强直性脊柱炎：动态增强MRI对其活动性的评估价值及中晚期伴发脊柱骨折的影像特点的研究

发布时间：2018-05-12 04:29

本文选题：强直性脊柱炎 + 磁共振　；参考：《南京医科大学》2017年硕士论文

【摘要】：目的1.研究磁共振动态增强成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)及联合应用弥散加权成像(diffusion-weighted imaging,DWI)技术对强直性脊柱炎(ankylosing spondylitis,AS)骶髂关节炎活动性的评估价值。2.探讨晚期AS伴发脊柱骨折的损伤机制及影像学特点,减少漏、误诊。材料和方法1.根据1984年纽约修订AS诊断标准,前瞻性的搜集本院32例AS病例(男性18例,女性14例),并评估所有病例的影像资料及临床资料,包括C反应蛋白(CRP)、红细胞沉降率(ESR)和Bath强直性脊柱炎疾病活动指数(BASDAI)评分。根据这些临床资料,将所有病例分成静止期组和活动期组,运用DCE-MRI的定量参数(Ktrans)及联合应用DWI的表观扩散系数(ADC)分析每组病例的MRI资料,并对两组病例的定量资料进行对比分析。最后将所有资料的参数及临床活动性指标进行Spearman相关性分析。2.回顾性搜集15例AS伴脊柱骨折患者的影像和临床资料,及37例普通脊柱骨折病人的资料,并对其进行分析。结果1.在32例病例中,18例(男性10例,女性8例)属于活动期组,另外14例(男性8例,女性6例)属于静止期组。DCE参数Ktrans值及DWI的ADC值在这两组的差异具有统计学意义(P= 0.02forKtrans,P= 0.002 forADC),这些定量参数在活动期组的值高于静止期组。Ktrans值与BASDAI评分(r=0.55,P=0.001),CRP 水平(r=0.351,P=0.049)或 ESR 水平(r=0.373,P=0.036)有着明显的相关性,而ADC值仅与BASDAI评分(r=0.503,p=0.003)或ESR水平(r=0.383,p=0.031)有相关性,另外Ktrans值和ADC值也有相关性(r=0.352,p=0.048)。2.(1)在AS患者中,有明确外伤史的有11例,影像学上表现为三柱骨折的有9例,可见明确椎管受压或脊髓损伤的有7例,骨折经过椎间部位的有6例;在普通脊柱骨折患者中,有明确外伤史的有36例,影像学上表现为三柱骨折的有4例,可见明确椎管受压或脊髓损伤的有5例,骨折经过椎间部位的有0例。(2)统计分析发现:AS伴脊柱骨折患者与普通脊柱骨折患者相比,无外伤原因所占比率差异有统计学意义(χ2值为4.565,P0.05),患者发生三柱骨折的比率差异有统计学意义(χ2值为11.274,P0.05),骨折导致椎管受压或脊髓损伤的比率差异有统计学意义(χ2值为4.873,P0.05),骨折经过椎间部位发生的比率差异有统计学意义(χ2值为13.041,P0.05)。结论1.DCE-MRI的定量参数(Ktrans)和DWI的ADC值可以较准确区分强直性脊柱炎炎性的活动期与静止期。DCE-MRI的定量参数(Ktrans)在评估AS骶髂关节炎症程度中有着很高的价值,Krans值可以作为一种良好的AS炎症活动性的影像学指标,且与ADC值相比,Ktrans值与临床活动性指标有着更好的一致性。2.AS伴发脊柱骨折与普通脊柱骨折损伤机制有明显的差异,X线、CT和MRI在显示AS伴脊柱骨折方面各有优势,有效地运用这些差异以及选用合适的影像检查将有助于减少漏、误诊。
[Abstract]:Objective 1. To study the value of DCE-MRI and DCE-MRI in evaluating the activity of ankylosing spondylitis in patients with ankylosing spondylitis (ASA). To investigate the mechanism of injury and imaging features of spinal fractures associated with advanced as, to reduce leakage and misdiagnosis. Materials and methods 1. According to the revised diagnostic criteria for as in New York in 1984, 32 cases of as (18 males and 14 females) were collected prospectively, and the imaging and clinical data of all cases were evaluated. It included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Bath ankylosing spondylitis disease activity index (BASDAI). According to these clinical data, all cases were divided into quiescent group and active group. The MRI data of each group were analyzed by using the quantitative parameters of DCE-MRI and the apparent diffusion coefficient of DWI. The quantitative data of the two groups were compared and analyzed. Finally, the parameters of all data and clinical activity index were analyzed by Spearman correlation analysis. 2. 2. The imaging and clinical data of 15 cases of as with spinal fracture and 37 cases of common spinal fracture were retrospectively collected and analyzed. Result 1. Of the 32 cases, 18 cases (10 males, 8 females) were in the active phase group, and 14 cases (8 males, 8 males). There was significant difference between the two groups (P = 0.02 for KtransP = 0.002 for DWI). These quantitative parameters in the active phase group were higher than those in the rest phase group and BASDAI score 0.555P 0.001CRP level (P = 0.351P = 0.049) or in the active phase group (P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.351P = 0.049). There was a significant correlation between the ESR level and the level of 0.373P0. 036 (P < 0. 036). The ADC value was only correlated with the BASDAI score (0.503p0. 003) or the ESR level (0.383p0. 031). In addition, there was a correlation between the Ktrans value and the ADC value. In as patients, there were 11 patients with definite traumatic history and 9 patients with 3 column fractures. It can be seen that there are 7 cases of vertebral canal compression or spinal cord injury, 6 cases of fracture passing through the intervertebral part, 36 cases of common spinal fracture with a clear history of trauma, and 4 cases of three column fracture on imaging. It can be seen that there are 5 cases of vertebral canal compression or spinal cord injury, and 0 cases of fracture passing through the intervertebral part. There was statistically significant difference in the ratio of non-traumatic causes (蠂 ~ 2 = 4.565, P 0.05), and in the incidence of three-column fracture (蠂 ~ 2 = 11.274, P 0.05). The ratio of vertebral canal compression or spinal cord injury caused by fracture had statistical significance (蠂 ~ 2). The ratio of fracture through intervertebral site was significantly different (蠂 ~ 2 = 13.041) (P 0.05). Conclusion the quantitative parameters of 1.DCE-MRI and DWI can be used to distinguish the active phase of ankylosing spondylitis from the rest phase. DCE-MRI has a high value in assessing the degree of sacroiliac arthritis as. A good imaging indicator of as inflammatory activity, Compared with the ADC value, the Ktrans value was more consistent with the clinical activity index. 2. There were significant differences in the mechanism of spinal fracture associated with as and common spinal fracture. X-ray CT and MRI had respective advantages in displaying as with spinal fracture. Effective use of these differences and selection of appropriate imaging will help reduce leakage and misdiagnosis.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R593.23;R683

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