Diagnostic value of T2* mapping-assisted MRI in patients with different degree of OA cartilage injury of knee joint
-
摘要:
目的探讨T2*mapping辅助MRI技术对差异性膝关节骨性关节炎软骨损伤程度的诊断价值。 方法选取我院2016年6月~2019年6月收治的膝关节骨性关节炎患者作为病变组,共46例,其中男性32例,女性14例,年龄22~69岁(41.19±15.53岁);另将7名健康志愿者作为对照组,其中男性5例,女性2例,年龄23~64岁(42.05±15.28岁)。两组均行膝关节MRI常规扫描及T2*mapping序列扫描,分别比较两组不同区域软骨T2*值,分析病变组软骨损伤程度、各区域浅深层软骨以及股骨内侧髁、外侧髁负重区与非负重区的T2*值。 结果病变组股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台T2*值均高于对照组(P < 0.05)。重度患者股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台T2*值均高于轻度患者(P < 0.05)。病变组股骨内侧髁、股骨外侧髁、内侧胫骨平台、外侧胫骨平台浅层软骨的T2*值均高于深层软骨(P < 0.05)。病变组股骨内侧髁、外侧髁负重区的T2*值均高于负重区(P < 0.05)。 结论T2*mapping辅助MRI技术在诊断差异性膝关节骨性关节炎软骨损伤程度中具有较高的价值,可为患者病情的判断提供可靠依据。 Abstract:ObjectiveTo evaluate the diagnostic value of T2* mapping-assisted magnetic resonance imaging (MRI) in patients with different degree of OA cartilage injury of knee joint. MethodsA total of 46 patients with knee OA admitted to our hospital from June 2016 to June 2019 were selected as pathological group. There were 32 males and 14 females in pathological group, with the age from 22-69 years old (41.19 ± 15.53). Another 7 healthy volunteers were taken as the control group, including 5 males and 2 females with the age from 23 to 64 years old (42.05±15.28). Two groups underwent routine MRI and T2* mapping sequence scans of the knee. The T2* values of cartilage in different areas were compared. In addition, T2* values in the loading zone and non-loading zone of the medial and lateral condyles of the femur were analyzed for the patients in the lesion group with different degree of cartilage damage, shallow and deep cartilage in each region. ResultsThe T2* values of medial femoral condyle, lateral femoral condyle, medial tibial plateau and lateral tibial plateau in the lesion group were significantly higher than those in the control group (P < 0.05). The T2* values of medial femoral condyle, lateral femoral condyle, medial tibial plateau and lateral tibial plateau in the severe group were significantly higher than those in the mild group (P < 0.05). The T2* values of the medial femoral condyle, the lateral femoral condyle, the medial tibial plateau and the superficial cartilage of the lateral tibial plateau in the lesion group were significantly higher than those in the deep cartilage (P < 0.05). The T2* values in the loading zone of medial femoral condyle and lateral condyle in the lesion group were significantly higher than that in the loading zone (P < 0.05). ConclusionT2* mapping-assisted MRI has a high value in the diagnosis of patients with different degree of OA cartilage injury of knee joint. It can provide reliable basis for the judgment of patients' conditions. -
Key words:
- osteoarthritis /
- knee /
- magnetic resonance imaging /
- cartilage damage
-
图 1 典型的膝关节软骨伪彩图
正常组、轻度OA、重度OA膝关节软骨成像(色阶由蓝色、绿色至红色代表T2*值逐渐升高).A, B: 43岁正常男性膝关节软骨T2* mapping伪彩图显示为软骨厚度均匀, 关节面连续光滑, 均匀蓝绿色的分层带状结构; C, D: 51岁女性,左膝关节反复不适1年余, X线平片未见明显异常.软骨伪彩表现为关节软骨内信号欠均匀, 在蓝绿色的背景下出现斑点状绿色、红色信号, 以关节承重面较为明显, 诊断为轻度OA; E, F: 65岁女性, 右膝关节疼痛、步行困难, 膝关节软骨明显变薄、不连续、并见缺损, 软骨伪彩图显示条片状红色信号影, 诊断为重度OA
Figure 1. Typical pseudo-color image of knee cartilage
