Perfusion abnormalities in subchondral bone associated with marrow edema, osteoarthritis, and avascular necrosis
Perfusion abnormalities in subchondral bone associated with marrow edema, osteoarthritis, and avascular necrosis
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DOI：
10.1196/annals.1402.069
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发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Tung, Glenn A.
中科院分区：
文献类型：
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作者：
Aaron, Roy K.;Dyke, Jonathan P.;Tung, Glenn A.
骨髓水肿可见于骨关节炎、缺血性坏死和包括骨髓水肿综合征在内的其他临床情况。骨髓水肿与骨痛有关，可能与骨性关节炎的病理生理学有关。我们的假设是，骨髓水肿与软骨下骨的灌注减少有关，这会导致局灶性和节段性骨坏死和软骨破裂。我们进一步假设，软骨下骨中流体动力学的改变构成了骨细胞高度敏感的物理化学环境的一部分，并随着流体流量、压力和氧气梯度的变化而改变其细胞因子表达谱。我们使用Gd-DTPA增强磁共振成像技术，研究了两种相关模型软骨下骨灌注的变化--Dunkin-Hartley豚鼠骨性关节炎模型，以及骨性关节炎和缺血性坏死相关的人骨髓水肿模型。采用药代动力学模型提取灌流动力学参数。得到了具有代表性的时间-强度曲线，它表征了正常骨和伴有骨髓水肿的骨。动态增强磁共振成像可能是早期诊断骨灌注异常的有用工具，并可用于表征与许多临床条件相关的骨髓水肿。这项技术还可能揭示骨关节炎和缺血性坏死软骨下灌注的病理生理学机制。
Bone marrow edema is seen in osteoarthritis, avascular necrosis, and other clinical conditions including the bone marrow edema syndrome. Bone marrow edema is associated with bone pain and may be related to the pathophysiology of osteoarthritis. Our hypothesis is that bone marrow edema is associated with a reduction in perfusion in subchondral bone, which contributes to focal and segmental bone necrosis and cartilage breakdown. We further hypothesize that altered fluid dynamics in subchondral bone comprise part of the physicochemical environment to which osteocytes are highly sensitive and alter their cytokine expression profile in response to changes in fluid flow, pressure, and oxygen gradients. We have used contrast-enhanced magnetic resonance imaging with Gd-DTPA to characterize changes in subchondral bone perfusion in two relevant and related models-the Dunkin-Hartley guinea pig model of osteoarthritis and human bone marrow edema associated with osteoarthritis and avascular necrosis. Pharmacokinetic modeling was used to extract dynamic parameters of perfusion. Representative time-intensity curves are derived, which characterize normal bone and bone with marrow edema. Dynamic contrast-enhanced magnetic resonance imaging may be a useful tool for the early diagnosis of bone perfusion abnormalities and may be used to characterize marrow edema associated with a number of clinical conditions. This technique may also shed light on the pathophysiology of subchondral perfusion in osteoarthritis and avascular necrosis.