rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2008-410rsp-548Research ArticleСтатьиArticlesВоспалительные изменения позвоночника у больных анкилозирующим спондилитом по данным магнитно-резонансной томографииSpine inflammatory changes in patients with ankylosing spondylitis assessed by magnetic resonance imageБочковаА. Г.BochkovaA G-ЛевшаковаА. В.LevshakovaA. V.-BunchukN. I.BunchukN. I.-200815102008465№5 (2008)1725Copyright © Бочкова А.Г., Левшакова А.В., Bunchuk N.I., 20082008Бочкова А.Г., Левшакова А.В., Bunchuk N.I.Bochkova A.G., Levshakova A.V., Bunchuk N.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/548

Резюме Цель. Выработать оптимальную методику МР-томографии позвоночника у больных анкилозирующим спондилитом (АС) и изучить связи воспалительных МРТ- изменений (ВМИ) с локализацией болевых ощущений, длительностью спондилита и клинической активностью заболевания. Материал и методы. МРТ позвоночника проведена 36 пациентам (22 муж. и 14 жен) с достоверным диагнозом идиопатического АС, установленным в соответствии с модифицированными Нью-Йоркскими критериями. Медиана возраста больных — 26 лет (диапазон: 19-55), длительности АС — 8 лет (диапазон: 1,8-24). HLA-B27 обнаружен у 34 (97%) больных. Высокая активность AC (BASDA1 >40) отмечалась у 21 пациента. Боли воспалительного характера (ВАШ >20 мм) в позвоночнике имелась у 92%, а ночные боли в спине у 61% пациентов. Медиана длительности болей воспалительного характера (длительность спондилита) определялась для каждого отдела позвоночника, который подвергался MPT-исследованию, и составляла 36 мес (диапазон: 1-240). МРТ позвоночника (Magnetom Symphony, Siemens, Германия; напряженность магнитного поля 1,5 Тесла) осуществлялась в Т1-, Т2- и T2-FS (подавление сигнала от жира) режимах. Количественный подсчет ВМИ (в режиме T2-FS) проводился только у 29 пациентов (на 41 изображении), которым МРТ проводилась как в сагиттальной, так и в аксиальной плоскостиях. Использовались два метода подсчета: 1) количество анатомических структур, в которых имелись ВМИ, и 2) раздельный подсчет ВМИ в телах позвонков и задних структурах позвоночника (по принципу «есть/нет»). Результаты. У 36 больных АС было получено 50 MPT-изображений различных отделов (30 - грудного, 12 — поясничного и 8 шейного) позвоночника. ВМИ позвоночника были найдены в общей сложности у 35 (97%) больных. 26% от всех ВМИ выявлены на аксиальных томограммах. У 3 пациентов с небольшой длительностью спондилита (медиана: 4 мес., диапазон: 1-18) ВМ И определялись только на аксиальных томограммах. ВМИ чаще наблюдались в грудном отделе (среднее число ВМИ различных анатомических структур на одном изображении составляло 7,1), реже в поясничном и шейном отделах (соответственно 3,7 и 2,1). У большинства (90%) больных локализация ВМИ точно соответствовала области болей. Количество ВМИ у больных с невысокой (BASDAI <40; п = 12) и высокой активностью АС (BASDAI >40; п = 17) значимо не отличались [медиана и диапазоны, составляли, соответственно 4 (0-23) и 6 (2-28); р = 0,35). Частота выявления ВМИ у пациентов с небольшой (медиана 4 мес.) и более значительной длительностью спондилита (медиана 54 мес), в целом, не отличалась. Однако у пациентов с «ранним» спондилитом ВМИ в задних структурах позвоночника выявлялись достоверно чаще, чем в телах позвонков (соответственно на 92,3% и 23,1% изображений; р<0,001). Заключение. Воспалительные MPT-изменения позвоночника часто выявляются у больных активным АС вне зависимости от длительности болей в спине. Чаще изменения отмечаются в грудном отделе, как в телах позвонков, так и в задних анатомических структурах. При раннем спондилите воспалительные MPT-изменения чаще выявлялись в задних структурах позвоночника, что указывает на необходимость при ранней диагностике АС получать МР-изображения не только в сагиттальной, но и в аксиальной проекциях.

