Detection and evaluation of initial cartilage pathology in man: A comparison between MRT, arthroscopy and near-infrared spectroscopy (NIR) in their relation to initial knee pain.
Detection and evaluation of initial cartilage pathology in man: A comparison between MRT, arthroscopy and near-infrared spectroscopy (NIR) in their relation to initial knee pain.
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DOI：
10.1016/j.pathophys.2009.04.001
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发表时间：
2010-02-01
期刊：
影响因子：
--
通讯作者：
Spahn, Gunter
中科院分区：
文献类型：
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作者：
Hofmann, Gunther O;Marticke, Julia;Spahn, Gunter
背景和目的：MRI和关节镜检查是评价软骨病理的重要方法。但经常初始变化的软骨结合慢性膝关节疼痛不能检测到采用这两种方法。需要更好的诊断工具来检测骨关节炎（OA）的早期阶段。本研究的目的是表明，近红外光谱（NIRS）可以纳入常规关节镜检查，以提高检测和评估的初始软骨病理。此外，还研究了具有OA初始症状的患者的MRI、关节镜检查和NIRS结果之间的相关性。（n=21，12名女性，9名男性，年龄：年龄15-59岁，平均34.19岁，膝关节疼痛至少持续半年，无膝关节外伤史（体重、吸烟行为），并使用膝关节损伤和骨关节炎结局评分（KOOS）进行临床评价。此外，还分析了血清参数（胆固醇、脂质），所有患者术前均进行了三个方向的常规X线检查（根据Kellgren和Lawrence进行评估）和MRI（根据ICRS评分评估软骨损伤）。在随后的关节镜检查中，根据ICRS评分评价软骨损伤。此外，在近红外光区（光谱范围在1150和1475 nm之间）使用特殊的微玻璃纤维探针研究了所有膝关节的软骨光谱反射。为了表征研究参数之间的关系，使用了斯皮尔曼等级相关系数。采用Cohens-Kappa检验计算观察者间方差。结果：MRI表现出较强的观察者间方差，与其他参数无显著相关性。关节镜检查结果也是如此。只有近红外光谱显示显着的相关性与三个五分之一的KOOS分项。在一般参数中，只有吸烟行为与两个KOOS评分显着相关。因此，NIRS似乎是检测人体软骨初始病理的敏感诊断工具。作为常规关节镜检查的一部分，光谱检查所需的额外时间为3 - 7 min（平均：4 min 18 s）。结论：特别是对于早期软骨病变（ICRS 0/I），MRI和关节镜检查的预测价值较低。观察者间方差非常高（Cohens-Kappa
BACKGROUND AND AIMS: MRI and arthroscopy are important methods in the evaluation of cartilage pathology. But frequently initial changes of cartilage in combination with chronic knee pain cannot be detected by employing these two methods. Better diagnostic tools for the detection of the early stages of osteoarthritis (OA) are required. The objective of this study was to show that near-infrared spectroscopy (NIRS) can be incorporated into routine arthroscopy to improve detection and assessment of the initial cartilage pathology. Furthermore correlations between findings in MRI, arthroscopy and NIRS in patients with initial symptoms of OA have studied.METHODS: Patients (n=21, 12 women, 9 men, age: 15-59 years, mean 34.19 years) with knee pain lasting for at least half a year without any trauma of the knee in their history were interviewed (body weight, smoking behaviour) and clinically evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS). Also serum parameters (cholesterol, lipids) were analysed, conventional X-rays in three directions (evaluated according to Kellgren and Lawrence) and MRI (evaluation of cartilage damage according to the ICRS-score) were performed preoperatively in all patients. During subsequent arthroscopy cartilage damage was evaluated according to the ICRS-score. In addition the spectral reflection of cartilage was investigated in all knees using a special micro-glass-fiber probe in the near-infrared light region (spectral range between 1150 and 1475nm). To characterize relations between the investigated parameters the Spearman's rank correlation coefficient was used. Inter-observer variance was calculated employing the Cohens-Kappa-test.RESULTS: MRI demonstrated a strong inter-observer variance with no significant correlations to other parameters. The same was observed for arthroscopic findings. Only NIRS showed significant correlations with three out of five KOOS subscores. Within the general parameters only smoking behaviour showed a significant correlation with two of the KOOS-scores. NIRS therefore seemed to be a sensitive diagnostic tool in detection of initial pathology in human cartilage. The additional necessary time for the spectroscopic investigation as part of the routine arthroscopy ranged between 3 and 7min (mean: 4min 18s).CONCLUSION: Particularly for early-stage cartilage lesions (ICRS 0/I) MRI and arthroscopy have rather low predictive value. The inter-observer variance is very high (Cohens-Kappa