Natural history and clinical significance of MRI-detected bone marrow lesions at the knee: a prospective study in community dwelling older adults
Natural history and clinical significance of MRI-detected bone marrow lesions at the knee: a prospective study in community dwelling older adults
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DOI：
10.1186/ar3210
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发表时间：
2010-01-01
影响因子：
4.9
通讯作者：
Jones, Graeme
中科院分区：
文献类型：
--
作者：
Dore, Dawn;Quinn, Stephen;Jones, Graeme
导读：关于骨髓病变（BMLs）的自然病史和临床意义，目前存在相互矛盾的数据。本研究的目的是通过定量测量来描述mri检测到的膝关节BMLs的自然病史，并检查BMLs与疼痛、功能和僵硬评分以及全膝关节置换术（TKR）手术的关系。方法：从普通人群中随机抽取395名老年男性和女性（平均年龄63岁，52 - 79岁），在基线和大约2.7年后进行测量。通过测量病变的最大面积，使用t2加权脂肪饱和度MRI来确定bml。重现性好（类内相关系数（ICC）： 0.97）。疼痛、功能和僵硬度通过西安大略大学和麦克马斯特大学骨关节炎（WOMAC）评分进行评估。基线时采用x线评估放射性骨关节炎（ROA）。结果：基线时，43% （n = 168/395）患有BML。其中25%缩小，24%增大。在剩余的样本（n = 227）中，7%发展为新的BML。在多变量模型中，仅在没有ROA的参与者中，BML大小的变化与疼痛和功能评分的变化相关（每增加1 SD β = 1.13至2.55，均P < 0.05）。最后，基线BML严重性预测TKR手术（优势比（OR） 2.10/单位，P = 0.019）。结论：在以人群为基础的样本中，身体质量指数（通过测量最大面积来评估）不是静态的，恶化和改善的比例相似。在没有确定ROA的患者中，BML大小的变化与疼痛的变化有关。这一发现表明，波动的膝关节疼痛可能归因于早期疾病参与者的bls。基线bml也预测TKR手术。这些发现表明，应该考虑旨在改变bml自然历史的治疗干预措施。
Introduction: There are conflicting data on the natural history and clinical significance of bone marrow lesions (BMLs). The aims of this study were to describe the natural history of MRI-detected BMLs at the knee using a quantitative measure and examine the association of BMLs with pain, function and stiffness scores, and total knee replacement (TKR) surgery.Methods: A total of 395 older males and females were randomly selected from the general population (mean age 63 years, range 52 to 79) and measured at baseline and approximately 2.7 years later. BMLs were determined using T2-weighted fat saturation MRI by measuring the maximum area of the lesion. Reproducibility was excellent (intraclass correlation coefficient (ICC): 0.97). Pain, function, and stiffness were assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. X-ray was used to assess radiographic osteoarthritis (ROA) at baseline.Results: At baseline, 43% (n = 168/395) had a BML. Of these 25% decreased in size and 24% increased. Of the remaining sample (n = 227), 7% developed a new BML. In a multivariable model, a change in BML size was associated with a change in pain and function scores (beta = 1.13 to 2.55 per 1 SD increase, all P < 0.05), only in those participants without ROA. Lastly, baseline BML severity predicted TKR surgery (odds ratio (OR) 2.10/unit, P = 0.019).Conclusions: In a population based sample, BMLs (assessed by measuring maximal area) were not static, with similar proportions both worsening and improving. A change in BML size was associated with changes in pain in those without established ROA. This finding suggests that fluctuating knee pain may be attributable to BMLs in those participants with early stage disease. Baseline BMLs also predicted TKR surgery. These findings suggest therapeutic interventions aimed at altering the natural history of BMLs should be considered.