Objective. To develop the optimal mode of spine evaluation with magnetic resonance image (MRl) in pts with ankylosing spondylitis (AS) and to study relationship between MR! signs of spinal inflammatory lesions (IL), spondylitis duration and clinical features of AS activity. Material and methods. MRl was performed in 36 pts (22 male, 14 female) fulfilling the modified NY criteria of AS. Median age of pis was 26 years (range 19 - 55), Median AS duration - 8 years (range 1,8 - 24). 34 (97%) pts were HLA-B27 positive. 21 (64%) pts had high AS activity - median BASDAI 40 (range 10 - 77). 92% of pts had inflammatory spine pain (VAS>20 mm) and 61% of pts had night pain. Median inflammatory pain duration had been defined separately for every part of the spine assessed by MRl. Median duration of axial pain was 36 months (range: 1-240). MR-scanning (Magnetom Symphony, Siemens, 1.5 T) was performed inTl, T2 and T2-FS (fat signal suppression) modes. IL scoring was done only in 29 pts evaluated in both sagittal and axial planes. We used two scoring methods: 1) individual IL score of the each spine element (vertebral bodies, processes, arches, zygapophyseai, costovertebral and costotransverse joints, ligaments), and 2) separate IL scoring in the vertebral bodies and posterior spinal elements in order "yes/no”. Results. 50 MRl images of different parts of the spine (8 cervical, 30 thoracic and 12 lumbar) have been obtained in 36 pts. Spine IL were found in 35 pts. 26% of all IL were revealed in axial planes. 3 pts with short AS duration had IL only on axial slices (zygapophyseai lumbar joints, costotransverse joints, processes). IL were revealed more often in thoracic (average score: 7.1), than in lumbar (3.7) and cervical (2.1) spine. In most (26 from 29 pts, 90%) pts IL were found in painful parts of spine. There was no IL score difference between pts(n=12) with low (BASDAI <40) and high (BASDAI>40; n=17) AS activity. Me and range were 4 (1.8-10.3) and 6 (4-16), respectively; p=0.35. There was also no difference in percent of images with IL between pts with short (Me: 4 months, range: 1-18; n= 10) and prolonged (Me: 54 months, range: 24-180; n=16) duration of spondylitis (100% and 94% of images, respectively). However, pts with early spondylitis had significantly more IL in posterior spinal structures than in vertebral bodies (92.3% and 23.1% images, respectively; p<0,001). Conclusion. Inflammatory MRl lesions are frequently observed in pts with active AS, more often in thoracic spine, and independently of spondylitis duration. Inflammatory MRl lesions in early spondylitis are revealed more often in posterior structures of spine. These results show the necessity to obtain MRl scans for early diagnosis of AS not only in sagittal but also in axial plane.

МРТанкилозирующий спондилитвоспалительные измененияMRlankylosing spondylitisinflammatory lesionsReferences<div><p>Baraliakos X., Landewe R., Hermann K.G. et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann. Rheum. Dis., 2005.64.730-734.</p><p>Maksymowych W.P., Inman R.D., Salonen D. et a I. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthr. Rheum. 2005,53,502-509.</p><p>Maksymowych IV.P., Lambert R.G.W. Magnetic resonance imaging for spondyloarthritis — avoiding the minefield (editorial). J. Rheumatol., 2007,34,259265.</p><p>Braun J., Baraliakos X., Golder W. et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthr. Rheum., 2003,48,1126— 1136.</p><p>Baraliakos X. Davis J. , Tsuji W., Braun J. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosisfactor-a receptor fusion protein etanercept. Arthr. Rheum., 2005,52,1216—1223.</p><p>Sieper J., Baraliakos X., Listing J. et al. Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2yrs of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology, 2005,44,1525-1530.