膝关节骨性关节炎软骨损伤的分布特征及MRI定量成像对比研究  

Distribution characteristics and quantitative MRI of cartilage injury in knee osteoarthritis

作　　者：赵双全[1] 梁久平[1] 宋建勋[1] 彭华荣[1] 王亚弟 成官迅[2] ZHAO Shuang-quan;LIANG Jiu-ping;SONG Jian-xun;PENG Hua-rong;WANG Ya-di;CHENG Guan-xun(Department of Radiology,Baoan People’s Hospital,Guangdong 518100,China)

机构地区：[1]深圳市宝安区人民医院医学影像科,广东深圳518100 [2]深圳市北京大学深圳医院医学影像科,广东深圳518306

出　　处：《影像诊断与介入放射学》2020年第3期189-194,共6页Diagnostic Imaging & Interventional Radiology

基　　金：深圳市宝安区医疗卫生基础研究项目(2019JC025)。

摘　　要：目的探讨关节镜下不同级别软骨损伤的分布差异,以及3.0 T MRI检查序列T1 mapping、T2 mapping及T2^*mapping对膝关节骨性关节炎软骨不同级别病损的诊断价值和定量值变化差异。方法选择有完整关节镜检查结果及MRI软骨定量检查资料(包括T1 mapping、T2 mapping、T2^*mapping)的患者共73个关节、213个病损部位。以关节镜结果作为标准,比较不同级别软骨损伤的分布部位,统计不同级别软骨损伤的T1 mapping、T2 mapping、T2^*mapping测量值之间的差异及变化规律。结果Ⅰ、Ⅱ级软骨损伤发生在髌股关节面最多,内侧关节面次之,外侧关节面较少,三者间均有统计学差异(P<0.05)。同一关节面的两个软骨亚区不同级别损伤的分布均没有差别(P>0.05)。T2 mapping和T2*mapping序列对Ⅰ~Ⅲ级损伤的分级正确率明显高于T1 mapping(P<0.05),T2 mapping和T2^*mapping序列无明显统计学差异(P>0.05);对Ⅳ级软骨损伤分级符合率,三者之间无明显统计学差异(P>0.05)。MRI检查序列对软骨损伤诊断符合率与关节镜结果一致性检验T2^*mapping序列最高,Kappa值为0.663。关节软骨损伤时T1 mapping、T2 mapping及T2*mapping值增加,在Ⅰ、Ⅱ级软骨损伤时升高明显,而在Ⅲ级损伤时升高程度下降,T2^*mapping值的变化较T2 mapping更为明显。不同级别损伤时,T1 mapping值变化无明显差异(P>0.05),T2 mapping及T2^*mapping值变化有统计学差异(P<0.05)。结论膝关节OA软骨损伤分布具有一定特征性,MRI定量成像技术对区分膝关节OA不同级别损伤有很好的诊断价值。Objective To investigate the distribution characteristics as well as T1-,T2-and T2^*-mapping MR quantitation of different grades of cartilage injury in knee osteoarthritis(OA).Methods MRI of 73 knee joints with 213 cartilage lesions was retrospectively analyzed.The arthroscopic results were used as gold standard to compare the distribution and differences of T1-,T2-,and T2^*-mapping values on MRI of different grades of cartilage lesions.Results GradeⅠandⅡcartilage lesions were significantly more common in the patellofemoral joint surface than that in the medial and lateral femorotibial joint surfaces(P<0.05).There was no difference in the distribution of lesion grades in the two cartilage subareas of the same articular surfaces(P>0.05).The accuracy of T2-and T2*-mapping was significantly higher than that of T1-mapping(P<0.05)for gradeⅠ-Ⅲlesions without significant difference in accuracy for gradeⅣlesions(P>0.05).There was no significant difference between T2-and T2^*-mapping for the lesion grades(P>0.05).The Kappa value of T2*-mapping was the highest(0.663).The values of T1-,T2-and T2^*-mapping increased significantly from gradeⅠto gradeⅡlesions with less increase in gradeⅢlesions.The changes of T2^*-mapping value were more obvious than that of T2-mapping.There was no significant difference in T1-mapping values(P>0.05)of different grade lesions whereas there was significant difference in T2-and T2*-mapping values(P<0.05).Conclusion The distribution characteristics and MRI quantitative imaging have good diagnostic value for distinguishing different grades of cartilage lesions in knee OA.

关 键 词：膝 骨性关节炎 软骨 磁共振成像 定量成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R684.3[医药卫生—诊断学]