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临床研究
IDEAL序列定量评估早期强直性脊柱炎椎旁肌脂肪浸润
黄瑞滨 杨宏武 苏树燕 陈柳江 庄儒耀 刘源

Cite this article as: Huang RB, Yang HW, Su SY, et al. Quantitative assessment of paraspinal muscle fat infiltration in early stage ankylosing spondylitis patients by using MRI IDEAL sequence[J]. Chin J Magn Reson Imaging, 2022, 13(1): 26-30.本文引用格式:黄瑞滨, 杨宏武, 苏树燕, 等. IDEAL序列定量评估早期强直性脊柱炎椎旁肌脂肪浸润[J]. 磁共振成像, 2022, 13(1): 26-30. DOI:10.12015/issn.1674-8034.2022.01.006.


[摘要] 目的 采用磁共振非对称回波的最小二程估算法迭代水脂分离(iterative decomposition of water and fat with echo asymmetric and leastsquares estimation, IDEAL)序列定量评估早期强直性脊柱炎(ankylosing spondylitis,AS)患者下腰部(L3/4、L4/5水平)多裂肌、竖棘肌脂肪浸润情况,分析其脂肪分数(ƞ)与临床指标的相关性。材料与方法 前瞻性纳入40例经临床诊断的早期AS患者(AS组)和41名年龄、性别、体质量指数相匹配的健康志愿者(对照组),行IDEAL序列检查,测量L3/4、L4/5竖棘肌、多裂肌ƞ值,同期收集AS组病程、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C反应蛋白(C-reactive protein,CRP)、巴斯强直性脊柱炎疾病活动指数(Bath Ankylosing Spondylitis Disease Activity Index,BASDAI)等临床指标。用独立样本t检验(或Mann-Whitney U检验)比较2组间定量资料。采用Spearman相关评价L3/4、L4/5多裂肌、竖棘肌ƞ值与临床指标的相关性。结果 AS组L3/4及L4/5水平竖棘肌、多裂肌平均ƞ值均高于对照组[(0.28±0.09) vs. (0.24±0.05);(0.32±0.07) vs. (0.26±0.05);(0.31±0.07) vs. (0.28±0.06);(0.36±0.08) vs. (0.30±0.06)],差异均有统计学意义(P<0.05)。AS组L3/4、L4/5水平竖棘肌、多裂肌平均ƞ值与病程呈正相关(P<0.05),与ESR、CRP、BASDAI评分均无明显相关(P>0.05)。结论 IDEAL序列能量化分析早期AS下腰部椎旁肌脂肪浸润情况,对临床治疗具有良好评估价值。
[Abstract] Objective To evaluate fat infiltration of the multifidus and erector spinal muscles of the lower waist (L3/4, L4/5 levels) of ankylosing spondylitis (AS) patients in early stage, and explore the correlation between them and clinical indicators.Materials and Methods: Using a prospective study, 40 clinically diagnosed AS patients in early stage (AS group) 41 healthy volunteers (control group) matched in age, sex, and body mass index, all subjects were evaluated using iterative decomposition of water and fat with echo asymmetric and leastsquares estimation (IDEAL) sequence examination, the fat fraction values (ƞ) of multifidus and erector muscles at the levels of L3/4 and L4/5 were measured respectively. The clinical indicators such as the course of disease, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS group were collected during the same period. The independent samples t test (or Mann-Whitney U test) was used to compare the quantitative data between the two groups. Spearman correlation was used to evaluate the correlation between ƞ values of multifidus, erector spinae at the levels of L3/4 and L4/5 and clinical indicators.Results The average ƞ values of erector spinae and multifidus muscles at the levels of L3/4 and L4/5 in AS group were higher than those in the control group [(0.28±0.09) vs. (0.24±0.05); (0.32±0.07) vs. (0.26±0.05); (0.31±0.07) vs. (0.28±0.06); (0.36±0.08) vs. (0.30±0.06)], the differences were statistically significant (P<0.05). The average ƞ values of erector spinae and multifidus muscles at the levels of L3/4 and L4/5 in AS group were positively correlated with the course of the disease (P<0.05), but were not significantly correlated with ESR, CRP, and BASDAI scores (P>0.05).Conclusions IDEAL sequence could be used in the quantitative analysis of fat infiltration in lower lumbar paraspinal muscles in early AS patients with good evaluation value for clinical treatment.
[关键词] 脊柱炎,强直性;脊柱旁肌;脂肪浸润;磁共振成像
[Keywords] spondylitis, ankylosing;paravertebral muscle;fat infiltration;magnetic resonance imaging