</p><p>Braun J., Landewe R., Hermann K-G. el al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthr. Rheum., 2006,54,1646—1652.</p><p>Heuft-Dorenbosch L., Landewe R., Weijers R. et al. Combining information obtained from magnetic resonance imaging and conventional radiographs to delect sacroiliitis in patients with recent onset inflammatory back pain. Ann. Rheum. Dis., 2006,65,804-808.</p><p>Puhakka K.B., Jurik A.G., Schiottz-Christensen B. et al. Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatology, 2004,43,234-237.</p><p>Brandt H.C., Spiller /. Song I-H. et al. Performance of referral recommendations in spondyloarthritis. Ann. Rheum. Dis. 2007, doi: 10.1136/ard.2006.068734.</p><p>Van der Linden S., Valkenburg H.A., Cats A. Modified New York criteria 1984 (Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria). Arthr. Rheum., 1984,27,361-368.</p><p>MimwitzS.A., Apicella P., Remus W.R., Hammerman A.M. MR imaging of bone marrow lesions: relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. Amer. J. Roentgenol., 1994,162,215-221.</p><p>Rudwaleit М., Schwarzlose S., Hilgert E.S. et al. Magnetic resonance imaging (MRl) in predicting a major clinical response to anti-TNF-treatment in ankylosing spondylitis. Ann. Rheum. Dis., 2007;doi: 10.1136/ard.2007.073098.</p><p>Sieper J., Braun J., Rudwaleit M. et al. A Ankylosing spondylitis: an overview. Ann. Rheum. Dis., 2002,61(suppl III),iii8-iiil8.</p><p>Goh L., Suresh P., Gafoor A. et al. Disease activity in longstanding ankylosing spondylitis—a correlation of clinical and magnetic resonance imaging findings. Clin. Rheumatol., 2007;doi: 10.1007/s10067-007- 0726-7.</p><p>Weber U., Pfirrmann C.W. A., Kissling R.O. et al. Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskeletal Disorders, 2007,8,20-27.</p><p>Crowther S.М., Lambert R.G.W., Dhillon S.S., Maksymowych W.P. High frequency of inflammatory lesions in the posterior structures of the spine in patients with ankylosing spondylitis (AS): a systematic evaluation by MRl. ACR/ARHP Ann. Scien. Meeting, 2007, Presentation Number, 2019 (abstract).</p><p>Rennie W.J., Dhillon S.S., Conner-Spady B. et al. Standard MRl assessment of spinal inflammatory lesions in /45 may omit a significant component of inflammation in the thoracic spine. Ann. Rheum. Dis., 2006, 65, Suppl 2:534 (abstract).</p><p>Appel H., Loddenkemper C., Grozdanovic Z. et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Art hr. Res. Ther. 2006,8, R143 (doi: 10.1186/ar2035).</p><p>Jee W.H., McCauley T.R., Lee S.H. et al. Sacroiliitis in patients with ankylosing spondylitis: association of MR findings with disease activity. Magn. Reson. Imaging., 2004,22,245-250.</p><p>Bredella M.A., Steinbach L.S., Morgan S. et al. MRl of the sacroiliac joints in patients with moderate to severe ankylosing spondylitis. Amer. J. Roentgenol., 2006,187.1420-1426.</p></div><br /><div><p>Baraliakos X., Landewe R., Hermann K.G. et al. Inflammation in ankylosing spondylitis: a systematic description of the extent and frequency of acute spinal changes using magnetic resonance imaging. Ann. Rheum. Dis., 2005.64.730-734.</p><p>Maksymowych W.P., Inman R.D., Salonen D. et a I. Spondyloarthritis Research Consortium of Canada magnetic resonance imaging index for assessment of spinal inflammation in ankylosing spondylitis. Arthr. Rheum. 2005,53,502-509.</p><p>Maksymowych IV.P., Lambert R.G.W. Magnetic resonance imaging for spondyloarthritis — avoiding the minefield (editorial). J. Rheumatol., 2007,34,259265.</p><p>Braun J., Baraliakos X., Golder W. et al. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis, before and after successful therapy with infliximab: evaluation of a new scoring system. Arthr. Rheum., 2003,48,1126— 1136.