Bone marrow lesions in knee osteoarthritis change in 6-12 weeks
Bone marrow lesions in knee osteoarthritis change in 6-12 weeks
复制标题
DOI：
10.1016/j.joca.2012.08.020
复制
发表时间：
2012-12-01
影响因子：
7
通讯作者：
Hutchinson, C. E.
中科院分区：
文献类型：
--
作者：
Felson, D. T.;Parkes, M. J.;Hutchinson, C. E.
目的：膝关节骨关节炎（OA）被认为是一种缓慢发展的疾病，伴有软骨形态的冰川变化，需要持续1-2年的潜在治疗试验，有证据表明超过6个月的软骨变化未被检测到。与软骨相比，骨具有快速适应的能力，例如骨折后。我们测试了骨髓病变（BMLs）在6周和12周内的体积变化，表明它们可能提供了关节损伤短期波动的证据。方法：在62例髌骨股骨膝OA患者（平均年龄55.7岁，59.7%为女性，平均BMI为31.0）中，我们获得了基线、6周和12周的膝关节mri增强。对于基线时存在BML的患者，我们在轴向质子密度脂肪饱和（FS）图像和对比后矢状T1加权FS图像上评估BML体积。我们手工分割BML体积，测试膝关节重新测量BML体积的可重复性。使用重复测量之间差异的标准差来计算Bland-Altman一致极限，我们确定了BML体积变化代表的变化大于偶然变化的程度。结果：52例患者基线时存在脑损伤。BML体积的重测信度较高（ICC 0.89, 95% Cl 0.80-0.97）。在6周和12周时，所有膝关节的BML体积至少有一些变化。在6周的轴位视图上，20/49（40.8%）的膝关节显示BML体积变化大于12周时的相似结果。BML的变化在BML增大和缩小的膝关节中均匀分布。63.3%的膝关节在6周或12周的轴位位上BML体积改变超过50%，矢状位上48.7%。结论：在许多膝OA患者中，膝关节BML体积在几周内发生变化。在某种程度上，它们可以被视为治疗目标，测试BML效应的试验可以避免通常的长时间结构修饰试验。(C) 2012国际骨关节炎学会。Elsevier Ltd.出版。版权所有。
Objectives: Knee osteoarthritis (OA) is thought to be a slowly evolving disease with glacial changes in cartilage morphology necessitating trials of potential treatments lasting 1-2 years with evidence that over 6 months change in cartilage is not detectable. In contrast to cartilage, bone has the capacity to adapt rapidly, such as after fracture. We tested whether bone marrow lesions (BMLs) change in volume in 6 and 12 weeks, suggesting they may provide evidence of short term fluctuations of joint damage.Methods: In 62 patients with patellofemoral knee OA (mean age 55.7 years, 59.7% women, mean BMI 31.0), we obtained baseline, 6 and 12 week knee MRIs with contrast enhancement. Of those with BMLs at baseline, we assessed BML volume on the axial proton density fat saturated (FS) images and postcontrast sagittal T1 weighted FS images. We manually segmented BML volumes, testing repeatability of BML volumes in knees remeasured. Using the standard deviation of the difference between repeated measurements to calculate Bland-Altman Limits of Agreement, we determined how much BML volume change represented a change greater than due to chance.Results: Fifty-two patients had BMLs at baseline. Test-retest reliability for BML volume was high (ICC 0.89, 95% Cl 0.80-0.97). All knees showed at least some change in BML volume by 6 and 12 weeks. On the axial view at 6 weeks, 20/49 (40.8%) knees showed BML volume changes greater than the limits of agreement with similar results at 12 weeks. BML changes were evenly divided among knees with enlarging and shrinking BMLs. 63.3% of the knees had more than 50% change in BML volume at either 6 or 12 weeks on the axial view and 48.7% on the sagittal view.Conclusions: Knee BML volumes change in several weeks in many persons with knee OA. To the extent that they could be regarded as treatment targets, trials testing BML effects could avoid the usual prolonged structure modification trials. (C) 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.