黄瑞滨    杨宏武    苏树燕    陈柳江    庄儒耀 *   刘源   

汕头大学医学院第一附属医院放射科,汕头 515041

庄儒耀,E-mail:SDFYzry@163.com

全体作者均声明无利益冲突。


基金项目: 2020年度汕头市医疗科技计划项目 汕府科[2021] 3号-68
收稿日期:2021-08-04
接受日期:2021-12-21
中图分类号:R445.2  R593.23 
文献标识码:A
DOI: 10.12015/issn.1674-8034.2022.01.006
本文引用格式:黄瑞滨, 杨宏武, 苏树燕, 等. IDEAL序列定量评估早期强直性脊柱炎椎旁肌脂肪浸润[J]. 磁共振成像, 2022, 13(1): 26-30. DOI:10.12015/issn.1674-8034.2022.01.006

       强直性脊柱炎(ankylosing spondylitis,AS)是以骶髂关节和脊柱慢性炎症为主要表现的全身性疾病,好发于青壮年,患病率约0.1%~1.6%[1]。在临床实践中,风湿科一直重视AS附着点、骨与骨髓的炎性病变,往往忽视了脊柱旁肌是否存在功能与结构的紊乱。近期的研究表明AS患者脊柱活动度下降,脊柱旁肌力学平衡遭破坏,肌肉失去活性,发生肌肉萎缩和脂肪化,是引起AS患者致残的一个重要因素,严重影响患者的运动功能、生活质量[2, 3]。2016年国际脊柱关节炎评价协会(Assessment of Spondyloarthritis International Society,ASAS)和欧洲抗风湿病联盟(European League Against Rheumatism,EULAR)联合制定的AS治疗指南中强调了以对脊柱旁肌进行强化训练为核心的运动疗法是治疗AS的重要组成部分[4]。因此,准确量化评估AS患者脊柱旁肌脂肪浸润程度具有重要意义。既往研究主要利用常规磁共振图像评估脊柱旁肌脂肪浸润程度,但这种方法易受主观因素影响,且无法定量评估脂肪浸润微观变化[5, 6, 7]。近年来,磁共振非对称回波的最小二程估算法迭代水脂分离技术(iterative decomposition of water and fat with echo asymmetric and leastsquares estimation, IDEAL)已广泛应用于临床肌肉疾病研究中[8]。目前国内外应用IDEAL成像对AS患者脊柱旁肌的研究未见报道。本研究采用IDEAL技术定量评估AS患者脊柱旁肌的脂肪浸润及其与临床指标的相关性,为临床及早采取运动疗法干预提供可靠依据。

1 材料与方法

1.1 研究对象

       前瞻性纳入2019年12月至2020年11月我院收治的强直性脊柱炎患者40例(AS组),其中男28例,女12例,年龄16~50 (27.55±7.06)岁,病程1~21 (4.05±1.75)年,体质量和体质量指数(body mass index,BMI)分别为(57.66±10.89) kg和(20.79±3.30) kg/m2。纳入标准:(1)符合早期AS诊断标准;(2)临床资料完整;(3) AS患者在IDEAL检查前均行X线及CT检查;(4)未行规律、系统运动疗法治疗。参考既往文献[9, 10],本研究早期AS诊断标准定义如下:患者有典型晨僵、腰背疼痛,休息后无改善,活动后改善,人类白细胞抗原(human leukocyte antigen-B27,HLA-B27)阳性,可有C反应蛋白(C-reactive protein,CRP)升高,红细胞沉降率(erythrocyte sedimentation rate,ESR)加快等变化,临床确诊为AS,而骶髂关节的X线和CT检查均在2级以下。排除标准:(1)存在背部骨骼肌肉及神经系统外伤、手术及肿瘤史;(2)患有严重心肺疾病;(3)脊柱畸形或腰椎间盘突出患者;(4)健身教练、运动员或健身爱好者;(5) MRI扫描禁忌患者;(6)骶髂关节炎的X线或CT检查为2级或以上患者。本研究中骶髂关节炎X线及CT分级标准:采用1984年修订的AS纽约分类标准骶髂关节炎X线分级标准[11]:0级:正常;1级:可疑异常;2级:局限性骨侵蚀或骨硬化;3级:中重度骶髂关节炎,出现以下1项或多项:骨侵蚀、骨硬化、关节间隙增宽或狭窄、部分强直;4级:完全强直。采用Lee等[12]制定的骶髂关节炎CT分级标准:0级:正常;1级:局限性骨侵蚀仅见于单个层面;2级:骨侵蚀见于<25%的层面,不伴关节间隙改变;3级:骨侵蚀见于≥25%的层面,伴有关节间隙改变和(或)部分强直;4级:完全强直。

