磁共振T2 mapping成像对膝关节骨性关节炎早期软骨损伤的诊断价值研究

发布时间：2018-05-14 08:18

本文选题：T2mapping + 骨性关节炎　；参考：《吉林大学》2014年硕士论文

【摘要】：研究目的：探讨不同程度的骨关节炎（OA）患者与健康受试者相比，股骨及胫骨软骨T2值的差异，并讨论将膝关节软骨T2值作为国人骨性关节炎早期诊断方法的应用价值。研究方法：对53名临床诊断为骨性关节炎的患者及7名健康受试者进行MRI扫描。临床诊断依据于2003年中华医学会风湿病学分会颁布的骨关节炎诊治指南，即膝关节骨性关节炎的诊断标准为近1个月内反复膝关节疼痛；X线片（站立或负重位）示关节间隙变窄、软骨下骨硬化和（或）囊性变，关节缘骨赘形成；关节液（至少两次）清亮、粘稠，WBC≤2000个/ml；④中老年患者（年龄≥38岁）；⑤晨僵≤3min，活动时有骨擦音（感）。满足①+②或者①+③+⑤+⑥条或①+④+⑤+⑥条即可诊断。入选的患者均有膝关节疼痛症状，活动部分受限。对60名受试对象进行膝关节MR（TRUE fisp及T2mapping）扫描。按照国际软骨修复协会（ICRS）标准及TRUE fisp图像请两位放射科医师对受试者软骨损伤程度进行分级。ICRS标准将关节软骨损伤分为五级：0级，关节软骨无明显形态学及信号改变，表面光滑；Ⅰ级，软骨内信号异常，，但软骨形常态正常；Ⅱ级软骨表面轻度不规则和/或局部软骨缺损深度未达全层厚度的50%；Ⅲ级，软骨表面重度不规则，软骨缺损深度达全层厚度的50%以上，但尚未累及全层软骨；Ⅳ级，全层剥脱、缺损，软骨下骨暴露伴或不伴软骨下骨质信号改变。根据分级结果，将受试者分为三组：轻度OA组、重度OA组及对照组。其中，轻度OA组对应ICRS标准I级和II级，重度OA组对应ICRS标准III级和IV级，对照组对应ICRS标准0级。膝关节MRI扫描后，其中五例患者所得图像伪影较重，不符合入组标准，最终入组受试者55例：其中轻度OA组入组受试者20例，包括17名女性及名男性；重度OA组入组受试者28例，包括14名女性和14名男性；对照组入组受试者7例，包括包括3名女性和4名男性。采用3.0T磁共振（MAGNETOM Skyra system，Siemens）对受试者进行膝关节扫描，使用膝关节专用线圈，仰卧位，脚先进，膝关节屈曲约20°。将受得到的受试者T2伪彩图上受试者的股骨及胫骨软骨分为四个软骨区，即股骨内侧软骨区、股骨外侧软骨区、胫骨内侧软骨区及胫骨外侧软骨区。对三个组股骨及胫骨T2弛豫时间的平均值以及股骨内侧软骨区、股骨外侧软骨区、胫骨内侧软骨区、胫骨外侧软骨区的T2弛豫时间进行统计学分析。研究结果： 1.OA患者软骨全层、股骨及胫骨内侧区软骨的T2值较健康对照组增加，P＜0.05，差别具有统计学意义。 2.除了胫骨外侧区软骨外，对于其余的软骨区，患者有轻度和重度OA受试者的T2值均较健康受试组有显著增加，P0.05，差别具有统计学意义。 3.轻度及重度OA患者之间的平均T2值未见显著差异，即P＞0.05，差别不具有统计学意义。结论： 1.骨性关节炎患者早期膝关节软骨形态未发生改变或轻度改变时，其关节软骨T2值即增高，提示T2mapping成像可以作为早期诊断诊断骨性关节炎的标准。 2.关节软骨的T2分布具有一定的空间分布特点，提示关节软骨的T2值可能与负重有关。 3.不同程度骨性关节炎患者关节软骨T2值未见统计学差异，提示关节软骨T2值不能对骨性关节炎进行分期。
[Abstract]:The purpose of the study is:
To explore the difference in the T2 value of the femoral and tibial cartilage compared with the healthy subjects in different degrees of osteoarthritis (OA) and the healthy subjects, and to discuss the value of the T2 value of the articular cartilage of the knee as an early diagnostic method for Chinese osteoarthritis.
Research methods:
53 patients with osteoarthritis and 7 healthy subjects were scanned by MRI. The clinical diagnosis was based on the guidelines for the diagnosis and treatment of osteoarthritis issued by the Chinese Medical Association of China in 2003. The diagnostic criteria for osteoarthritis of the knee are repeated knee pain within 1 months, and the X-ray (standing or weight negative) shows the joint. Interspace narrowing, subchondral osseosclerosis and (or) cystic degeneration, joint margin osteophyte formation; joint fluid (at least two times) clear, sticky, WBC less than 2000 /ml; (4) elderly patients (age 38 years old); 5 morning stiffness less than 3min, bone fricative (sense) during activity. There is a pain in the knee joint, and the active part is limited.
The knee joint MR (TRUE FISP and T2mapping) scan was performed on 60 subjects. According to the International Cartilage Repair Association (ICRS) standard and TRUE FISP image, two radiologists were asked to classify articular cartilage damage into grade five: grade 0. There were no obvious morphological and signal changes in articular cartilage. Smooth; grade I, abnormal cartilage signal, but normal cartilaginous normal state, mild irregular and / or local cartilage defect depth of 50%; grade III, severe irregular cartilage surface, more than 50% of total thickness of cartilage defect, but still not involved in whole layer cartilage; grade IV, full layer exfoliation, defect, soft Subchondral bone exposure with or without subchondral bone signal changes.
