Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis.
Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis.
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DOI：
10.1186/ar3488
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发表时间：
2011
影响因子：
4.9
通讯作者：
Hayashi D
中科院分区：
文献类型：
--
作者：
Guermazi A;Roemer FW;Burstein D;Hayashi D
传统上，软骨成像是通过传统放射摄影间接实现的。关节间隙宽度的损失或“关节间隙狭窄”被认为是软骨变薄的替代标志。然而，放射线照相术由于其不能使软骨可视化、难以在系列评估中确定关节的最佳和可再现定位以及难以对关节间隙变窄进行视觉分级而受到严重限制。随着先进的磁共振成像（MRI）扫描仪，新的脉冲序列和成像技术的可用性，软骨的直接可视化已经成为可能。MRI不仅可以显示软骨，还可以同时显示骨关节炎的其他重要特征。通过MRI描述的“放射前”软骨变化可以通过半定量或定量方法可靠地测量。MRI能够准确测量膝关节骨关节炎中定量软骨形态的纵向变化。此外，成分MRI允许对“形态学前”变化进行成像（即，在任何明显的形态学改变发生之前，对细微的物质内基质变化进行可视化）。在X线片上检测关节间隙变窄似乎已经过时，现在可以通过使用传统的以及复杂的MRI技术直接可视化软骨的形态和形态前变化。
Imaging of cartilage has traditionally been achieved indirectly with conventional radiography. Loss of joint space width, or 'joint space narrowing', is considered a surrogate marker for cartilage thinning. However, radiography is severely limited by its inability to visualize cartilage, the difficulty of ascertaining the optimum and reproducible positioning of the joint in serial assessments, and the difficulty of grading joint space narrowing visually. With the availability of advanced magnetic resonance imaging (MRI) scanners, new pulse sequences, and imaging techniques, direct visualization of cartilage has become possible. MRI enables visualization not only of cartilage but also of other important features of osteoarthritis simultaneously. 'Pre-radiographic' cartilage changes depicted by MRI can be measured reliably by a semiquantitative or quantitative approach. MRI enables accurate measurement of longitudinal changes in quantitative cartilage morphology in knee osteoarthritis. Moreover, compositional MRI allows imaging of 'pre-morphologic' changes (that is, visualization of subtle intrasubstance matrix changes before any obvious morphologic alterations occur). Detection of joint space narrowing on radiography seems outdated now that it is possible to directly visualize morphologic and pre-morphologic changes of cartilage by using conventional as well as complex MRI techniques.
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影响因子：
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