强直性脊柱炎脊柱Andersson损害的磁共振成像特点

doi:10.3969/j.issn.1004-583X.2022.10.008

摘要/Abstract

摘要：

目的探讨强直性脊柱炎(ankylosing spondylitis,AS) 脊柱Andersson损害(Andersson lesions,AL) 的磁共振成像(magnetic resonance imaging, MRI)特征。方法回顾性分析2018年7月-2021年11月在哈尔滨工业大学医院放射科、2018年1月-2021年11月在哈尔滨医科大学附属第二医院MRI诊断科进行脊柱MRI检查的AS患者78例,依据MRI表现,将出现AL的AS患者分为炎症型组(n=23)和创伤型组(n=10),并比较两组临床资料。结果 78例AS患者中出现AL 33例,检出率为42.3%。创伤型组改良Stoke强直性脊柱炎脊柱评分(modified Stoke ankylosing spondylitis spine score, mSASSS)高于炎症型组(P<0.05)。两组受累椎体-椎间盘单元(discovertebral units,DVUs)差异有统计学意义(P<0.05),MRI影像学特点不同。相关分析显示,红细胞沉降率(erythrocyte sedimentation rate, ESR)、C反应蛋白(C-reactive protein,CRP)、人类白细胞抗原-B27(human leukocyte antigen-B27,HLA-B27)、Bath强直性脊柱炎病情活动指数(Bath ankylosing spondylitis disease activity index, BASDAI)、mSASSS与受累DVUs数量均无相关性(P>0.05)。结论 AL在AS患者中并不罕见,炎症型AL与创伤型AL有不同的MRI表现,MRI在检测和评价AL中具有重要价值。

关键词: 脊椎炎,强直性, Andersson损害, 磁共振成像

Abstract:

Objective To investigate the magnetic resonance imaging (MRI) characteristics of Anderson lesions (AL) associated with ankylosing spondylitis (AS). Methods A retrospective analysis was made on 78 AS patients who underwent spinal MRI examination in the Department of Radiology, Harbin Institute of Technology Hospital from July 2018 to November 2021, and in the Department of MRI, the 2nd Affiliated Hospital of Harbin Medical University from January 2018 to November 2021.The clinical data were compared in two groups which comprised 23 (inflammatory group) and 10 (traumatic group) patients. Results Among 78 AS patients, 33 had AL, with a detection rate of 42.3%. The modified Stoke ankylosing spondylitis spine score (mSASSS) in traumatic group was higher than that in inflammatory group (P<0.05). The difference of involved discovertebral units (DVUs) between the two groups was statistically significant (P<0.05), and the MRI characteristics were different. Correlation analysis showed that erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), human leucocyte antigen-B27 (HLA-B27), Bath ankylosing spondylitis disease activity index (BASDAI), mSASSS were not correlated with the number of involved DVUs(P>0.05). Conclusion AL is not rare in AS patients. Inflammatory AL and traumatic AL have different MRI manifestations. MRI has important value in detecting and evaluating AL.

Key words: ankylosing spondylitis, Andersson lesions, magnetic resonance imaging

中图分类号:

R593.23

高颖, 韩忠丽, 汪洪艳, 李晓夫. 强直性脊柱炎脊柱Andersson损害的磁共振成像特点[J]. 临床荟萃, 2022, 37(10): 927-930.

Gao Ying, Han Zhongli, Wang Hongyan, Li Xiaofu. Magnetic resonance imaging characteristics of Andersson lesions associated with ankylosing spondylitis[J]. Clinical Focus, 2022, 37(10): 927-930.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.10.008

