Grey-scale Reversed T<sub>1</sub>-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis

LI Ximeng; LI Wenjuan; ZHANG Ke; LIU Chaoran; ZHU Yunfei; ZHAN Yingying; LIANG Mingzhu; HONG Guobin

doi:10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.004

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Grey-scale Reversed T₁-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis

Clinical Research | 更新时间：2024-06-05

- Grey-scale Reversed T₁-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis
- Journal of Sun Yat-sen University(Medical Sciences) Vol. 45, Issue 3, Pages: 412-419(2024)
- 作者机构：
  
  1.中山大学附属第五医院放射科，广东珠海 519000
  2.南方医科大学珠江医院影像诊断科，广东广州 510280
- 作者简介：
  
  LIANG Mingzhu；E-mail： liangmzhu5@mail.sysu.edu.cn
  HONG Guobin；E-mail： honggb@smu.edu.cn
- 基金信息：
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.004
  CLC： R445.2
- Published：20 May 2024，
  
  Received：10 April 2024，
  
  Accepted：13 May 2024
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李禧萌,李文娟,张珂等.T₁灰阶反转图评估中轴型脊柱关节炎骶髂关节结构性病变的价值[J].中山大学学报（医学科学版）,2024,45(03):412-419.

LI Ximeng,LI Wenjuan,ZHANG Ke,et al.Grey-scale Reversed T₁-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(03):412-419.
李禧萌,李文娟,张珂等.T₁灰阶反转图评估中轴型脊柱关节炎骶髂关节结构性病变的价值[J].中山大学学报（医学科学版）,2024,45(03):412-419. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.004.

LI Ximeng,LI Wenjuan,ZHANG Ke,et al.Grey-scale Reversed T₁-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis[J].Journal of Sun Yat-sen University(Medical Sciences),2024,45(03):412-419. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.004.

摘要

目的

探讨 T

灰阶反转（rT

）图对中轴型脊柱关节炎（ax-SpA）骶髂关节结构性病变的诊断价值。

方法

回顾性搜集我院 2020 年 2 月至 2022 年 12 月在 1 周内行骶髂关节MRI 及 CT 检查并符合 ax-SpA 诊断标准的患者52例，共计104 个骶髂关节。两名放射科医师基于常规T

WI、rT

、T

WI + rT

三组图像，分别评估ax-SpA骶髂关节结构病变：骨侵蚀、骨质硬化、关节间隙改变，在斜冠状位图像上将骶髂关节分为前、中、后 3 部分，每部分分骶面、髂面，共6个区域，并按拟定评分规则对上述 3 种结构性病变进行评分，其中1名医师间隔1月后再次进行评分。由第3名肌骨影像专科医师同样使用上述方法评估CT图像作为参考标准。使用组内相关系数（ICC）分析医师间及医师内分别评估各病变评分一致性；采用Friedman

检验比较三组图像对各病变评分与 CT评分的差异；以 CT为参考标准，采用诊断性试验分析计算三组图像诊断骨侵蚀、骨质硬化及关节间隙改变的准确率、灵敏度、特异度，并采用McNemar 检验比较rT

、T

WI + rT

与T

WI的差异。

结果

三组图像评分各类结构病变医师间、医师内一致性好，其中以T

WI + rT

的一致性最优，评估各类病变ICC≥0.856 95%CI（0.794，0.900），优于rT

及T

WI［ rT

：ICC≥0.819 95%CI（0.745，0.874），T

WI：ICC≥0.754 95%CI（0.656，0.827）］；T

WI + rT

对各病变的评分结果与CT评分结果相当， rT

对骨侵蚀、关节间隙改变评分与CT相当（

＞0.05）。相较T

WI，T

WI + rT

诊断各病变均有更高的准确率及灵敏度（准确率

骨侵蚀

：90.3%

76. 9%；灵敏度

骨侵蚀

： 91.6%

76.1%；准确率

骨质硬化

：89.4%

80.8%；灵敏度

骨质硬化

： 84.6%

73.9%；准确率

关节间隙改变

： 86.5%

73.1%；灵敏度

关节间隙改变

： 84.9%

60.4%；

0.05）；rT

提高了对骨侵蚀、关节间隙改变诊断的准确性和灵敏度（准确率

骨侵蚀

： 87.5%

76.9%；灵敏度

骨侵蚀

： 88.7%

76.1%；准确率

关节间隙改变

： 85.6%

73.1%；灵敏度

关节间隙改变

： 83.0%

60.4%；

0.05）。

结论

能提高ax-SpA骶髂关节结构性病变的诊断效能，T

WI + rT

效能更优。

Abstract

Objective

To analyze the value of grey-scale reversed T

-weighted （rT

） MRI in the detection of structural lesions of the sacroiliac joint （SIJ） in patients with axial spondyloarthritis （ax-SpA）.

Methods

Fifty-two ax-SpA patients who underwent both MRI and CT in our hospital within a week from February 2020 to December 2022 were retrospectively included. Both sacral and iliac side of each SIJ on oblique coronal images were divided into anterior， middle and posterior portion. Two radiologists reviewed independently three groups of MRI including T1-weighted imaging （T

WI）， rT

and T

WI + rT

images to evaluate the structural lesions like erosions， sclerosis and joint space changes in each of t

he 6 regions of the SIJ. One of the radiologist did the evaluation again one month later. CT images were scored for lesions by a third radiologist and served as the reference standard. Intra-class correlation coefficients （ICC） were calculated to test the inter- and intra-reader agreement for the assessment of SIJ lesions. A Friedman test was performed to compare the lesion results of MRI

and CT image findings. We examined the diagnostic performance ［accuracy， sensitivity （SE） and specificity］ of different groups of MRI in the detection of lesions by using diagnostic test. A McNemar test was used to compare the differences of three groups of MRI findings.

Results

CT showed erosions in 71 joints， sclerosis in 65 and joint space changes in 53. Good inter-and intra-reader agreements were found in three groups of MRI images for the assessment of lesions， with the best agreement in T

WI + rT

. There were no difference between T

WI + rT

and CT for the assessment of all lesions， nor between rT

and CT for the assessment of erosions and joint space changes （

0.05）. T

WI + rT

yielded better accuracy and SE than T

WI in detection of all lesions （Accuracy

erosions

： 90.3%

76. 9%； SE

erosions

： 91.6%

76.1%； Accuracy

sclerosis

： 89.4%

80.8%； SE

sclerosis

： 84.6%

73.9%； Accuracy

joint space changes

： 86.5%

73.1%； SE

joint space changes

： 84.9%

60.4%；

0.05）. rT

yielded better accuracy and SE than T

WI in detection of erosions and joint space changes （Accuracy

erosions

： 87.5%

76.9%； SE

erosions

： 88.7%

76.1%； Accuracy

joint space changes

： 85.6%

73.1%； SE

joint space changes

： 83.0%

60.4%；

0.05）.

Conclusions

In the detection of SIJ structural lesions in ax-SpA， rT

improves the diagnostic performance and T

WI + rT

is more superior to others.

关键词

中轴型脊柱关节炎骶髂关节炎结构性病变磁共振成像灰阶反转

Keywords

axial spondyloarthritis （ax-SpA）sacroiliac joint （SIJ）structural lesionsMRIgrey-scale reversed

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Grey-scale Reversed T1-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis

DOI：10.13471/j.cnki.j.sun.yat-sen.univ（med.sci）.20240515.004

摘要

Abstract

关键词

Keywords

references

Grey-scale Reversed T₁-weighted MRI for Detecting Structural Lesions of the Sacroiliac Joint in Patients with Axial Spondyloarthritis