武汉同济医院李小明 A novel diagnostic method （spectral computed tomography of sacroiliac joints） for axial spondyloarthritis.

J Formos Med Assoc. 2016 Aug;115（8）:658-64. doi: 10.1016/j.jfma.2015.07.003. Epub 2015 Sep 1.

A novel diagnostic method （spectral computed tomography of sacroiliac joints） for axial spondyloarthritis.

Zhang P¹, Yu KH², Guo RM³, Ran J³, Liu Y³, Morelli J⁴, Runge VM⁵, Li XM⁶.

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Abstract

BACKGROUND/PURPOSE:

To evaluate the diagnostic value of spectral computed tomography （CT） of sacroiliac joints for axial spondyloarthritis（SpA）.

METHODS:

We retrospectively analyzed the records of 125 patients with low back pain （LBP） suspected of having SpA. Each patient underwentsacroiliac joint spectral CT examination. Water- and calcium-based material decomposition images were reconstructed. After 3-6 months of follow-up, 76 were diagnosed with SpA, and the remaining 49 patients were diagnosed with nonspecific LBP （nLBP）. The slope of sacroiliac bone marrow HU （Hounsfield unit） curve （λHU）, CT value, and bone marrow to normal muscle ratios of water and calcium concentrations in the ilium and sacrum were calculated and compared between nLBP and SpA patients.

RESULTS:

The iliac λHU was 8.26 ± 3.91 for nLBP and 9.81 ± 4.92 for SpA. The mean iliac ratios of water and calcium concentrations were 1.04 ± 0.03 and 21.67 ± 4.40, respectively, for nLBP, and 1.07 ± 0.04 and 111.5 ± 358.98, respectively, for SpA. The mean iliac CT values were 311.12 ± 86.52 HU for nLBP and 423.97 ± 127.51 HU for SpA. There were statistically significant differences in iliac ratios of water and calcium concentrations, CT value, and λHU between nLBP and SpA patients （p < 0.05）. The sensitivity of iliac λHU was the highest. The diagnostic odds ratio of ratio of iliac calcium concentration was the highest, and its negative likelihood ratio was the lowest.

CONCLUSION:

Spectral CT not only shows bone erosion and sclerosis, but also shows and quantitatively measures bone marrow edema in thesacroiliac joints of SpA patients.

Copyright © 2015. Published by Elsevier B.V.

KEYWORDS:

axial spondyloarthritis; sacroiliac joint; spectral CT

PMID: 26341148 DOI: 10.1016/j.jfma.2015.07.003