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I10/927

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参考文献 21

[1]	Kiefer D, Braun J, Kiltz U. Axial spondyloarthritis: Update on management based on the interdisciplinary S3 guidelines on axial spondyloarthritis including early forms and ankylosing spondylitis[J]. Z Rheumatol, 2022, 81(3):198-204. doi: 10.1007/s00393-021-01147-4 pmid: 35113204
[2]	Navarro Compán V, Sepriano A, El-Zorkany B, et al. Axial spondyloarthritis[J]. Ann Rheum Dis, 2021, 80(12):1511-1521. doi: 10.1136/annrheumdis-2021-221035 pmid: 34615639
[3]	Baraliakos X, Braun J. Opinion: Perspectives on imaging in axial spondyloarthritis[J]. Nat Rev Rheumatol, 2013, 9(8):498-502. doi: 10.1038/nrrheum.2013.83 pmid: 23774899
[4]	Daveb R, Ram H, Krishnan A. Andersson lesion:Are we misdiagnosing it? a retrospective study of clinico-radiological features and outcome of short segment fixation[J]. Eur Spine J, 2011, 20(9):1503-1509. doi: 10.1007/s00586-011-1836-0 URL
[5]	Iaremenko O, Shynkaruk I, Fedkov D, et al. Bone turnover biomarkers, disease activity, and MRI changes of sacroiliac joints in patients with spondyloarthritis[J]. Rheumatol Int, 2020, 40(12):2057-2063. doi: 10.1007/s00296-020-04708-z URL
[6]	Jones A, Bray TJP, Mandl P, et al. Performance of magnetic resonance imaging in the diagnosis of axial spondyloarthritis: A systematic literature review[J]. Rheumatology (Oxford), 2019, 58(11):1955-1965. doi: 10.1093/rheumatology/kez172 pmid: 31046102
[7]	van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984, 27(4):361-368. doi: 10.1002/art.1780270401 URL
[8]	Park YS, Kim JH, Ryu JA, et al. The Andersson lesion in ankylosing spondylitis: Distinguishing between the inflammatory and traumatic subtypes[J]. J Bone Joint Surg Br, 2011, 93(7):961-966.
[9]	Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: The Bath ankylosing spondylitis disease activity index[J]. J Rheumatol, 1994, 21(12):2286-2291. pmid: 7699630
[10]	Qin W, Yang P, Zhou F, et al. Andersson lesion occurring in the lumbosacral segment of a young man: A case report and literature review[J]. World Neurosurg, 2020, 143:419-422. doi: S1878-8750(20)31667-3 pmid: 32798782
[11]	Wu M, Yan F, Ping A, et al. Effects of Andersson lesion treatment in ankylosing spondylitis: A medical record review study focused on medium- to long-term outcomes[J]. Int J Rheum Dis, 2020, 23(6):753-762. doi: 10.1111/1756-185X.13826 pmid: 32266777
[12]	Wang HF, Bi C, Chen ZQ. Research progress on Andersson lesion in ankylosing spondylitis[J]. Zhonghua Wai Ke Za Zhi, 2017, 55(10):798-800.
[13]	Qiao M, Qian BP, Qiu Y, et al. Radiologic and pathological investigation of pseudarthrosis in ankylosing spondylitis: Distinguishing between inflammatory and traumatic etiology[J]. J Rheumatol, 2019, 46(3): 259-265. doi: 10.3899/jrheum.171249 pmid: 30219768
[14]	von der Höh NH, Henkelmann J, Jarvers JS, et al. Magnetic resonance tomography for the early detection of occult fractures of the spinal column in patients with ankylosing spondylitis[J]. Eur Spine J, 2020, 29(4): 870-878. doi: 10.1007/s00586-020-06309-7 pmid: 31993791
[15]	Langlois S, Cedoz JP, Lohse A, et al. Aseptic discitis in patients with ankylosing spondylitis: A retrospective study of 14 cases[J]. Joint Bone Spine, 2005, 72(3):248-253. pmid: 15850997
[16]	Kim SK, Shin K, Song Y, et al. Andersson lesions of whole spine magnetic resonance imaging compared with plain radiography in ankylosing spondylitis[J]. Rheumatol Int, 2016, 36(12):1663-1670. doi: 10.1007/s00296-016-3542-z URL
[17]	胡嘉文, 冀肖健, 陈双萍, 等. 强直性脊柱炎合并脊柱骨折的临床与影像特点[J]. 解放军医学院学报, 2022, 43(1):31-35, 44.
[18]	Hu X, Kong Y, Li B. Andersson lesion in the thoracic spine[J]. J Clin Rheumatol, 2021, 27(7):e258. doi: 10.1097/RHU.0000000000001402 URL
[19]	Byravan S, Jain N, Stairs J, et al. Is there a correlation between patient-reported Bath ankylosing spondylitis disease activity index (BASDAI) score and MRI findings in axial spondyloarthropathy in routine clinical practice?[J]. Cureus, 2021, 13(11):e19626.
[20]	Baraliakos X, Østergaard M, Gensler LS, et al. Comparison of the effects of secukinumab and adalimumab biosimilar on radiographic progression in patients with ankylosing spondylitis: Design of a randomized, phase IIIb study (SURPASS)[J]. Clin Drug Investig, 2020, 40(3):269-278. doi: 10.1007/s40261-020-00886-7 URL
[21]	Huang JC, Qian BP, Qiu Y, et al. Occult Andersson lesions in patients with ankylosing spondylitis: Undetectable destructive lesions on plain radiographs[J]. Chin Med J, 2021, 134(12):1441-1449. doi: 10.1097/CM9.0000000000001557 URL