       选择同期在我院进行体格检查的无背部骨骼肌肉及神经系统外伤、手术及肿瘤史、无脊柱畸形或腰椎间盘突出、非从事体育相关职业的健康愿者41例(对照组),其中女14例,男27例,年龄23~38 (27.65±3.50)岁,体质量和BMI分别为(62.02±8.96) kg和(21.63±2.18) kg/m2。AS组和对照组间的性别、年龄、体质量及BMI比较,差异均无统计学意义(χ2=0.160,P=0.689;z=-0.697,P=0.486;t=-1.970,P=0.052;t=-1.349,P=0.181)。

       本研究经过汕头大学医学院第一附属医院临床研究伦理委员会批准(批准号:B-2020-215),所有受试者均被告知试验内容和MR检查注意事项,均自愿参加并签署了知情同意书。

1.2 方法

1.2.1 临床观察和评估指标

       记录AS组患者病程、入院一周内的ESR、CPR等实验室指标并计算Bath强直性脊柱炎疾病活动指数(Bath Ankylosing Spondylitis Disease Activity Index,BASDAI)评分[12]。对AS患者过去1周的5种症状6个内容应用视觉模拟测试表进行评分,包括整体疲劳状态、中轴关节痛、外周关节痛、局限触痛或压痛、晨僵的程度及持续时间,没有症状为0分,最严重的为10分,晨僵每持续15 min为1分,晨僵持续2 h或以上为10分,晨僵程度与持续时间两项内容的平均分为晨僵得分,5种症状的平均分为BASDAI评分,总分范围为0~10分,BASDAI<4分为疾病缓解期,BASDAI≥4为疾病活动期,其分数越高,代表病情越严重。

1.2.2 MRI检查

       采用GE 1.5 T MRI扫描仪(HDxt,GE,美国),腹部8通道相控阵线圈。仰卧位,足先进模式,定位时中点位于肚脐上方,范围包括T11-S2椎体。常规扫描序列包括斜冠状位骶髂关节T1WI及STIR、矢状位腰椎T1WI及STIR序列。参考既往文献[6,14, 15, 16, 17],AS患者脊柱旁多裂肌和竖棘肌脂肪浸润以下腰部L3/4和L4/5层面更为明显,因此本研究以腰椎T1WI矢状位为定位像,选取L3和L4下终板层面作为研究层面,所有受试者均扫描T1WI、T2WI及IDEAL扫描,扫描前自动匀场。T1WI序列:TR 450 ms,TE 9 ms,FOV 400 mm×400 mm,层厚5 mm,层间距0 mm,频率编码方向为前后,扫描用时1 min 26 s;T2WI序列:TR 3880 ms,TE 120 ms,FOV 400 mm×400 mm,层厚5 mm,层间距0 mm,频率编码方向为前后,扫描用时1 min 33 s。IDEAL序列:TR 4850 ms,TE 68 ms,FOV 400 mm×400 mm,矩阵为256×192,层厚5 mm,层间距0 mm,激励次数1,回波链长度12,带宽31.25 kHz,扫描层数10层,扫描时间4 min 7 s。抑脂序列采用频率选择饱和法。IDEAL序列扫描完成后系统自动进行后处理可获得水像、脂像、同相位和反相位图像。所有序列扫描前常规进行匀场。

1.2.3 图像后处理

       应用Fuction tool后处理工具对MR功能序列扫描图像进行后处理。由2名分别具有3年和7年肌肉病影像诊断工作经验的医师在L3、L4椎体下终板层面分别勾画出多裂肌和竖棘肌最大层面勾画ROI,ROI沿肌肉边缘进行圈画,并尽量避开椎体、附件及皮下软组织(图1),相应部位左、右侧ROI测量结果取平均值。根据公式(1)计算脂肪分数ƞ,其中F为脂肪信号强度,W为水像信号强度。

图1  32岁男性早期强直性脊柱炎患者的下腰部椎旁肌IDEAL序列示意图。依次为横轴位L3/4水平多裂肌和竖棘肌水图、脂图勾画ROI以及L4/5水平多裂肌和竖棘肌水图、脂图勾画ROI。
Fig. 1  Example images acquired at lower lumbar paraspinal muscles in a 32-year-old male patient with early AS. In turn was axial mutifidus and erector spinae water map, fat map with outline ROI at the levels of L3/4 and L4/5, respectively.

