Increase in bone marrow lesions associated with cartilage loss - A longitudinal magnetic resonance imaging study of knee osteoarthritis
Increase in bone marrow lesions associated with cartilage loss - A longitudinal magnetic resonance imaging study of knee osteoarthritis
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DOI：
10.1002/art.21789
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发表时间：
2006-05-01
影响因子：
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通讯作者：
Felson, David T.
中科院分区：
文献类型：
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作者：
Hunter, David J.;Zhang, Yuqing;Felson, David T.
目标。虽然骨髓病变(BMLS)是X线所见的关节间隙丢失的有力预测指标，但这些病变的自然病史、它们与软骨丢失的关系以及这些病变与软骨丢失之间的关联尚不清楚。在一项有症状的膝骨性关节炎(OA)的自然病史研究中，使用纵向磁共振成像(MRI)数据对这些问题进行了检验。对217例(男性122例，女性95例；平均年龄+/-SD，年龄66.4+/-9.4岁)的原发膝骨性关节炎患者在基线、15个月和30个月进行了膝关节MRI检查。为了评估机械排列，在15个月时拍摄了长肢X线片。软骨下骨髓异常，在内侧和外侧胫股关节分级，定义为在脂肪抑制的T2加权图像上骨髓内信号强度增强的边缘不良区域。所有时间点的胫股内侧关节和外侧胫股关节软骨形态特征采用半定量评分。对于每一个内侧和外侧间隔，使用广义估计方程来评估胫股BMLS与胫股软骨评分的纵向关系，并调整对齐。57%的膝关节在基线时有BMLS，其中99%在随访时保持不变或增大。基线BML评分较高的膝关节间隔区软骨丢失较大。BMLS的增加与软骨评分的进一步恶化密切相关。增大或新的BMLS大多发生在对齐不良的肢体上，在对齐不良的一侧(例如，内翻对齐的膝盖出现新的内侧BMLS)。调整对线后，BML改变与胫股内侧软骨丢失的相关性不显著。骨髓损伤不太可能消失，而且通常会随着时间的推移而变得更大。与保持不变的BML相比，增大的BML与更多的软骨丢失密切相关。此外，BML的任何变化都是通过肢体对齐来调节的。
Objective. Although bone marrow lesions (BMLs) are powerful predictors of joint space loss as visualized on radiographs, the natural history of these lesions, their relationship to cartilage loss, and the association between change in these lesions and cartilage loss are unknown. These questions were tested using longitudinal magnetic resonance imaging (MRI) data in a natural history study of symptomatic knee osteoarthritis (OA).Methods. MRI of the knee was performed at baseline, 15 months, and 30 months in 217 patients with primary knee OA (122 men, 95 women; mean +/- SD age 66.4 +/- 9.4 years). To assess mechanical alignment, long-limb films were obtained at 15 months. Subchondral bone marrow abnormalities, graded in the medial and lateral tibiofemoral joints, were defined as poorly marginated areas of increased signal intensity in the marrow on fat-suppressed, T2-weighted images. Cartilage morphologic features in the medial and lateral tibiofemoral joints were scored at all time points using a semiquantitative scale. For each of the medial and lateral compartments, generalized estimating equations were used to evaluate the longitudinal relationship of tibiofemoral BMLs to the tibiofemoral cartilage score, with adjustment for malalignment.Results. Fifty-seven percent of knees had BMLs at baseline, of which 99% remained the same or increased in size at followup. Knee compartments with a higher baseline BML score had greater cartilage loss. An increase in BMLs was strongly associated with further worsening of the cartilage score. Enlarging or new BMLs occurred mostly in malaligned limbs, on the side of the malalignment (e.g., new medial BMLs in varus-aligned knees). The association of BML change with medial tibiofemoral cartilage loss was not significant after adjusting for alignment.Conclusion. Lesions of the bone marrow are unlikely to resolve and often get larger over time. Compared with BMLs that stay the same, enlarging BMLs are strongly associated with more cartilage loss. Furthermore, any change in BML is mediated by limb alignment.