3.0T磁共振对膝关节移植软骨的形态学评估及T2mapping分层定量评价

发布时间：2018-05-18 22:13

本文选题：磁共振 + T2值　；参考：《中国人民解放军医学院》2015年硕士论文

【摘要】：目的使用3.0T MRI评估基质诱导自体软骨移植(matrix-associated autologous chondrocyte transplantation,MACT)术后1年移植软骨的形态学表现,并与临床评分系统作相关性分析。方法纳入9例(12膝12处移植软骨)MACT术后患者,于术后1年进行磁共振扫描检查,对影像表现采用软骨修复组织MR观察评分系统(MOCART评分系统),临床症状采用Lysholm评分,并对两者做相关性分析。同时,采用组内相关系数(ICC)对不同观察者间的评估差异度做可靠性分析。结果MOCATR评分结果显示,术后1年所有移植软骨中,50%的修复区表现为完全填充；66.7%的修复区移植软骨与邻近软骨信号强度一致或基本一致；75%修复区与邻近正常软骨边缘完全整合；66.7%修复区软骨下骨板和软骨下骨完整。观察者间结果可靠性ICC评分：ICC值=0.862(ICC值0.81表示可信度良好)。同时对患者进行临床Lysholm评分,评分结果：78.42±13.70。术后1年MOCART评分与临床Lysholm评分相关性分析结果：分类变量“软骨缺损修复与填充程度”与Lysholm评分相关系数0.654,P值0.02,两者呈明显的正相关,具有统计学意义。“修复组织结构”、“修复组织信号强度”、“软骨下骨改变”等其他分类变量与Lysholm评分均未见明显的相关性。结论移植软骨的高分辨磁共振形态学评估,是MACT术后随访观察移植软骨的有效手段,且与临床症状有一定的相关性。目的评估磁共振T2mapping成像技术在基质诱导自体软骨移植(MACT)术后移植软骨的定量分析价值。方法纳入6例(9膝9处移植软骨)MACT术后患者,分别在术后3月、6月及12月进行磁共振动态随访检查,测量软骨修复区与正常对照区深浅两个区域及全层T2值,横向比较同一时间点同一膝关节修复区与正常区T2值差异,纵向评估术后3、6、12月修复区T2值的变化。结果MACT术后3、6月移植区全层T2值分别为(68.32±10.36)ms,(58.11±6.68)ms,显著高于邻近正常软骨(P0.05),术后12月修复区全层T2值(46.01±2.15)ms,较正常对照区无明显统计学差异(P=0.063)。术后6、12个月修复区深浅层T2值比较：6个月浅层T2值(59.21±7.45)ms,深层(56.89±6.13)ms；12个月浅层T2值(49.78±2.46)ms,深层(42.23±4.52)ms。术后6、12个月浅层软骨T2值均显著高于深层(P均0.05)。术后3个月修复区浅层T2值(68.42±10.33)ms,深层(68.25±10.51)ms,深浅层未见明显统计学差异；术后3、6、12个月修复区深浅层T2值纵向变化均有统计学差异(P均0.05)。结论T2mapping是评估移植软骨胶原含量的重要指标,对移植软骨分层定量评价,可动态观察移植软骨的修复过程。MACT术后磁共振T2mapping成像可作为评估关节软骨修复效果的重要依据。
[Abstract]:Objective to evaluate the morphologic features of grafted cartilage one year after matrix-associated autologous chondrocyte transplantation with matrix induced autologous cartilage transplantation using 3.0T MRI, and to analyze the correlation with clinical scoring system. Methods 9 patients with 12 knees and 12 grafts of cartilage grafted after MACT were examined by magnetic resonance imaging (MRI) one year after operation. The imaging findings were assessed by Mr observation system of cartilage repair tissue and Lysholm scoring system for clinical symptoms. And the correlation between the two is analyzed. Intra-group correlation coefficient (ICC) was used to analyze the reliability of the difference between different observers. Results the MOCATR score showed that, One year after operation, 50% of the repair areas of all transplanted cartilage showed that 66.7% of the repair areas were completely filled with the adjacent cartilage. The signal intensity of the transplanted cartilage was the same as that of the adjacent cartilage. 75% of the repair areas were fully integrated with the adjacent normal cartilage edge. 66.7% of the soft areas were completely integrated with the adjacent normal cartilage margins. The subosseous bone plate and subchondral bone were intact. The reliability ICC score of the inter-observer results was 0.862 and 0.81 indicating that the reliability was good. At the same time, the patients were evaluated with clinical Lysholm score: 78.42 卤13.70. 1 year after operation, the correlation between MOCART score and clinical Lysholm score: the correlation coefficient between the classification variable "degree of cartilage defect repair and filling" and Lysholm score was 0.654g P value 0.02, which was significantly positive correlation with statistical significance. There was no significant correlation between Lysholm score and other classification variables, such as "repair tissue structure", "repair tissue signal intensity", "subchondral bone change" and so on. Conclusion the morphologic evaluation of graft cartilage with high resolution magnetic resonance imaging is an effective method to observe the graft cartilage after MACT, and has some correlation with clinical symptoms. Objective to evaluate the quantitative value of magnetic resonance (T2mapping) imaging in cartilage grafts after matrix induced autologous cartilage transplantation. Methods six patients with 9 knees and 9 transplanted cartilage grafts after MACT were examined by dynamic magnetic resonance imaging (MRI) in 3 months, 6 months and 12 months, respectively. T2 values were measured in the deep and shallow areas of the cartilage repair area and the normal control area, as well as in the whole layer. The T _ 2 values of the same knee repair area and normal area were compared at the same time point, and the changes of T _ 2 value in the repair area 3 ~ 6 and 12 months after operation were evaluated longitudinally. Results the T _ 2 values of the whole graft area in 3 and 6 months after MACT were 68.32 卤10.36 Ms and 58.11 卤6.68 msrespectively, which were significantly higher than those in the adjacent normal chondrocytes (P0.05). The T _ 2 value of the whole layer in the repair area was 46.01 卤2.15msat 12 months after MACT, and there was no significant difference compared with the normal control area (P0.063ms). At 6 and 12 months after operation, the T 2 values of the deep and shallow layers were 59.21 卤7.45 msand 56.89 卤6.13 Ms, 49.78 卤2.46 msand 42.23 卤4.52 msrespectively. The T 2 value of superficial cartilage at 6 and 12 months after operation was significantly higher than that in deep layer (P < 0.05). There was no significant difference in T _ 2 value of the superficial layer and deep layer (68.25 卤10.51ms) and in the deep layer (68.42 卤10.33m / s), but there was no significant difference in the depth and shallow layer between the deep and shallow layers 3 months after operation and 12 months after operation (P < 0.05). Conclusion T2mapping is an important index to evaluate the collagen content of allograft cartilage. The quantitative evaluation of graft cartilage stratification can dynamically observe the repair process of transplanted cartilage. Mr T2mapping imaging after MACT can be used as an important basis for evaluating the effect of articular cartilage repair.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R445.2;R687.4

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