平面波超敏感血流显像与能量多普勒超声在评估强直性脊柱炎外周附着点炎中的应用价值

The Application Value of Angio plus Planwave Ultrasensitive Imaging and Color Power Imaging in the Evaluation of Peripheral Enthesopathy of Ankylosing Spondylitis

摘要: 目的：比较平面波超敏感血流显像技术(AP)与能量多普勒超声(CPI)显示强直性脊柱炎(AS)患者外周附着点血流的丰富程度及显示率的差异，探讨AP对于在不同疾病分期的AS患者外周附着点炎诊断中的应用价值。方法：分别应用AP和CPI两种超声模式检查46例活动期AS患者和66例非活动期AS患者左右两侧共8处外周附着点，比较两种超声模式下的外周附着点血流丰富程度及血流显示率的差异性。结果：对于活动期AS患者增厚的肌腱端，AP模式和CPI模式下的血流显示率分别为71.2%和57.7%，对于非活动期AS患者增厚的肌腱端，AP模式和CPI模式下的血流显示率分别为55.6%和38.9%，AP对于外周附着点内低速血流的敏感性高于CPI，同时AP和CPI对活动期和非活动期外周附着点血流的分级结果一致性较好，分别为Kappa = 0.72，P < 0.001和Kappa = 0.63，P < 0.001，但AP较CPI能够提高外周附着点的低速血流信号的血流分级。结论：应用AP和CPI检查血流丰富程度均能够为诊断AS患者外周附着点炎及评估其活动性提供重要参考依据，但AP相较CPI更具优势，能够发现细微血流，而且AP能够提高外周附着点的实际血流显示率，上调血流级别，血流显示更加清晰，有助于更好地评估各期AS患者外周附着点炎的活动性，尤其对于非活动期AS患者，其诊断价值更高。

Abstract: Objective: To compare the differences in the richness and display rate of peripheral enthesopathy blood flow between Angio plus planwave ultrasensitive imaging (AP) and Color Power Imaging (CPI) in patients with ankylosing spondylitis (AS), and explore the application value of AP in the diagnosis of peripheral enthesopathy in AS patients at different disease stages. Methods: Two ultrasound modes, AP and CPI, were used to examine the peripheral attachment points on both sides of 46 active AS patients and 66 non-active AS patients, with 8 peripheral enthesopathy on both side. The differences in blood flow richness and display rate at the peripheral enthesopathy under the two ultrasound modes were compared. Results: For the thickened tendon ends of active AS patients, the blood flow display rates under AP mode and CPI mode were 71.2% and 57.7%, respectively. For the thickened tendon ends of non-active AS patients, the blood flow display rates under AP mode and CPI mode were 55.6% and 38.9%, respectively. AP showed higher sensitivity to low-speed blood flow at peripheral enthesopathy compared to CPI. Additionally, AP and CPI had good consistency in grading peripheral enthesopathy blood flow during both active and non-active phases, with Kappa values of 0.72 and 0.63, P < 0.001 and P < 0.001, respectively. However, AP could improve the grading of low-speed blood flow signals at peripheral enthesopathy more effectively than CPI. Conclusion: Both AP and CPI can provide important reference for diagnosing peripheral enthesopathy in AS patients and assessing its activity. However, AP has more advantages over CPI, as it can detect subtle blood flow. Moreover, AP can increase the actual blood flow display rate of the peripheral enthesopathy, elevate the blood flow grade, and make the blood flow display clearer. This helps better assess the activity of peripheral enthesopathy in AS patients at different stages, especially for non-active AS patients, where its diagnostic value is even higher.