According to the classification results, the subjects were divided into three groups: mild OA group, severe OA group and control group. Among them, the mild OA group corresponds to the ICRS standard I grade and II grade, the severe OA group corresponds to the ICRS standard III grade and IV, the control group corresponds to the ICRS standard. After the knee joint MRI scan, the image artifact obtained in five cases is heavier and does not conform to the standard of entry group, final entry In the group of 55 subjects, there were 20 subjects in the mild OA group, including 17 women and male, 28 subjects in the severe OA group, including 14 women and 14 men, and 7 subjects in the control group, including 3 women and 4 men.
The subjects were scanned by 3.0T magnetic resonance (MAGNETOM Skyra system, Siemens), using special coils of the knee joint, supine position, advanced foot, and knee flexion about 20 degrees.
The femoral and tibial cartilage was divided into four cartilaginous regions, namely, the medial femur area, the lateral cartilaginous area of the femur, the medial tibial cartilage area and the lateral tibial cartilage area. The mean value of the T2 relaxation time of the femur and tibia and the medial femoral cartilage area, the lateral cartilaginous area of the femur, the tibia and the tibia in the three group of the subjects were divided into four cartilaginous regions. T2 relaxation time in lateral cartilage area and lateral tibial cartilage area was statistically analyzed.
The results of the study:
In 1.OA patients, the T2 value of cartilage layer, femur and medial tibia cartilage was increased compared with healthy control group, P < 0.05, the difference was statistically significant.
2. in addition to the cartilage in the lateral tibia, for the rest of the cartilage, the T2 values of the patients with mild and severe OA were significantly higher than those in the healthy subjects, P0.05, and the difference was statistically significant.
3. there was no significant difference in mean T2 between mild and severe OA patients, that is, P > 0.05, and the difference was not statistically significant.
Conclusion:
The T2 value of articular cartilage increased when the cartilage of 1. osteoarthritis patients had not changed or changed slightly at early stage, suggesting that T2mapping imaging could be used as a standard for early diagnosis and diagnosis of osteoarthritis.
2. the T2 distribution of articular cartilage has some spatial distribution characteristics, suggesting that the T2 value of articular cartilage may be related to weight bearing.
3. there was no statistical difference in the T2 value of articular cartilage in patients with osteoarthritis of different degrees, suggesting that the T2 value of articular cartilage can not be staged in osteoarthritis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R684.3

【参考文献】