表 1 病变组与对照组膝关节不同区域软骨T2*值对比(ms, Mean±SD)
Table 1. Comparison of the T2* values of cartilage in different areas of knee joint in lesion group and control group
组别 股骨内侧髁 股骨外侧髁 内侧胫骨平台 外侧胫骨平台 病变组(n=46) 52.67±2.81 53.47±2.68 48.02±5.71 46.45±5.24 对照组(n=7) 37.25±3.67 38.21±4.28 38.32±7.52 38.86±7.36 t 12.997 12.907 4.017 3.382 P 0.000 0.000 0.000 0.001 表 2 病变组不同严重程度OA不同区域软骨T2*值对比(ms, Mean±SD)
Table 2. Comparison of the T2* values of cartilage in different areas of different severity OA in the lesion group
组别 股骨内侧髁 股骨外侧髁 内侧胫骨平台 外侧胫骨平台 轻度患者(n=32) 49.72±2.46 50.82±2.45 45.28±5.23 43.82±4.86 重度患者(n=14) 57.72±3.55 56.72±2.75 50.72±5.94 49.75±7.28 t 8.834 7.242 3.115 3.256 P 0.000 0.000 0.003 0.002 表 3 病变组OA各区域浅深层软骨T2*值对比(ms, Mean±SD, n=46)
Table 3. Comparison of the T2* values of shallow and deep cartilage in each region of OA in the lesion group
组别 股骨内侧髁 股骨外侧髁 内侧胫骨平台 外侧胫骨平台 浅层软骨 55.28±2.95 56.32±2.93 50.83±6.02 48.73±5.72 深层软骨 50.18±2.54 50.23±2.18 46.17±5.29 44.31±5.10 t 8.886 11.310 3.944 3.912 P 0.000 0.000 0.000 0.000 表 4 病变组OA股骨内侧髁、外侧髁负重区与非负重区的T2*值对比(ms, Mean±SD, n=46)
Table 4. Comparison of the T2* values of loading zone and non-loading zone of the medial and lateral condyles of the femur of OA in the lesion group
组别 股骨内侧髁 股骨外侧髁 负重区 57.22±2.94 55.92±2.87 非负重区 49.73±2.38 50.86±2.23 t 13.430 9.442 P 0.000 0.000 -
[1] Zhao XX, Ruan JJ, Tang H, et al. Multi-compositional MRI evaluation of repair cartilage in knee osteoarthritis with treatment of allogeneic human adipose-derived mesenchymal progenitor cells[J]. Stem Cell Res Ther, 2019, 10(1): 308-17. [2] Esculier JF, Jarrett M, Krowchuk NM, et al. Cartilage recovery in runners with and without knee osteoarthritis: a pilot study[J]. Knee, 2019, 26(5): 1049-57. [3] Hangaard S, Gade JS, Hansen P, et al. Single-vs. double-dose gadolinium contrast in delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in knee osteoarthritis: is dose reduction possible on 3-T MRI[J]?Acta Radiol, 2019, 60(6): 749-54. [4] 毕文忠, 王磊, 张炜, 等.磁共振We DESS及T2-mapping序列对膝骨性关节炎早期软骨退变的诊断价值[J].中国数字医学, 2019, 14 (2): 65-7. http://d.old.wanfangdata.com.cn/Periodical/zgszyx201902024 [5] 石磊, 于静红, 张晰尧.膝关节骨性关节炎模型软骨T2-mapping表现与蛋白多糖含量的相关分析[J].放射学实践, 2019, 34(12): 1375-9. http://d.old.wanfangdata.com.cn/Periodical/fsxsj201912019 [6] Soellner S T, Goldmann A, Muelheims D, et al. Intraoperative validation of quantitative T2 mapping in patients with articular cartilage lesions of the knee[J]. Osteoarthr Cartil, 2017, 25(11): 1841-9. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=f3aff511c98ff5c0ff8882cd9f16b080 [7] 王琳, 沈鸿鹄, 刘鹏飞.基于MR成像的膝关节局灶性病变及软骨T2值与膝关节疼痛的相关性研究[J].哈尔滨医科大学学报, 2017, 51 (3): 228-31. http://d.old.wanfangdata.com.cn/Periodical/hebykdxxb201703009 [8] Hu JZ, Zhang Y, Duan CY, et al. Feasibility study for evaluating early lumbar facet joint degeneration using axial T1 ρ, T2, and T2* mapping in cartilage[J]. J Magn Reson Imaging, 2017, 46(2): 468- 75. [9] 何琦非, 龚晓峰, 许毅博, 等.不同年龄与性别的pilon骨折患者预后特点分析[J].中华创伤骨科杂志, 2017, 19(12): 1056-62. http://d.old.wanfangdata.com.cn/Periodical/zhcsgkzz201712009 [10] 杨赞礼, 刘俊波, 黄武斌, 等.血浆和关节液趋化因子12的表达水平与膝骨关节炎严重程度的相关性[J].