多层螺旋CT后处理技术在强直性脊柱炎骶髂关节病变中的诊断价值

摘要

Objective To investigate the diagnostic value of multi-slice spiral CT(MSCT) and its multi-planar reconstruction(MPR) and curved planar reconstruction(CPR) on sacroiliac joint with ankylosing spondylitis(AS).Methods Fifty-six patients with AS proved clinically were examined and analyzed with MSCT and reconstruction.Then the CT manifestations of sacroiliace joints were analyzed.And choose a sagittal image respectively in the margin of the sacrum one-four,one-second and two-four.Then went down the sacrum line trace for CPR technique get double sided sacroiliac joint imaging.The images,MPR transect images and CPR image were analyed.Results Early CT findings included coarsearticular surface,interrupted jiont cortex,vague articular face,subcortical microcysts and sclerotic articular surface,while jiont space was normal.CT findings in progressive stage were uneven articular surface,damaged bony cortex,subcartilaginous bone microcyats,obviously sclerotic articular surface,extended jiontspace.In stable stage,CT findings included joint ankylosis,articular space dsiappearance,and sacroiliac ligament calcification.Fifty-six cases of AS patients,bilateral simultaneous involvement in 47 cases,unilateral involvement in 9 cases,axial image diagnosis,Ⅰ-Ⅱ grade 16 cases,Ⅲ-Ⅳ grade 26 cases.MPR image diagnosis of Ⅰ-Ⅱ grade 24 cases,Ⅲ-Ⅳ Grade 26 cases,CPR class Ⅰ diagnostic images-Ⅱ grade 29 cases,Ⅲ-Ⅳ grade in 26 cases,early diagnosis of axial images and reconstruction images were significantly different (P ＜ 0.05),the late diagnosis rates were not significantly different (P ＞ 0.05).Conclusions It is valuable to use MPR and CPR images to diagnosis sacroiliac joint lesions in patients with ankylosing spondylitis.Especially CPR image can be used to comprehensively observe sacroiliac joint,and it is more meaningful in early diagnosis of sacroiliac joint lesions in patients with AS.%目的 探讨多层螺旋CT(MSCT)多平面重组(MPR)技术和曲面重组(CPR)技术在强直性脊柱炎(AS)骶髂关节病变中的诊断价值.方法 对56例临床确诊的AS患者进行双侧骶髂关节MSCT容积扫描获得原始横断面图像,并进行MPR获得双侧骶髂关节矢状面和冠状面图像,然后选取矢状面图像分别在骶骨上缘1/4、1/2、3/4处沿骶骨走行划曲线进行CPR技术获得双侧骶髂关节成像.分别对横断面图像、MPR图像和CPR图像进行比较分析.结果 AS患者CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧,早期CT表现为关节面毛糙、关节面皮质中断或白线消失,软骨下骨质受侵蚀、囊变,关节面轻度硬化,但关节间隙无改变.进展期主要表现为关节面不光整、局部骨皮质呈锯齿状改变,软骨下骨质囊状破坏、骨质硬化明显,关节间隙增宽.稳定期主要表现为关节骨性强直、关节间隙消失,骶髂韧带钙化.56例AS患者,双侧同时受累47例,单侧受累9例；轴位图像诊断,Ⅰ～Ⅱ级16例,Ⅲ～Ⅳ级25例；MPR图像诊断Ⅰ～Ⅱ级24例,Ⅲ～Ⅳ级26例;CPR图像诊断Ⅰ～Ⅱ级29例,Ⅲ～Ⅳ级26例,早期诊断率轴位图像与重建图像比较差异有统计学意义(P＜0.05),晚期诊断率比较差异无统计学意义(P＞0.05).结论 多层螺旋CT和后处理MPR图像和CPR图像对强直性脊柱炎骶髂关节病变中的诊断有重要价值,特别是CPR图像能全面观察骶髂关节,对强直性脊柱炎骶髂关节病变的早期诊断更有意义.