1.3 统计学分析

       使用SPSS 22.0软件(SPSS Inc,Chicago,IL,USA)进行统计学分析,采用组内相关系数(intraclass correlation coefficient,ICC)评价2名医师测量椎旁肌肉ƞ值的一致性,ICC值大于0.80认为测量结果一致性较好。计数资料用频率(构成比)表示,组间的比较采用χ2检验。计量资料采用Kolmogorov-Smirnov进行正态性检验,符合正态分布的用均值±标准差(x¯±s)表示,组间比较采用独立样本t检验;非正态分布的计量资料以中位数和四分位距[M (P25,P75)]表示,组间比较采用独立样本的非参数检验(Mann-Whitney U检验)。采用Spearman相关分析分别评估AS组ƞ值与病程、ESR、CRP、BASDAI评分的相关性。P<0.05为差异有统计学意义。

2 结果

2.1 多裂肌和竖棘肌ƞ值的可重复性分析

       2名观察者测得的L3/4及L4/5层面多裂肌、竖棘肌的ƞ的ICC值分别为0.83、0.86、0.91、0.93,说明2名观察者结果具有很好的一致性,然后取两人平均数作为最终数据。

2.2 AS组和对照组ƞ值比较

       AS组L3/4及L4/5层面多裂肌、竖棘肌的ƞ值均高于较对照组,其差异有统计学意义(P<0.05),见表1

表1  AS组和对照组竖棘肌、多裂肌的ƞ值比较
Tab. 1  Comparison of ƞ values of erector spinous, multifidus muscles between AS group and control group

2.3 AS组多裂肌、竖棘肌ƞ值与临床指标相关性

       AS组的相关临床指标平均值分别为:病程(4.05±1.75)年,ESR (9.83±3.96) mm/h,CRP (3.07±1.83) mg/L,BASDAI评分(2.48±1.97)分。AS组L3/4层面、L4/5层面多裂肌、竖棘肌ƞ值均与病程呈正相关(P<0.05)。AS组L3/4、L4/5层面多裂肌及竖棘肌ƞ值与ESR、CRP、BASDAI评分均无明显相关(P>0.05),见表2

表2  AS组多裂肌、竖棘肌ƞ值与临床指标相关性
Tab. 2  Spearman correlation analysis of ƞ values of erector spinous, multifidus in AS group and clinical indicators

3 讨论

       本研究主要采用IDEAL序列对AS患者下腰部多裂肌和竖棘肌的脂肪浸润进行定量分析,结果显示AS组L3/4及L4/5水平竖棘肌、多裂肌平均ƞ值均高于健康志愿者组,差异均有统计学意义(均P<0.05);AS组L3/4、L4/5水平竖棘肌、多裂肌平均ƞ值与病程呈正相关(均P<0.05),与ESR、CRP、BASDAI评分均无明显相关(均P>0.05)。

3.1 本研究的创新性

       既往已有研究采用CT、表面肌点描记术以及常规MRI成像评估AS患者脊柱旁肌的形态、结构和功能改变[6,15,18, 19]。但CT技术具有辐射风险、表面肌点描记术无法评估肌内微观变化、常规MRI视觉评估分级方法易受主观因素影响且对于早期AS患者脊柱旁肌轻微脂肪化不敏感限制了它们在临床广泛应用。IDEAI技术采用非对称采集.并采用最小二程估算法迭代进行后处理,保证足够的信号强度的同时,使水脂分离彻底,扫描一次能得到水像、脂像、正相位和反相位4种图像,可以利用后处理软件计算出脂肪分数,极大提高了可重复性,进而客观、定量评估肌肉脂肪浸润程度[20, 21, 22, 23]。本研究首次提出并验证了应用IDEAL序列定量评估早期AS患者下腰部脊柱旁肌脂肪浸润的可行性,对指导临床预防脊柱旁肌脂肪浸润而影响运动功能和生活质量有一定的临床意义[24, 25]

