本文選題：強(qiáng)直性脊柱炎 + 磁共振　； 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的1.研究磁共振動態(tài)增強(qiáng)成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)及聯(lián)合應(yīng)用彌散加權(quán)成像(diffusion-weighted imaging,DWI)技術(shù)對強(qiáng)直性脊柱炎(ankylosing spondylitis,AS)骶髂關(guān)節(jié)炎活動性的評估價值。2.探討晚期AS伴發(fā)脊柱骨折的損傷機(jī)制及影像學(xué)特點(diǎn),減少漏、誤診。材料和方法1.根據(jù)1984年紐約修訂AS診斷標(biāo)準(zhǔn),前瞻性的搜集本院32例AS病例(男性18例,女性14例),并評估所有病例的影像資料及臨床資料,包括C反應(yīng)蛋白(CRP)、紅細(xì)胞沉降率(ESR)和Bath強(qiáng)直性脊柱炎疾病活動指數(shù)(BASDAI)評分。根據(jù)這些臨床資料,將所有病例分成靜止期組和活動期組,運(yùn)用DCE-MRI的定量參數(shù)(Ktrans)及聯(lián)合應(yīng)用DWI的表觀擴(kuò)散系數(shù)(ADC)分析每組病例的MRI資料,并對兩組病例的定量資料進(jìn)行對比分析。最后將所有資料的參數(shù)及臨床活動性指標(biāo)進(jìn)行Spearman相關(guān)性分析。2.回顧性搜集15例AS伴脊柱骨折患者的影像和臨床資料,及37例普通脊柱骨折病人的資料,并對其進(jìn)行分析。結(jié)果1.在32例病例中,18例(男性10例,女性8例)屬于活動期組,另外14例(男性8例,女性6例)屬于靜止期組。DCE參數(shù)Ktrans值及DWI的ADC值在這兩組的差異具有統(tǒng)計學(xué)意義(P= 0.02forKtrans,P= 0.002 forADC),這些定量參數(shù)在活動期組的值高于靜止期組。Ktrans值與BASDAI評分(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)有著明顯的相關(guān)性,而ADC值僅與BASDAI評分(r=0.503,p=0.003)或ESR水平(r=0.383,p=0.031)有相關(guān)性,另外Ktrans值和ADC值也有相關(guān)性(r=0.352,p=0.048)。2.(1)在AS患者中,有明確外傷史的有11例,影像學(xué)上表現(xiàn)為三柱骨折的有9例,可見明確椎管受壓或脊髓損傷的有7例,骨折經(jīng)過椎間部位的有6例;在普通脊柱骨折患者中,有明確外傷史的有36例,影像學(xué)上表現(xiàn)為三柱骨折的有4例,可見明確椎管受壓或脊髓損傷的有5例,骨折經(jīng)過椎間部位的有0例。(2)統(tǒng)計分析發(fā)現(xiàn):AS伴脊柱骨折患者與普通脊柱骨折患者相比,無外傷原因所占比率差異有統(tǒng)計學(xué)意義(χ2值為4.565,P0.05),患者發(fā)生三柱骨折的比率差異有統(tǒng)計學(xué)意義(χ2值為11.274,P0.05),骨折導(dǎo)致椎管受壓或脊髓損傷的比率差異有統(tǒng)計學(xué)意義(χ2值為4.873,P0.05),骨折經(jīng)過椎間部位發(fā)生的比率差異有統(tǒng)計學(xué)意義(χ2值為13.041,P0.05)。結(jié)論1.DCE-MRI的定量參數(shù)(Ktrans)和DWI的ADC值可以較準(zhǔn)確區(qū)分強(qiáng)直性脊柱炎炎性的活動期與靜止期。DCE-MRI的定量參數(shù)(Ktrans)在評估AS骶髂關(guān)節(jié)炎癥程度中有著很高的價值,Krans值可以作為一種良好的AS炎癥活動性的影像學(xué)指標(biāo),且與ADC值相比,Ktrans值與臨床活動性指標(biāo)有著更好的一致性。2.AS伴發(fā)脊柱骨折與普通脊柱骨折損傷機(jī)制有明顯的差異,X線、CT和MRI在顯示AS伴脊柱骨折方面各有優(yōu)勢,有效地運(yùn)用這些差異以及選用合適的影像檢查將有助于減少漏、誤診。
[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.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R593.23;R683

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