提示异常改变。其中,64例表现为脊柱椎体的病变,52例表现为椎旁韧带骨化,47例上述两种病变共存。共441个椎体出现椎体病变,以腰椎及第1骶椎为著。椎体病变于CT图像上表现为:局灶性骨质破坏、邻近松质骨内的骨质硬化以及韧带骨赘形成。其中,65.1%的受累椎体其病变仅累及椎角,而34.9%的受累椎体则同时累及“椎角+附近终板”。上述椎角病变可起源于椎体骺环的任何部位。78.2%的受累椎体其病变位于椎间盘的上下两缘,而表现为“对吻状”的连续性受累,而21.8%的受累椎体则为跳跃性受累。受累椎体邻近的椎间隙高度多为正常或轻度狭窄。椎旁韧带骨化病灶共320处,以棘上韧带为著,CT图像表现为:细小的高密度灶、且呈节段性分布。椎小关节及胸肋关节无异常改变。结论SAPHO综合征患者脊柱病变以腰椎及第1骶椎为著,椎体病变于CT图像上表现为:局灶性骨质破坏、邻近松质骨内骨质硬化以及韧带骨赘形成。椎体多以“对吻状”的连续性受累方式为主。椎旁韧带骨化病灶以棘上韧带为著。椎小关节及胸肋关节无异常改变。以上征象有助于临床及影像医生全面地认识此疾病受累范围及影像表现,结合病史做出精准的诊断。第二部分SAPHO综合征患者脊柱及骶髂关节病变的MRI表现目的分析SAPHO综合征患者脊柱病变的MRI表现,以提高各科医师对此疾病的认识。方法纳入38例SAPHO综合征患者。对本组患者进行统一扫描参数的全脊柱MRI检查及双侧骶髂关节MRI检查。结果38例SAPHO综合征患者的MRI图像均提示异常。其中,15例仅脊柱受累,4例仅骶髂关节受累,19例为两者均受累。(1)共34例患者的310个椎体受累(范围:2-24个/例,平均:7个/例),以腰椎及第1骶椎为著。80.3%的受累椎体表现为“对吻状”的连续性受累,而19.7%的受累椎体则为跳跃性受累。37.4%受累椎体的椎间盘出现轻度狭窄。7.1%的受累椎体邻近的前纵韧带水肿增厚。1.3%受累椎体的椎小关节受累。(2)在受累的310个椎体中,共567个病变。其中,35.8%的病变仅累及椎角,而64.2%同时累及椎角及其附近终板。13.9%的病变在MRI图像上仅表现为骨髓水肿信号,49.2%的病变表现为骨髓水肿和脂肪沉积混合信号,36.9%的病变仅表现为脂肪沉积信号。50.6%的病变出现骨质侵蚀。46.9%的病变出现骨质硬化。(3)共23例患者的骶髂关节受累,其中78.3%的患者为双侧受累。以关节计数,则41个骶髂关节受累。(4)58.5%的受累关节其病变以骶骨侧为著,14.6%的病变关节强直,14.6%的病变关节附近软组织水肿增厚。结论SAPHO综合征患者的脊柱病变表现为多椎体受累(水肿、脂肪变及硬化信号为主)。椎体多以连续性“对吻状”的受累方式为主。受累椎体邻近的椎间盘、椎体后部成分及椎旁韧带受累程度较轻。骶髂关节多为双侧受累、病变以骶骨侧为著,较少发生关节强直。以上征象有助于临床及影像医生认识此疾病的受累部位及疾病发展-转归中的MRI信号变化,进而提示其病理特点,有助于早诊断早治疗。第三部分MRI评分对SAPHO综合征患者病情活动性判断的价值目的评估MRI评分对SAPHO综合征患者病情活动性判断的价值。方法纳入30例SAPHO综合征患者。上述患者均于我院进行治疗前的基线病情评估。评估方法主要包括:(1)临床评分:患者整体的VAS(Visual Analogue Score)评分;BASDAI=Bath强直性脊柱炎疾病活动指数;BASFAI=Bath强直性脊柱炎功能指数;BASMI=Bath强直性脊柱炎度量指标;ASDAS-CRP=基于CRP(C反应蛋白)的强直性脊柱炎疾病活动评分。(2)实验室检查:ESR(红细胞沉降率);CRP;血清骨钙素浓度;血清β-CTx浓度。(3)MRI检查及评分:对30例患者的脊柱及骶髂关节进行半定量MRI评分,评分方法采用修订的SPARCC(加拿大脊柱关节研究协会)脊柱及骶髂关节病变活动性评分方法。对MRI总评分与各临床评分及实验室检查结果的相关性进行Spearman相关分析。结果MRI总评分与ASDAS-CRP及CRP呈线性相关,相关系数分别为0.601及0.476。结论本研究中修订的SPARCC半定量MRI评分系统可反映SAPHO综合征患者的炎症活动程度,可以作为临床治疗疗效评价的重要指标。
[Abstract]:The first part of SAPHO syndrome of spinal lesions in patients with CT CT syndrome SAPHO objective to analyze the comprehensive performance of spinal lesions, in order to improve the understanding of this disease doctor. Method 69 cases of patients with SAPHO syndrome of the whole spine CT image. For each patient, a total assessment of 25 vertebrae. Observation index: segmental vertebral involvement the CT images show the distribution of lesions in the vertebral lesions, the symmetry and location of vertebral involvement, abnormal height of intervertebral disc and paravertebral ligament attachment point calcification, abnormal vertebrae and thoracic rib joint. Results 69 cases of patients with the image of whole spine CT showed abnormal changes. Among them, 64 cases showed spinal vertebral lesions, 52 cases showed paravertebral ligament ossification, 47 cases of the two diseases coexist. 441 vertebrae in the lumbar vertebral lesions, and 1 sacral vertebral lesions. For now on CT images on the table: Focal bone destruction, adjacent cancellous bone in bone sclerosis and syndesmophyte formation. Among them, 65.1% vertebral body lesions involving only the vertebral angle, while 34.9% of the vertebral body and involved vertebral angle near the vertebral endplate +. Angle lesions can be originated from the vertebral epiphyseal ring any part of.78.2% the vertebral body lesions located in the intervertebral disc on the two margin, and performance for the "continuous involvement of kiss shaped, and 21.8% for jumping vertebral body involvement. Involvement of vertebral body adjacent intervertebral height were normal or mild stenosis. Paravertebral ossification of ligament lesions were 320 cases with spine ligament the CT imaging showed high density lesions: fine, and a segmental distribution. Vertebral facet joint and Sternocostal joints showed no abnormal changes. Conclusion SAPHO syndrome patients with lumbar spine lesions and 1 sacral vertebra. The vertebral lesions in CT images showed: focal bone destruction Bad, the adjacent cancellous bone with bone sclerosis and osteophyte formation. Vertebral ligament to "kissing" continuous involvement mainly. Paravertebral ossification of ligament lesions with supraspinous ligament. For facet joints and Sternocostal joints showed no abnormal changes. The above features is helpful to clinical and imaging doctors face understanding the disease