[CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint]

To investigate the clinical value of CT-guided percutaneous needle biopsy and intra-articular injection of sacroiliac joint.

CT-guided percutaneous puncture was conducted to the bilateral sacroiliac joints of 3 specimens of adult pelvis, 18 patients with ankylosing spondylitis (AS), and 10 patients with undifferentiated spondyloarthropathy (uSpA) suspected as early AS clinically. All 28 patients had taken non-steroidal anti-inflammatory agents without adequate control of symptoms or with serious side effects. Biopsy of synovium with 16G or 18G needles and intra-articular injection of steroid were made to the 28 patients.

The general success rate of puncture was 4/6 among the specimens of pelvis and was 96.4% (54/56) among the 28 patients. The level of needle insertion was 1.69 cm +/- 0.63 cm up the lower edge of the joint. The obtainment rate of biopsy specimen was 88.5% (46/54) for the cases punctured successfully. The positive rate of pathological examination was 91.7% (22/24). Marked inflammatory changes were found in the biopsy specimens from AS patients and early inflammatory changes were found in the biopsy specimens from uSpA patients. The immediate effective rate of intra-articular steroid injection was 78.6% (22/28). No complication and side effect was found.

CT-guided percutaneous puncture is an effective and safe guided method for biopsy and intra-articular injection of sacroiliac joint. The proper level of puncture is by the juncture of the middle 1/3 and lower 1/3 of sacroiliac joint. Needle biopsy helps early diagnosis of AS for patients with uSpA. Intra-articular injection is an effective supplementary therapy for AS and uSpA patients.