Buck Florian M, Hoffmann Alexander, Hofer Bernhard, Pfirrmann Christian W A, Allgayer Bernhard
Department of Diagnostic Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Skeletal Radiol. 2009 Apr;38(4):339-47. doi: 10.1007/s00256-008-0627-0. Epub 2008 Dec 3.
The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI).
Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed.
At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm(3); range, 1,200-39,200 mm(3)). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001).
In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.
本研究的目的是将静息及运动时的慢性膝关节内侧疼痛与磁共振成像（MRI）上的骨闪烁显像摄取、骨髓水肿模式（BMEP）、软骨损伤、半月板撕裂及侧副韧带病变相关联。
本研究纳入了在我院连续就诊的50例慢性膝关节内侧疼痛患者。使用视觉模拟量表（VAS）评估静息及运动时的疼痛程度。在MR图像上，测量BMEP体积，并评估股骨-胫骨软骨、内侧半月板及内侧副韧带（MCL）的完整性。测量半定量闪烁显像剂摄取情况。进行多变量线性回归分析。
在检查当天，40例患者报告静息时膝关节内侧疼痛，49例患者在爬楼梯时疼痛（静息时平均VAS为33mm，范围0 - 80mm；爬楼梯时平均VAS为60mm，范围20 - 100mm）。骨闪烁显像显示36例患者显像剂摄取增加（摄取因子，平均3.7，范围2.4 - 18.0）。MRI显示31例患者存在BMEP（平均体积，4070mm³；范围，1200 - 39200mm³）。所有存在BMEP的患者骨闪烁显像均异常。10%静息时疼痛的患者及8%运动时疼痛的患者未显示BMEP，但闪烁显像有显像剂摄取。MCL周围的显像剂摄取及信号改变可显著预测静息时的疼痛（显像剂摄取p = 0.004；MCL信号改变p = 0.002）。只有MCL信号改变可显著预测运动时的疼痛（p = 0.001）。
在慢性膝关节内侧疼痛中，骨闪烁显像中显像剂摄取增加对膝关节内侧疼痛的敏感性高于MRI上的BMEP。静息及运动时的疼痛程度与MCL及其周围的信号改变相关。