3.2 AS患者与健康志愿者下腰部多裂肌、竖棘肌ƞ值比较

       本研究结果显示,早期AS患者L3/4、L4/5水平多裂肌、竖棘肌的平均脂肪分数均显著高于正常组,这与先前的研究结果不完全相一致[5, 6, 7]。Resorlu等[5]应用MRI T2WI图像通过视觉评估分级法评估L1-5共四个层面的AS患者脊柱旁肌脂肪肌肉程度并与正常人群相比较,结果发现,L1/2、L2/3及L4/5层面的脊柱旁肌脂肪浸润程度差异有统计学意义(P<0.05),而在L3/4层面差异无统计学意义(P>0.05)。分析其原因,考虑与Resorlu等[5]入选的AS组年龄比较大(42.57±11.45)岁、病程较久(11.05±9.20)年以及视觉评估法分级中0、1级脂肪浸润的比例较少有关。Akgul等[6]与Ozturk等[24]研究则表明,在AS早期时就已经存在脊柱旁肌的脂肪浸润,而且早于形态学改变。因此,基于先前研究基础上,本研究较严格匹配两组间年龄、性别、体重及BMI以减小这些因素对脊柱旁肌微量脂肪含量定量分析的影响。结果表明,通过IDEAL成像可更为准确定量评估AS患者脊柱旁肌的脂肪含量,尤其是对于早期患者肌肉轻微脂肪浸润微观变化评估更具价值[26]

3.3 AS组多裂肌、竖棘肌ƞ值与病程、ESR、CRP、BASDAI评分相关性

       本研究结果显示,早期AS患者下腰部多裂肌、竖棘肌脂肪浸润与病程呈显著正相关,这与以往的研究结果相一致[5]。本研究中,入组的为AS早期、病程较短、BASDAI评分低的患者,与正常健康成人相比,结果显示下腰部多裂肌、竖棘肌已有脂肪浸润。与Zhang等[27]对AS患者棘上韧带和脊柱旁肌的病理组织学研究发现结果相符合。在AS炎症早期,少量细胞质转化生长因子β1 (transforming growth factor,TGF-β1)聚集在炎症部位,通过类似正向反馈调节方式又促使单核细胞产生大量TGF-β1从而加重组织炎症反应。TGF-β1过度表达不仅能促进炎性反应,还是目前公认的强效致纤维化因子,引起肌肉胶原纤维增多。此外,AS患者血清肿瘤坏死因子-α (tumor necrosis factor,TNF-α)水平升高,导致蛋白分解并减少蛋白合成,进而诱导骨骼肌内蛋白的丢失,肌肉纤维直径变细、Ⅱ型肌纤维减少,肌肉间隙增宽,原有的肌纤维被胶原纤维及脂肪组织代替[28]。由于AS患者脊柱旁肌肌群起止点或者肌筋膜的炎症细胞、TGF-β1过度表达以及TNF-α水平升高情况持续存在,则可导致胸腰背部脊柱旁肌受累处肌肉痉挛、僵硬、紧绷。这又促使患者为避免疼痛不适而减少日常活动、运动,脊柱平衡受打破,随着病程的进展,导致脊柱旁肌萎缩和脂肪化逐渐加重[29, 30]

       本研究中,AS组L3/4、L4/5层面多裂肌及竖棘肌ƞ值与ESR、CRP、BASDAI评分均无显著相关性,与以往的研究结果不相一致[31, 32]。分析其原因,首先,ESR、CRP这两个炎性指标容易受到机体个体差异、检测因素影响,而且当感染、组织损伤、炎症反应及恶性肿瘤等均可引起这两个指标升高;BASDAI评分虽然临床应用比较方便、简单,但属于主观性判断,缺乏评估炎症过程的特异性指标,没有考虑到个体变量之间的冗余性和依赖性[8]。其次,ESR、CRP和BASDAI评分升高往往反映的是疾病活动情况,在组织学微观变化上,主要的病理生理改变可能是以炎症水肿为主,而与脂肪浸润不一定具有显著相关[8]。目前关于AS脊柱旁肌脂肪浸润与炎性指标、疾病活动度的相关性尚不明了,还需进一步研究证实。

