Mazzuca Steven A, Brandt Kenneth D, Schauwecker Donald S, Katz Barry P, Meyer Joan M, Lane Kathleen A, Bradley John D, Hugenberg Steven T, Wolfe Frederick, Moreland Larry W, Heck Louis W, Yocum David E, Schnitzer Thomas J, Sharma Leena, Manzi Susan, Oddis Chester V
Department of Medicine, Indiana University School of Medicine (IUSM), Indianapolis, 46202, USA.
J Rheumatol. 2005 Aug;32(8):1540-6.
To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a baseline late-phase bone scan and assessments of the radiographic and symptomatic severity of knee osteoarthritis (OA) at baseline as predictors of loss of articular cartilage thickness, as reflected in joint space narrowing (JSN) in the medial tibiofemoral compartment.
Subjects (174 obese women, 45-64 yrs of age, with unilateral knee OA) were a subset of a larger cohort who participated in a placebo controlled trial of a disease modifying OA drug. Uptake of technetium medronate (99mTc-MDP) in anteroposterior (AP) and lateral views of a late-phase bone scan was measured at baseline in a region of interest drawn around the medial tibia, and was adjusted for (i.e., expressed as a ratio to) uptake in a reference segment of the tibial shaft, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiographic examination of the knees (semiflexed AP view) and a pain assessment with the WOMAC OA Index at baseline, 16 months, and 30 months.
Controlling for baseline joint space width and treatment group, multiple linear regression models showed that the adjusted 99mTc-MDP uptake at baseline was a significant predictor of joint space narrowing (JSN) in the index knee at 16 months (b = 0.180, p = 0.015) and 30 months (b = 0.221, p = 0.049). In the contralateral knee, uptake was only a marginally significant predictor of JSN at 30 months (b = 0.246, p = 0.083). Uptake in the upper and middle tertiles of the distribution predicted subjects who would exhibit JSN >/= 0.50 mm within 16 months with 65% sensitivity (PPV 23%) and 36% specificity (NPV 77%). In contrast, a prediction rule based solely on the presence of Kellgren-Lawrence grade 3 OA severity and greater than median WOMAC Pain score identified progressors with 65% sensitivity (PPV 48%) and 79% specificity (NPV 88%).
Although the level of adjusted 99mTc-MDP uptake was significantly associated with JSN in knees with established radiographic OA, baseline bone scintigraphy is inferior to the radiographic severity of OA and knee pain (alone or in combination) as a predictor of loss of articular cartilage in subjects with knee OA.
比较基线晚期骨扫描以及基线时膝关节骨关节炎（OA）的影像学和症状严重程度评估作为关节软骨厚度丢失预测指标的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV），关节软骨厚度丢失通过胫股内侧间室的关节间隙狭窄（JSN）反映。
受试者（174名45 - 64岁的肥胖女性，患有单侧膝关节OA）是一个更大队列的子集，该队列参与了一种改善病情的OA药物的安慰剂对照试验。在基线时，在围绕胫骨内侧绘制的感兴趣区域测量晚期骨扫描前后位（AP）和侧位视图中锝美罗酸盐（99mTc - MDP）的摄取，并将其调整为（即表示为与）胫骨骨干参考段的摄取之比，该参考段用作内部标准。每位受试者在基线、16个月和30个月时接受膝关节的荧光透视标准化放射学检查（半屈曲AP视图）以及使用WOMAC OA指数进行疼痛评估。
在控制基线关节间隙宽度和治疗组的情况下，多元线性回归模型显示，基线时调整后的99mTc - MDP摄取是16个月时（b = 0.180，p = 0.015）和30个月时（b = 0.221，p = 0.049）指数膝关节关节间隙狭窄（JSN）的显著预测指标。在对侧膝关节中，摄取仅在30个月时是JSN的边缘显著预测指标（b = 0.246，p = 0.083）。分布上三分位数中上部的摄取预测在16个月内关节间隙狭窄≥0.50 mm的受试者，敏感性为65%（PPV 23%），特异性为36%（NPV 77%）。相比之下，仅基于存在Kellgren - Lawrence 3级OA严重程度和高于中位数的WOMAC疼痛评分的预测规则识别进展者的敏感性为65%（PPV 48%），特异性为79%（NPV 88%）。
尽管调整后的99mTc - MDP摄取水平与已确诊放射学OA的膝关节中的关节间隙狭窄显著相关，但作为膝关节OA患者关节软骨丢失的预测指标，基线骨闪烁显像不如OA的放射学严重程度和膝关节疼痛（单独或联合）。
