将SPARCC关于核磁共振成像骶髂关节结
2019-2-2 来源:不详 浏览次数:次将SPARCC关于核磁共振成像
骶髂关节结构损伤的评分方法
用于中国中轴型脊柱炎患者
背景/目的对于脊柱关节炎患者骶髂关节(SIJ)的结构性进展的评估需求尚未满足,但是放射检查并不可靠且缺乏响应能力。加拿大脊椎关节炎研究协会(SPARCC)开发的骶髂关节结构评分(SSS)被证明是一种新的基于磁共振成像(MRI)评价结构损伤的可靠评分方法。在这项研究中,我们试图采用骶髂关节结构评分法(SSS)记录结构病变的特点,并验证中国中轴型脊柱关节炎患者的关节结构评分(SSS)。
方法三位研究人员(两位放射科医生和一位风湿病学家)研究了位病人的MR影像上的脂肪化生、侵蚀、回填和强直。所有这些患者都符合ASAS(脊柱关节炎国际社会评估标准)关于中轴型脊柱关节炎的分类标准。骶髂关节结构得分(SSS)法对这四种结构损伤评估是基于t1加权自旋回波磁共振成像和二分法计分(病变存在/不存在),使用连续5片通过关节的软骨部分。评分范围为脂肪化生(0-40)、侵蚀(0-40)、回填(0-20)、关节僵硬(0-20)。
结果患者包括名男性和81名女性,平均年龄为26.2±8.4岁,症状持续时间为4.7±6.1年。骶髂关节结构得分(SSS)的评分(四种病变之和)为18.4±9.1。名患者(88.0%)有脂肪化生记录,名患者(81.1%)有侵蚀记录,名患者(58.2%)有回填记录,名患者(24.6%)有关节僵硬记录。四种病变出现在骶髂关节左边或右边的概率并无差别(p都0.05)。侵蚀和回填的出现在骶髂关节上半部分比下半部分频率更高(p都0.05)。髂骨发生侵蚀和脂肪化生的频率高于骶骨(p都0.05)。就观察者间信度而言,脂肪化生为好(ICC0.70-0.75),侵蚀为好(ICC0.67-0.73),回填为较好到好(ICC0.56-0.66),僵硬为好到非常好(ICC0.78-0.88)。
结论加拿大脊椎关节炎研究协会(SPARCC)的骶髂关节结构得分(SSS)法,在检测中国脊柱关节炎患者的骶髂关节结构变化时,可靠性尚可。
原文
ApplicationoftheSpondyloarthritisResearchConsortiumofCanadaMagnetic
ResonanceImagingSacroiliacJointStructuralScoreinChinesePatientswithAxialSpondyloarthritis
ZaiyingHu1,JunQi2,ShanglinZhu3,BaiyuZhang3andZetaoLiao4,1DepartmentofRheumatology,ThirdAffiliatedHospitalofSunYatsenUniversity,Guangzhou,China,2TheThirdAffiliatedHospitalofSunYat-senUniversity,guangzhou,China,3SixthAffiliatedHospitalofSunYat-senUniversity,Guangzhou,China,4Rheumatology,3rdAffiliatedHoapitalofSunYat-SenUni,Guangzhou,China
Background/Purpose
Thereisanunmetneedforreliableassessmentofstructuralprogressioninthesacroiliacjoints(SIJ)ofpatientswithaxialspondyloarthritis(SpA),butradiographyisunreliableandlacksresponsiveness.TheSpondyloarthritisResearchConsortiumofCanada(SPARCC)SIJStructuralScore(SSS)isdevelopedandprovedtobeanewreliablescoringmethodforevaluatingstructurallesionsbasedonmagneticresonanceimaging(MRI).Inthisstudy,wetriedtorecordthefeaturesofstructurallesionsusingSSSandtovalidateSSSinChinesepatientswithaxialSpA.
Methods
Threereaders(tworadiologistsandonerheumatologist)investigatedfatmetaplasia,erosion,backfillandankylosisseenonMRimagesfrompatients.AllthesepatientsfulfilledtheASASclassificationcriteriaforaxialSpA.TheSSSmethodforassessmentofthesefourkindsofstructurallesionswasbasedonT1-weightedspinechoMRI,anddichotomousscoring(lesionpresent/absent)offiveconsecutiveslicesthroughthecartilaginousportionofthejoint.Scoringrangeswerefatmetaplasia(0-40),erosion(0-40),backfill(0-20),andankylosis(0-20).
Results
Thereweremaleand81femalepatientsincluded.Themeanageofthemwas26.2±8.4yearsold.Theirsymptomdurationwas4.7±6.1years.ThetotalSSSscore(sumoffourkindsoflesions)ofthemwas18.4±9.1.(88.0%)wererecordedwithfatmetaplasia,(81.1%)patientswererecordedwitherosion,(58.2%)wererecordedwithbackfill,and(24.6%)wererecordedwithankylosis.TherewerenodifferencesoftheratesoffourkindsoflesionsappearedontheleftortherightSIJ(allp0.05).ErosionandbackfillweremorefrequentlyseenintheupperhalfthaninthelowerhalfSIJ(bothp0.05).Theiliumboneswerewithmoreoftenwitherosionandfatmetaplasiathanthesacrumbones(bothp0.05).Interobserverreliabilitywasgoodforfatmetaplasia(ICC0.70-0.75),alsogoodforerosion(ICC0.67-0.73),fairtogoodforbackfill(ICC0.56-0.66),andgoodtoexcellentforankylosis(ICC0.78-0.88).
Conclusion:
TheSPARCCMRISSSmethodcoulddetectstructuralchangesintheSIJwithacceptablereliabilityinChinesepatientswithaxialSpA.
Disclosure:Z.Hu,None;J.Qi,None;S.Zhu,None;B.Zhang,None;Z.Liao,None.
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