Mazzuca Steven A, Brandt Kenneth D, Schauwecker Donald S, Buckwalter Kenneth A, Katz Barry P, Meyer Joan M, Lane Kathleen A
Department of Medicine, Department of Orthopaedic Surgery, Indiana University School of Medicine (IUSM), Indianapolis, Indiana 46202-5100, USA.
J Rheumatol. 2004 Feb;31(2):329-32.
To determine the predictive value of bone scintigraphy with respect to joint space narrowing (JSN) in patients with knee osteoarthritis (OA), based on quantitative estimates of uptake of a bone-seeking radiopharmaceutical and fluoroscopically standardized knee radiography.
Our study group included 86 obese women, 45-64 years of age, with unilateral knee OA. Uptake of technetium medronate (99mTc-MDP) in late-phase bone scans was measured at baseline in 5 regions of interest (ROI: lateral femur, lateral tibia, medial femur, medial tibia, and patellofemoral joint) and was adjusted for uptake (i.e., expressed as a ratio to uptake) in a ROI in the shaft of the tibia, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiograph of the knees (semiflexed anteroposterior view) at baseline, 16, and 30 months. Magnification-corrected minimum joint space width in the medial tibiofemoral compartment was measured by digital image analysis.
Followup was available for 79 patients (92%) at 16 months and from 73 patients (85%) at 30 months. On average, 99mTc-MDP uptake in each ROI and in the whole knee (average of 4 tibiofemoral ROI) was 170-240% of that in the tibial shaft. Uptake in the medial tibia and in the whole knee was significantly correlated with JSN at 16 and 30 months (r = 0.22-0.30, p < 0.05). However, after controlling for age, body mass index, and radiographic severity of OA, the associations between adjusted uptake and JSN were not significant. The rate of JSN in knees of patients with OA who were in the lower tertile with respect to adjusted 99mTc-MDP uptake in the medial tibia was significantly less rapid than in patients in whom uptake was in the middle and upper tertiles (0.04 mm/yr vs 0.18 mm/yr; p < 0.05). However, after controlling for overall radiographic severity at baseline, the difference in 30-month JSN in knees of patients with OA in the lower versus middle/upper tertiles was not significant.
The predictive utility of bone scintigraphy is confirmed by these data. However, its practical value is considerably diminished, insofar as similarly predictive information may be obtained by routine radiographic examination, without the radiation exposure and cost of scintigraphy.
基于亲骨性放射性药物摄取的定量估计和透视标准化膝关节X线摄影，确定骨闪烁显像对膝骨关节炎（OA）患者关节间隙狭窄（JSN）的预测价值。
我们的研究组包括86名45 - 64岁的肥胖女性，均为单侧膝OA。在基线时，于5个感兴趣区域（ROI：股骨外侧、胫骨外侧、股骨内侧、胫骨内侧和髌股关节）测量晚期骨扫描中锝美罗酸盐（99mTc - MDP）的摄取情况，并根据作为内标的胫骨干中一个ROI的摄取情况进行调整（即表示为摄取比率）。每位受试者在基线、16个月和30个月时均接受膝关节的透视标准化X线摄影（半屈曲前后位）。通过数字图像分析测量经放大校正后的内侧胫股关节间隙最小宽度。
16个月时79例患者（92%）、30个月时73例患者（85%）有随访数据。平均而言，每个ROI以及整个膝关节（4个胫股ROI的平均值）中99mTc - MDP的摄取量是胫骨干摄取量的170% - 240%。内侧胫骨和整个膝关节的摄取量在16个月和30个月时与JSN显著相关（r = 0.22 - 0.30，p < 0.05）。然而，在控制了年龄、体重指数和OA的放射学严重程度后，校正摄取量与JSN之间的关联并不显著。在内侧胫骨中99mTc - MDP校正摄取量处于较低三分位数的OA患者膝关节中，JSN的进展速度明显慢于摄取量处于中间和较高三分位数的患者（0.04 mm/年对0.18 mm/年；p < 0.05）。然而，在控制基线时的总体放射学严重程度后，OA患者膝关节在较低与中间/较高三分位数之间30个月时的JSN差异并不显著。
这些数据证实了骨闪烁显像的预测效用。然而，其实际价值显著降低，因为通过常规X线检查可获得类似的预测信息，且无需承受闪烁显像的辐射暴露和费用。
