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膝关节骨性关节炎(osteoarthritis, OA)首先以关节软骨的变性及破坏为主, 是引起关节疼痛、晨僵和功能障碍的最常见原因。研究[1]表明, 3.0T MRI对软骨损伤检测的敏感性、特异性、准确性分别为70.10%、93.13%、77.37%。3D-WATSc与关节镜对膝关节软骨病损的诊断结果之间一致性极佳[2]。MRI对膝关节OA软骨缺损的评价采用全器官磁共振评分法(whole-organ magnetic resonance imaging score, WORMS), WORMS对软骨丢失的发生具有很高的可靠性[3]。MR T2 mapping成像是通过测量T2横向弛豫时间来定量分析关节软骨内组织成分的变化, 进而对早期软骨病变做出诊断[4]。本研究对膝关节软骨形态进行WORMS评分及T2值测量, 探讨膝关节OA软骨WORMS与T2值之间的关系。
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OA组P、MF、MT、LT区软骨T2值与WORMS相关系数分别为0.657、0.718、0.703、0.854, 各组T2值与WORMS相关系数值有统计学意义(P < 0.05), 且呈正相关; LF区T2值与WORMS相关系数为-0.026, 且二者无相关性。
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除股骨外侧区T2值在各组间差异无统计学意义(P>0.05)外, 其余各亚区T2值在各组间差异均有统计学意义(P < 0.01);各亚组内不同分级程度组两两比较差异均无统计学意义(P>0.05)(见表 1)。
分组 n P MF LF MT LT H组 10 32.37±1.33 41.65±1.90 43.52±1.84 31.23±1.89 30.51±2.41 OA1组 21 38.64±4.05 45.82±3.31 46.64±3.59 33.96±1.79 31.25±3.35 OA2组 26 40.10±4.67 48.96±3.03 46.61±4.89 37.60±1.30 37.71±2.34 OA3组 18 50.67±6.70 52.72±1.57 48.10±7.78 41.21±1.38 45.76±2.17 F - 36.71 41.99 1.67 116.81 120.27 P - < 0.01 < 0.01 >0.05 < 0.01 < 0.01 MS组内 - 23.272 7.366 26.972 2.406 6.953 表 1 各组平均T2值在各亚区比较
因OA1组WORMS得分0~1分的病人, 正常软骨WORMS得分亦可表现为0~1分, 所以软骨形态WORMS无法对正常软骨形态及膝关节OA早期病变软骨进行鉴别, 根据以上结果, 对P、MF、MT区H组与OA1组间T2值有统计学差异的各区, 采用ROC曲线分析T2值的诊断效能, 判断T2值在诊断膝关节OA软骨形态改变前病变的价值, 结果显示, T2值在P、MF、MT鉴别出OA1组的敏感度分别为78.3%、62.2%、54.8%, 特异度分别为100%、80%、70%(见表 2)。
亚区 临界值/ms 最大约登指数 曲线下面积 敏感度/% 特异度/% P 34.55 0.783 0.886 78.3 100 MF 45.20 0.482 0.757 68.2 80 MT 33.75 0.248 0.523 54.8 70 表 2 P、MF、MT区T2值在H组与OA1组间的诊断效能评价
膝关节骨性关节炎软骨形态与T2值的MRI对比性分析
Comparative analysis of MRI findings of cartilage morphology and T2 value in knee osteoarthritis
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摘要:
目的对比分析膝关节骨性关节炎(OA)软骨损伤的MRI形态评分及T2值变化。 方法收集65例膝关节OA病人及10名健康受试者,行膝关节MRI矢状位3D-WATSc、T2 mapping扫描,将病人组分轻度(OA1)组、中度(OA2)组、重度(OA3)组,评价OA组各亚区软骨T2值与全器官磁共振评分法(WORMS)的相关性,比较各亚区T2值在各组间的差异。 结果除股骨外侧区外,OA组软骨T2值与WORMS评分呈正相关(r=0.657~r=0.854,P < 0.05);除股骨外侧区T2值外,其余各亚区T2值在各组间差异均有统计学意义(P < 0.01);T2值在髌骨区、内侧股骨区、内侧胫骨区发现膝关节OA软骨形态改变前病变的敏感性分别为78.3%、68.2%、54.8%,特异度分别为100%、80%、70%。 结论MRI半定量评价指标WORMS与定量评价指标T2值均能有效评价膝关节OA软骨变化,T2值能够区分膝关节OA软骨损伤程度,发现软骨形态改变前的病变。 Abstract:ObjectiveTo compare the changes of MRI morphological score and T2 value of cartilage injury in knee osteoarthritis(OA). MethodsSixty-five knee OA patients and 10 healthy subjects were selected to undergo MRI scanning of sagittal 3D-WATSc and T2 mapping.The patients were divided into mild(OA1), moderate(OA2) and severe(OA3) groups.The correlation between T2 value of cartilage and the whole-organ magnetic resonance imaging score (WORMS) in each sub-region of OA groups was evaluated, and the difference of T2 value in each sub-region among three groups was compared. ResultsExcept for the lateral region of femoral, T2 values were positively correlated with WORMS scores in OA groups(r=0.657-r=0.854, P < 0.05), and the differences of T2 values in other sub-regions were statistically significant (P < 0.01).The sensitivity of T2 value in patella, medial region of femoral and medial region of tibia to detect the pre-pathological changes of cartilage morphology of knee OA was 78.3%, 68.2% and 54.8%, respectively, and the specificity was 100%, 80% and 70%, respectively. ConclusionsBoth the MRI semi-quantitative evaluation index WORMS, and the MRI quantitative evaluation index T2 value can effectively evaluate the change of knee OA cartilage.T2 value can differentiate the severity of cartilage injury of knee OA, and discover the cartilage lesions before morphological changes. -
Key words:
- osteoarthritis /
- knee /
- magnetic resonance imaging /
- T2 value /
- articular cartilage
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表 1 各组平均T2值在各亚区比较
分组 n P MF LF MT LT H组 10 32.37±1.33 41.65±1.90 43.52±1.84 31.23±1.89 30.51±2.41 OA1组 21 38.64±4.05 45.82±3.31 46.64±3.59 33.96±1.79 31.25±3.35 OA2组 26 40.10±4.67 48.96±3.03 46.61±4.89 37.60±1.30 37.71±2.34 OA3组 18 50.67±6.70 52.72±1.57 48.10±7.78 41.21±1.38 45.76±2.17 F - 36.71 41.99 1.67 116.81 120.27 P - < 0.01 < 0.01 >0.05 < 0.01 < 0.01 MS组内 - 23.272 7.366 26.972 2.406 6.953 表 2 P、MF、MT区T2值在H组与OA1组间的诊断效能评价
亚区 临界值/ms 最大约登指数 曲线下面积 敏感度/% 特异度/% P 34.55 0.783 0.886 78.3 100 MF 45.20 0.482 0.757 68.2 80 MT 33.75 0.248 0.523 54.8 70 -
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