3.4 本研究局限性及展望

       本研究尚存在一些不足之处。第一,样本例数相对较少,可能会引起结果偏倚,未来可进一步扩大样本量,纳入不同病程、不同X线/CT分级病例进行研究;第二,脊柱旁肌是一个纵向分布的整体器官,而脊柱旁肌AS炎症的累及可能存在于多个脊柱节段,而本实验只选取了下腰部L3/4和L4/5层面,不能很好地量化整个肌肉的退变情况;第三,用单一IDEAL评估难以完全解释AS脊柱旁肌退变的复杂病理生理学及生物力学机制。本实验组将进一步设计应用T2 mapping、超声弹性成像、能谱CT等成像技术对AS脊柱旁肌进行定量分析[34, 35, 36]

       综上所述,我们的初步研究表明,IDEAL序列能量化和客观分析早期AS患者下腰部椎旁肌脂肪浸润情况,可为临床及早采取运动疗法治疗具有良好评估价值。

[1]
谢雅, 杨克虎, 吕青, 等. 强直性脊柱炎/脊柱关节炎患者实践指南[J]. 中华内科杂志, 2020, 59(7): 511-518. DOI: 10.3760/cma.j.cn112138-20200505-00448.
Xie Y, Yang KH, LV Q, et al. Practice guideline for patients with ankylosing spondylitis/spondyloarthritis[J]. Chin J Intern Med, 2020, 59(7): 511-518. DOI: 10.3760/cma.j.cn112138-20200505-00448.
[2]
Acar Y, Ilcin N, Gurpinar B, et al. Core stability and balance in patients with ankylosing spondylitis[J]. Rheumatol Int, 2019, 39(8): 1389-1396. DOI: 10.1007/s00296-019-04341-5.
[3]
Sarac DC, Bayram S, Tore NG, et al. Association of Core Muscle Endurance Times With Balance, Fatigue, Physical Activity Level, and Kyphosis Angle in Patients With Ankylosing Spondylitis[J]. J Clin Rheumatol, 2020. DOI: 10.1097/RHU.0000000000001641.
[4]
van der Heijde D, Ramiro S, Landewe R, et al. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis[J]. Ann Rheum Dis, 2017, 76(6): 978-991. DOI: 10.1136/annrheumdis-2016-210770.
[5]
Resorlu H, Savas Y, Aylanc N, et al. Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis[J]. Mod Rheumatol, 2017, 27(4): 683-687. DOI: 10.1080/14397595.2016.1245176.
[6]
Akgul O, Gulkesen A, Akgol G, et al. MR-defined fat infiltration of the lumbar paravertebral muscles differs between non-radiographic axial spondyloarthritis and established ankylosing spondylitis[J]. Mod Rheumatol, 2013, 23(4): 811-816. DOI: 10.1007/s10165-012-0750-6.
[7]
Bok DH, Kim J, Kim TH. Comparison of MRI-defined back muscles volume between patients with ankylosing spondylitis and control patients with chronic back pain: age and spinopelvic alignment matched study[J]. Eur Spine J, 2017, 26(2): 528-537. DOI: 10.1007/s00586-016-4889-2.
[8]
张旭霞, 张皓, 南江, 等. 磁共振脂肪测量技术在肌肉病变中的应用进展[J]. 磁共振成像, 2019, 10(6): 474-478. DOI: 10.12015/issn.1674-8034.2019.06.017.
Zhang XX, Zhang H, Nan J, et al. Muscle fat measurement by magnetic resonance technology: The progresses in muscle disease[J]. Chin J Magn Reson Imaging, 2019, 10(6): 474-478. DOI: 10.12015/issn.1674-8034.2019.06.017.
[9]
樊琦玮, 陈巧玲. 弥散加权成像及动态增强扫描对老年早期强直性脊柱炎骶髂关节的评价价值[J]. 中国老年学杂志, 2019, 39(20): 5041-5044. DOI: 10.3969/j.issn.1005-9202.2019.20.050.
Fan QW, Chen QL. Evaluation of Diffusion Weighted Imaging and Dynamic Enhanced Scanning of Sacroiliac Joints in Elderly Patients with Early Ankylosing Spondylitis[J]. Chin J Gerontol, 2019, 39(20): 5041-5044. DOI: 10.3969/j.issn.1005-9202.2019.20.050.
[10]
中华医学会风湿病学分会. 强直性脊柱炎诊断及治疗指南[J]. 中华风湿病学杂志, 2010, 14(8): 557-559. DOI: 10.3760/cma.j.issn.1007-7480.2010.08.012.
Chinese Society of Rheumatology. Guidelines for the diagnosis and treatment of ankylosing spondylitis[J]. Chin J Rheumatol, 2010, 14(8): 557-559. DOI: 10.3760/cma.j.issn.1007-7480.2010.08.012.
[11]
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984, 27(4): 361-368. DOI: 10.1002/art.1780270401.