involvement and imaging findings, combined with history make precise diagnosis. Second patients with SAPHO syndrome the spine and sacroiliac joint lesions in MRI objective analysis SAPHO comprehensive MRI syndrome patients with spinal lesions, in order to improve the recognition of this disease doctor. Methods a total of 38 cases of patients with SAPHO syndrome. This group of patients with uniform scanning parameters of whole spine MRI examination and bilateral sacroiliac joint MRI scan. Results 38 cases of SAPHO MRI syndrome patients showed abnormal image. Among them, 15 cases of spinal involvement, 4 cases of sacroiliac joint involvement, 19 Two cases were involved. (1) a total of 310 vertebral bodies in 34 patients (range: 2-24 / 7 cases, average per case), and 1 in lumbar sacral vertebral involvement for.80.3% were the "continuity of involvement kiss shaped, while 19.7% of the vertebral body is disc skipping involvement.37.4% vertebral involvement appeared facet joint involvement in mild stenosis of.7.1% vertebral body adjacent to the anterior longitudinal ligament thickening of.1.3% vertebral body. (2) in 310 vertebral bodies in 567 lesions. Among them, 35.8% lesions involving only the vertebral angle, and 64.2% involved the vertebral angle and near endplate.13.9% lesions in MRI images showed only bone marrow edema signal, 49.2% lesions showed bone marrow edema and fat deposition in mixed signal, 36.9% lesions showed only fat deposition signal.50.6% lesions on bone erosion.46.9% lesions appear bone sclerosis. (3) a total of 23 cases The sacroiliac joint involvement of patients, including 78.3% patients with bilateral involvement. The joint count, 41 sacroiliac joint involvement (4). 58.5% of the affected joint lesions in the sacral side, 14.6% lesions ankylosis, thickened lesions near the joint soft tissue edema in 14.6%. Conclusion the SAPHO spinal lesions the patients with multiple vertebral body involvement (edema, fatty degeneration and sclerosis. In the main signal) vertebral continuity "to kiss" involvement style. Intervertebral disc adjacent vertebral body, vertebral posterior components and paravertebral ligament involvement to a lesser degree. The sacroiliac joint is more bilateral involvement, lesions in the sacral side the less occurrence of joint ankylosis. Above findings contribute to the clinical outcome of the changes of MRI signal and image understanding of the disease doctors and disease development in the affected areas, and suggest the pathological characteristics, contribute to the early diagnosis and treatment. The third part MRI The score of SAPHO syndrome and the disease activity of the purpose to evaluate the value of MRI score for SAPHO syndrome, the disease activity of value judgment. Methods a total of 30 cases of patients with SAPHO syndrome. The patients were evaluated at baseline condition before treatment in our hospital. The evaluation method mainly includes: (1) the clinical score of patients: the VAS (Visual Analogue Score) score; BASDAI=Bath ankylosing spondylitis disease activity index; BASFAI=Bath Ankylosing Spondylitis Functional Index; ankylosing spondylitis BASMI=Bath index; ASDAS-CRP= based on CRP (C protein) of the ankylosing spondylitis disease activity score (2). Laboratory examination: ESR (erythrocyte sedimentation rate); CRP; the serum osteocalcin concentration; serum beta -CTx concentration. (3) MRI examination and semi quantitative score: the MRI score of the spine and sacroiliac joints in 30 patients, using the revised SPARCC score method (Canada spine Joint Research Association) the sacroiliac joint disease activity score method. The Spearman sacral spine and correlation analysis of MRI score and the clinical score and laboratory results. Results the total score of MRI was linearly correlated with ASDAS-CRP and CRP, the correlation coefficients were 0.601 and 0.476. conclusion in this study SPARCC MRI semi quantitative score the system can reflect the severity of inflammation in patients with SAPHO, can be used as an important index to evaluate the clinical curative effect.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R597;R816.8

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