广东医学, 2017, 38(4): 571-3. http://d.old.wanfangdata.com.cn/Periodical/gdyx201704021 [11] Ferizi U, Rossi I, Lee Y, et al. Diffusion tensor imaging of articular cartilage at 3T correlates with histology and biomechanics in a mechanical injury model[J]. Magn Reson Med, 2017, 78(1): 69-78. [12] 陈宁杰, 赵卉, 郝风云, 等.晚期膝骨关节炎滑膜MRI厚度与疼痛及功能评分相关性[J].中华关节外科杂志:电子版, 2019, 13(4): 412-8. http://d.old.wanfangdata.com.cn/Periodical/zhgjwkzz201904005 [13] 董进, 韩瑞, 宋少辉, 等.膝关节骨性关节炎软骨损伤的MRI形态评分及T2值变化与临床表现的相关性[J].中国现代医学杂志, 2019, 29(4): 69-72. http://d.old.wanfangdata.com.cn/Periodical/zgxdyxzz201904015 [14] 方长海, 樊慧慧, 郭荣州, 等.骨性关节炎患者内侧副韧带慢性损伤的MRI评价及危险因素分析[J].实用放射学杂志, 2019, 35(7): 1107- 11, 1123. http://d.old.wanfangdata.com.cn/Periodical/syfsxzz201907023 [15] Wirth W, Maschek S, Roemer FW, et al. Radiographically normal knees with contralateral joint space narrowing display greater change in cartilage transverse relaxation time than those with normal contralateral knees: a model of early OA? -data from the Osteoarthritis Initiative (OAI)[J]. Osteoarthr Cartil, 2019, 27(11): 1663-8. [16] Eijkenboom JFA, Timmer ER, van der Heijden RA, et al. Association between self-reported measures, physical examination, and early magnetic resonance imaging signs of osteoarthritis in patients with patellofemoralpain[J].J Orthop Sports Phys Ther, 2019, 49(9):634-9. [17] von Drygalski A, Barnes RFW, Jang H, et al. Advanced magnetic resonance imaging of cartilage components in haemophilic joints reveals that cartilage hemosiderin correlates with joint deterioration [J]. Haemophilia, 2019, 25(5): 851-8. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1111/hae.13802 [18] 卢彦君, 卢竞, 李涛. T2* mapping技术评估早期膝关节软骨退变[J].影像研究与临床应用, 2020, 4(2): 78-9. http://d.old.wanfangdata.com.cn/Periodical/yxyjyyxyy202002046 [19] 成洪亮.磁共振T2-Mapping成像T2值对膝关节软骨损伤诊断分级评价的作用[J].临床研究, 2019(11): 150-2. http://d.old.wanfangdata.com.cn/Periodical/yyybj201911082 [20] 王可欣, 石磊, 于静红, 等.膝关节骨性关节炎软骨基质金属蛋白酶1的表达与磁共振T2-mapping的相关性研究[J].临床放射学杂志, 2019, 38(9): 1718-23. http://d.old.wanfangdata.com.cn/Periodical/lcfsxzz201909031 [21] 李淑华, 张俊祥, 刘志军, 等.膝关节骨性关节炎MR软骨形态及T2值测量与临床相关性[J].实用放射学杂志, 2017, 33(11): 1732-5, 1750. http://d.old.wanfangdata.com.cn/Periodical/syfsxzz201711023 [22] Kester BS, Carpenter PM, Yu HJ, et al. T1ρ/T2 mapping and histopathology of degenerative cartilage in advanced knee osteoarthritis[J]. World J Orthop, 2017, 8(4): 350-6. [23] 孙兆男, 王旭超, 徐敏, 等.磁共振T2 mapping成像评价膝关节骨关节炎软骨损伤的应用价值[J].磁共振成像, 2019, 10(9): 680-4. http://d.old.wanfangdata.com.cn/Periodical/cgzcx201909009 [24] Sasho T, Katsuragi J, Yamaguchi S, et al. Associations of threedimensional T1 rho MR mapping and three-dimensional T2 mapping with macroscopic and histologic grading as a biomarker for early articular degeneration of knee cartilage[J]. Clin Rheumatol, 2017, 36(9): 2109-19. [25] 钟浩博, 刘伟乐, 孙春汉, 等.关节镜下自体软骨细胞移植治疗退行性膝关节软骨损伤: 2年随访报告[J].分子影像学杂志, 2019, 42(4): 444-8. doi: 10.12122/j.issn.1674-4500.2019.04.05 [26] Verschueren J, van Tiel J, Reijman M, et al. Influence of delayed gadolinium enhanced MRI of cartilage (dGEMRIC) protocol on T2- mapping: is it possible to comprehensively assess knee cartilage composition in one post-contrast MR examination at 3 Tesla[J]? Osteoarthr Cartil, 2017, 25(9): 1484-7.