Schlossbauer T, Mioc T, Sommerey S, Kessler S B, Reiser M F, Pfeifer K-J
Institute of Clinical Radiology, University of Munich, Munich, Germany.
Eur J Med Res. 2008 Sep 22;13(9):409-14.
To report on qualitative and quantitative MRI findings in early stage of diabetic osteoarthropathy (CA) and correlation with clinical symptoms.
Clinical data of 13 patients (mean age = 61.2 years) with Charcot arthropathy (CA, Eichenholtz 0) were compared with findings in native and contrast-enhanced MRI. 12 patients had diabetes mellitus (7 type 2, 5 type 1), one had idiopathic polyneuropathy. Evaluation was performed at acute stage of CA and at a 4 months follow-up. After baseline assessment, patients were treated with pressure-relieving means. Mean values of signal-intensity in short T1 inversion recovery (STIR) images of bones of the foot and ankle and corresponding contrast-enhancement were evaluated. Additional MRI-findings (soft tissue edema, varicosis, tenovaginitis, joint effusion) were analyzed. A correlation with symptoms (reddening, swelling, hyperthermia, pain) was performed.
Bone marrow edema in affected bones significantly decreased (p<0.001). Soft tissue edema and pain showed a significant correlation with intensity of bone marrow edema (p<0.05). The presence of bone marrow edema in the STIR sequence was strongly associated with a corresponding contrast enhancement (p<0.0001, kappa-coefficients 0.976 at baseline and 0.953 at follow-up).
MRI in early stage of CA provides valuable diagnostic information on the activity of the disease. A significant correlation of intensity of bone marrow edema in MRI and some clinical parameters (soft tissue edema and pain) was found. Paramagnetic contrast-agent did not provide additional information. This is the first report on quantitative assessment of signal alterations in stage 0 CA before and after treatment.
报告糖尿病性骨关节病（Charcot关节病，CA）早期的定性和定量MRI表现及其与临床症状的相关性。
将13例Charcot关节病（CA，Eichenholtz 0期）患者（平均年龄61.2岁）的临床资料与平扫及增强MRI表现进行比较。其中12例患有糖尿病（7例2型，5例1型），1例患有特发性多发性神经病。在CA急性期及4个月随访时进行评估。基线评估后，患者接受减压治疗。评估足踝部骨骼短T1反转恢复（STIR）图像中的信号强度平均值及相应的强化情况。分析其他MRI表现（软组织水肿、静脉曲张、腱鞘炎、关节积液）。将其与症状（发红、肿胀、发热、疼痛）进行相关性分析。
患骨骨髓水肿明显减轻（p<0.001）。软组织水肿和疼痛与骨髓水肿程度呈显著相关性（p<0.05）。STIR序列中骨髓水肿的存在与相应的强化密切相关（p<0.0001，基线时kappa系数为0.976，随访时为0.953）。
CA早期的MRI可为疾病活动提供有价值的诊断信息。发现MRI中骨髓水肿程度与一些临床参数（软组织水肿和疼痛）存在显著相关性。顺磁性对比剂未提供额外信息。这是关于0期CA治疗前后信号改变定量评估的首篇报道。