[12]
Lee YH, Hong YS, Park W, et al. Value of multidetector computed tomography for the radiologic grading of sacroiliitis in ankylosing spondylitis[J]. Rheumatol Int, 2013, 33(4): 1005-1011. DOI: 10.1007/s00296-012-2450-0.
[13]
罗铧, 吴海燕, 陈玥, 等. 弥散加权成像联合临床炎性指标诊断早期强直性脊柱炎骶髂关节病变研究[J]. 中国医学装备, 2021, 18(4): 53-57. DOI: 10.3969/J.ISSN.1672-8270.2021.04.013.
Luo H, Wu HY, Chen Y. Application of the combination of DWI and clinical inflammatory index in sacroiliac joint lesion of early AS[J]. China Medical Equipment, 2021, 18(4): 53-57. DOI: 10.3969/J.ISSN.1672-8270.2021.04.013.
[14]
Wang CM, Hong WH, Ho HH, et al. Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study[J]. Biomed J, 2019, 42(2): 124-130. DOI: 10.1016/j.bj.2019.01.001.
[15]
Gordon TP, Sage MR, Bertouch JV, et al. Computed tomography of paraspinal musculature in ankylosing spondylitis[J]. J Rheumatol, 1984, 11(6): 794-797.
[16]
Hebert JJ, Kjaer P, Fritz JM, et al. The relationship of lumbar multifidus muscle morphology to previous, current, and future low back pain: a 9-year population-based prospective cohort study[J]. Spine (Phila Pa 1976), 2014, 39(17): 1417-1425. DOI: 10.1097/BRS.0000000000000424.
[17]
Crawford RJ, Elliott JM, Volken T. Change in fatty infiltration of lumbar multifidus, erector spinae, and psoas muscles in asymptomatic adults of Asian or Caucasian ethnicities[J]. Eur Spine J, 2017, 26(12): 3059-3067. DOI: 10.1007/s00586-017-5212-6.
[18]
White A, Abbott H, Masi AT, et al. Biomechanical properties of low back myofascial tissue in younger adult ankylosing spondylitis patients and matched healthy control subjects[J]. Clin Biomech (Bristol, Avon), 2018, 57: 67-73. DOI: 10.1016/j.clinbiomech.2018.06.006.
[19]
Han G, Jiang Y, Zhang B, et al. Imaging Evaluation of Fat Infiltration in Paraspinal Muscles on MRI: A Systematic Review with a Focus on Methodology[J]. Orthop Surg, 2021, 13(4): 1141-1148. DOI: 10.1111/os.12962.
[20]
汪洋, 查云飞, 邢栋. 腰椎旁肌肉脂肪含量与椎间盘退变关系的定量MRI研究[J]. 磁共振成像, 2018, 9(11): 819-824. DOI: 10.12015/issn.1674-8034.2018.11.004.
Wang Y, Zha YF, Xing D. Quantitative MRI study of the relationship between fat content in lumbar paravertebral muscles and disc degeneration[J]. Chin J Magn Reson Imaging, 2018, 9(11): 819-824. DOI: 10.12015/issn.1674-8034.2018.11.004.
[21]
Sherlock SP, Zhang Y, Binks M, et al. Quantitative muscle MRI biomarkers in Duchenne muscular dystrophy: cross-sectional correlations with age and functional tests[J]. Biomark Med, 2021, 15(10): 761-773. DOI: 10.2217/bmm-2020-0801.
[22]
Yin L, Xie ZY, Xu HY, et al. T2 Mapping and Fat Quantification of Thigh Muscles in Children with Duchenne Muscular Dystrophy[J]. Curr Med Sci, 2019, 39(1): 138-145. DOI: 10.1007/s11596-019-2012-8.
[23]
王玉锦, 周舒畅, 祝婷婷. T2-mapping和化学位移成像定量观察正常成人多裂肌内少量脂肪的价值[J]. 放射学实践, 2019, 34(2): 188-192. DOI: 10.13609/j.cnki.1000-0313.2019.02.015.
Wang YJ, Zhou SC, Zhu TT. Objective measurement of minimal fat in normal multifidus muscle using T2-mapping and chemical shift imaging IDEAL[J]. Radiol Prac, 2019, 34(2): 188-192. DOI: 10.13609/j.cnki.1000-0313.2019.02.015.
