风湿

脊柱关节炎患者核磁DWI成像对诊断、疾病活动和疗效评估有益

作者:Bradbury LA,et al 翻译:北医三院翟佳羽 来源:中国风湿病公众论坛 日期:2018-06-14
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         脊柱关节炎患者核磁DWI成像对诊断、疾病活动和疗效评估有益

关键字:  脊柱关节炎 

        摘要:目的:我们检测弥散加权磁共振成像(DWI)的鉴别能力及其作为评估肿瘤坏死因子拮抗剂治疗强直性脊柱炎疗效的客观指标的潜力。方法:对于3个队列进行前瞻性研究:(1)18例符合修订纽约标准的强直性脊柱炎患者巴氏强直性脊柱炎疾病活动指数(BASDAI)>4、红细胞沉降率>25且C反应蛋白>10;(2)20例符合国际脊柱关节炎协会标准(ASAS)的放射学阴性中轴型脊柱关节炎(nr-axSpA)患者;(3)20例慢性腰背痛的非强直性脊柱炎患者,年龄18至45岁且影像学不符合ASAS中轴型脊柱关节炎标准。第1组患者在阿达木单抗治疗前后进行研究。采用DWI、传统MRI和标准非成像测量对患者进行评估。结果:基线期,与标准非成像测量相比,DWI表观弥散系数(ADC)值显示出良好的判别性能(第1组或第2组与第3组相比曲线下面积>80%)。ADC值在治疗后有显著下降(治疗前0.45±0.443,治疗后0.154±0.23,p=0.0017),但比较治疗前后有一定鉴别能力(AUC=68%)。这种结果类似于加拿大脊柱关节炎研究小组(SPARCC)评分系统。结论:DWI对于强直性脊柱炎和放射学阴性中轴型脊柱关节炎的诊断有益。与SPARCC MRI评分类似对于疾病活动性及治疗反应的评估有一定的作用。

        附原文:OBJECTIVE: We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factorinhibition in ankylosing spondylitis (AS). METHODS: Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures. RESULTS: At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. CONCLUSION: DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity ortreatment response, with performance similar to that of the SPARCC MRI score.

        引自:Bradbury LA, Hollis KA, Gautier B, et al. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis. J Rheumatol. 2018 Feb 15. pii: jrheum.170312. doi: 10.3899/jrheum.170312. [Epub ahead of print]

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