机器型号	重复时间(ms)	回波时间(ms)	层厚(mm)	视野(mm)	矩阵
飞利浦1.5T
T1WI	253~538	8~10	5	280×280	576×576
T2WI	1 395~2 573	84~120	5	264×264	528×528
T2WI-FS	1 455~2 350	84~120	5	264×264	528×528
西门子1.5T
T1WI	400~756	9.7~11	4	306×384	512×512
T2WI	2 020~3 830	99~104	4	384×384	512×512
T2WI-FS	2 160~2 500	99~104	4	384×384	512×512

机器型号	重复时间(ms)	回波时间(ms)	层厚(mm)	视野(mm)	矩阵
飞利浦1.5T
T1WI	253~538	8~10	5	280×280	576×576
T2WI	1 395~2 573	84~120	5	264×264	528×528
T2WI-FS	1 455~2 350	84~120	5	264×264	528×528
西门子1.5T
T1WI	400~756	9.7~11	4	306×384	512×512
T2WI	2 020~3 830	99~104	4	384×384	512×512
T2WI-FS	2 160~2 500	99~104	4	384×384	512×512

组别	例数	年龄(岁)	性别[例(%)]		病程(年)	ESR(mm/hr)	CRP(mg/dl)	HLA-B27		mSASSS(分)	BASDAI(分)
组别	例数	年龄(岁)	男	女	病程(年)	ESR(mm/hr)	CRP(mg/dl)	阳性	阴性	mSASSS(分)	BASDAI(分)
炎症型	23	34.96±7.37	13(56.5)	10(43.5)	4.35±1.23	24.25±12.38	1.53±0.40	21(91.3)	2(0.7)	15.35±3.65	4.03±0.62
创伤型	10	41.20±6.37	6(60.0)	4(40.0)	5.80±0.79	26.55±13.88	1.60±0.35	10(100.0)	0	35.32±4.50	4.21±1.06
统计值		t=2.322			t=3.426	t=0.473	t=0.444			t=9.316	t=0.630
P值		>0.05	>0.05		>0.05	>0.05	>0.05	>0.05		0.000	>0.05

组别	例数	年龄(岁)	性别[例(%)]		病程(年)	ESR(mm/hr)	CRP(mg/dl)	HLA-B27		mSASSS(分)	BASDAI(分)
组别	例数	年龄(岁)	男	女	病程(年)	ESR(mm/hr)	CRP(mg/dl)	阳性	阴性	mSASSS(分)	BASDAI(分)
炎症型	23	34.96±7.37	13(56.5)	10(43.5)	4.35±1.23	24.25±12.38	1.53±0.40	21(91.3)	2(0.7)	15.35±3.65	4.03±0.62
创伤型	10	41.20±6.37	6(60.0)	4(40.0)	5.80±0.79	26.55±13.88	1.60±0.35	10(100.0)	0	35.32±4.50	4.21±1.06
统计值		t=2.322			t=3.426	t=0.473	t=0.444			t=9.316	t=0.630
P值		>0.05	>0.05		>0.05	>0.05	>0.05	>0.05		0.000	>0.05

组别	受累 DVUs 数量	颈椎受累 DVUs (C1-C7)	上胸椎受累 DVUs (T1-T9)	胸腰段受累 DVUs (T10-L2)	下腰椎受累 DVUs (L3-L5)
炎症型	32	4(12.5)	6(18.8)	15(46.9)	7(21.8)
创伤型	10	0	0	7(70.0)	3(30.0)
χ²值		19.528
P值		0.000