[24]
Ozturk EC, Yagci I. The structural, functional and electrophysiological assessment of paraspinal musculature of patients with ankylosing spondylitis and non-radiographic axial spondyloarthropathy[J]. Rheumatol Int, 2021, 41(3): 595-603. DOI: 10.1007/s00296-020-04781-4.
[25]
Aranda-Valera IC, Garrido-Castro JL, Martinez-Galisteo A, et al. Patients with Axial Spondyloarthritis Show an Altered Flexion/Relaxation Phenomenon[J]. Diagnostics (Basel), 2021, 11(5). DOI: 10.3390/diagnostics11050810.
[26]
Otto LAM, Froeling M, van Eijk RPA, et al. Quantification of disease progression in spinal muscular atrophy with muscle MRI-a pilot study[J]. NMR Biomed. 2021, 34(4): e4473. DOI: 10.1002/nbm.4473.
[27]
Zhang Y, Xu H, Hu X, et al. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis[J]. Int J Rheum Dis, 2016, 19(4): 420-429. DOI: 10.1111/1756-185X.12305.
[28]
Ibáñez VS, Visman IM, van Denderen C, et al. Muscle wasting in male TNF-alpha blocker naive ankylosing spondylitis patients: a comparison of gender differences in body composition[J]. Rheumatology (Oxford), 2017, 56(9): 1566-1572. DOI: 10.1093/rheumatology/kex187.
[29]
Yurdakul OV, Ince OE, Bagcier F, et al. Evaluating the strength of spinal and proximal girdle muscles in patients with axial spondyloarthritis: Correlation with activity, disability, and functionality[J]. Int J Rheum Dis, 2021, 24(5): 701-710. DOI: 10.1111/1756-185X.14102.
[30]
Kim SC, Lee YG, Park SB, et al. Muscle Mass, Strength, Mobility, Quality of Life, and Disease Severity in Ankylosing Spondylitis Patients: A Preliminary Study[J]. Ann Rehabil Med, 2017, 41(6): 990-997. DOI: 10.5535/arm.2017.41.6.990.
[31]
Öztürk ZA, Kul S, Türkbeyler İH, et al. Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia?[J]. Exp Gerontol, 2018, 110: 223-229. DOI: 10.1016/j.exger.2018.06.013.
[32]
El Maghraoui A, Ebo'o FB, Sadni S, et al. Is there a relation between pre-sarcopenia, sarcopenia, cachexia and osteoporosis in patients with ankylosing spondylitis?[J]. BMC Musculoskelet Disord, 2016, 17: 268. DOI: 10.1186/s12891-016-1155-z.
[33]
Cruz-Jentoft AJ, Romero-Yuste S, Chamizo CE, et al. Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions[J]. Aging Clin Exp Res, 2021. DOI: 10.1007/s40520-021-01800-7.
[34]
Wang M, Fu W, Meng L, et al. SWE and SMI ultrasound techniques for monitoring needling treatment of ankylosing spondylitis: study protocol for a single-blinded randomized controlled trial[J]. Trials, 2021, 22(1): 385. DOI: 10.1186/s13063-021-05344-z.
[35]
Molwitz I, Leiderer M, Mcdonough R, et al. Skeletal muscle fat quantification by dual-energy computed tomography in comparison with 3T MR imaging[J]. Eur Radiol, 2021, 31(10): 7529-7539. DOI: 10.1007/s00330-021-07820-1.
[36]
Ran J, Yin C, Liu C, et al. The Diagnostic Value of MR IVIM and T2 Mapping in Differentiating Autoimmune Myositis From Muscular Dystrophy[J]. Acad Radiol, 2021, 28(6): e182-e188. DOI: 10.1016/j.acra.2020.04.022.

上一篇 T1-mapping 技术对肿瘤坏死因子-α 拮抗剂治疗中轴型脊柱关节病疗效监测的初步研究
下一篇 心脏磁共振组织特征追踪技术对射血分数保留的肥厚型心肌病患者左心功能的初步研究
  
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