</p><p>Baraliakos X. Davis J. , Tsuji W., Braun J. Magnetic resonance imaging examinations of the spine in patients with ankylosing spondylitis before and after therapy with the tumor necrosisfactor-a receptor fusion protein etanercept. Arthr. Rheum., 2005,52,1216—1223.</p><p>Sieper J., Baraliakos X., Listing J. et al. Persistent reduction of spinal inflammation as assessed by magnetic resonance imaging in patients with ankylosing spondylitis after 2yrs of treatment with the anti-tumour necrosis factor agent infliximab. Rheumatology, 2005,44,1525-1530.</p><p>Braun J., Landewe R., Hermann K-G. el al. Major reduction in spinal inflammation in patients with ankylosing spondylitis after treatment with infliximab. Results of a multicenter, randomized, double-blind, placebo-controlled magnetic resonance imaging study. Arthr. Rheum., 2006,54,1646—1652.</p><p>Heuft-Dorenbosch L., Landewe R., Weijers R. et al. Combining information obtained from magnetic resonance imaging and conventional radiographs to delect sacroiliitis in patients with recent onset inflammatory back pain. Ann. Rheum. Dis., 2006,65,804-808.</p><p>Puhakka K.B., Jurik A.G., Schiottz-Christensen B. et al. Magnetic resonance imaging of sacroiliitis in early seronegative spondylarthropathy. Abnormalities correlated to clinical and laboratory findings. Rheumatology, 2004,43,234-237.</p><p>Brandt H.C., Spiller /. Song I-H. et al. Performance of referral recommendations in spondyloarthritis. Ann. Rheum. Dis. 2007, doi: 10.1136/ard.2006.068734.</p><p>Van der Linden S., Valkenburg H.A., Cats A. Modified New York criteria 1984 (Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria). Arthr. Rheum., 1984,27,361-368.</p><p>MimwitzS.A., Apicella P., Remus W.R., Hammerman A.M. MR imaging of bone marrow lesions: relative conspicuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. Amer. J. Roentgenol., 1994,162,215-221.</p><p>Rudwaleit М., Schwarzlose S., Hilgert E.S. et al. Magnetic resonance imaging (MRl) in predicting a major clinical response to anti-TNF-treatment in ankylosing spondylitis. Ann. Rheum. Dis., 2007;doi: 10.1136/ard.2007.073098.</p><p>Sieper J., Braun J., Rudwaleit M. et al. A Ankylosing spondylitis: an overview. Ann. Rheum. Dis., 2002,61(suppl III),iii8-iiil8.</p><p>Goh L., Suresh P., Gafoor A. et al. Disease activity in longstanding ankylosing spondylitis—a correlation of clinical and magnetic resonance imaging findings. Clin. Rheumatol., 2007;doi: 10.1007/s10067-007- 0726-7.</p><p>Weber U., Pfirrmann C.W. A., Kissling R.O. et al. Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskeletal Disorders, 2007,8,20-27.</p><p>Crowther S.М., Lambert R.G.W., Dhillon S.S., Maksymowych W.P. High frequency of inflammatory lesions in the posterior structures of the spine in patients with ankylosing spondylitis (AS): a systematic evaluation by MRl. ACR/ARHP Ann. Scien. Meeting, 2007, Presentation Number, 2019 (abstract).</p><p>Rennie W.J., Dhillon S.S., Conner-Spady B. et al. Standard MRl assessment of spinal inflammatory lesions in /45 may omit a significant component of inflammation in the thoracic spine. Ann. Rheum. Dis., 2006, 65, Suppl 2:534 (abstract).</p><p>Appel H., Loddenkemper C., Grozdanovic Z. et al. Correlation of histopathological findings and magnetic resonance imaging in the spine of patients with ankylosing spondylitis. Art hr. Res. Ther. 2006,8, R143 (doi: 10.1186/ar2035).</p><p>Jee W.H., McCauley T.R., Lee S.H. et al. Sacroiliitis in patients with ankylosing spondylitis: association of MR findings with disease activity. Magn. Reson. Imaging., 2004,22,245-250.</p><p>Bredella M.A., Steinbach L.S., Morgan S. et al. MRl of the sacroiliac joints in patients with moderate to severe ankylosing spondylitis. Amer. J. Roentgenol., 2006,187.1420-1426.</p></div><br />

The authors declare that there are no conflicts of interest present.