The Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, New York 14642, USA.
J Orthop Res. 2010 Sep;28(9):1220-8. doi: 10.1002/jor.21103.
Magnetic resonance imaging (MRI) of bone marrow edema (BME) has been found to be helpful in the diagnosis of back pain attributed to degenerative disk disease (DDD) and spondyloarthropathy (SA), but its interpretation is limited by a lack of knowledge of its nature and natural history. We assessed effects of compressive forces to mouse tail segments of WT and TNF-Tg mice with SA, via contrast enhanced-MRI and histology. Normalized marrow contrast enhancement (NMCE) of uninstrumented WT vertebrae significantly decrease, threefold (p < 0.01) from 8 to 12 weeks of age, while the NMCE of TNF-Tg vertebrae remained elevated. Compressive loading (6x body weight) increased NMCE twofold (p < 0.02) within 2 weeks in WT tails, which was equal to 6x loaded TNF-Tg tails within 4 weeks. Histology confirmed degenerative changes and that load-induced NMCE corresponded to increased vascular sinus tissue (35 +/- 3% vs. 19 +/- 3%; p < 0.01) and cellularity (4,235 +/- 886 vs.1,468 +/- 320 cells/mm(2); p < 0.01) for the loaded versus unloaded WT, respectively. However, micro-computed tomography (CT) analyses failed to detect significant load-induced changes to bone. While the bone marrow of loaded WT and TNF-Tg vertebrae were similar, histology demonstrated mild cellular infiltrate and increased osteoclastic resorption in the WT tails versus severe inflammatory-erosive arthritis in TNF-Tg joints. Significant (p < 0.05) decreases in cortical and trabecular bone volume in uninstrumented TNF-Tg versus WT vertebrae were confirmed by micro-CT. Thus, chronic load-induced DDD causes BME signals in vertebrae similar to those observed from SA, and both DDD and SA signals correlate with a conversion from yellow to red marrow, with increased vascularity.
磁共振成像(MRI)骨髓水肿(BME)已被发现有助于诊断退行性椎间盘疾病(DDD)和脊柱关节病(SA)引起的背痛,但由于缺乏对其性质和自然史的了解,其解释受到限制。我们通过对比增强 MRI 和组织学评估了施加于 SA 所致 WT 和 TNF-Tg 小鼠尾巴段的压缩力的影响。未受仪器影响的 WT 椎体的骨髓对比增强(NMCE)显著降低,从 8 至 12 周龄时降低三倍(p < 0.01),而 TNF-Tg 椎体的 NMCE 仍然升高。WT 尾巴的压缩载荷(6x 体重)在 2 周内使 NMCE 增加两倍(p < 0.02),而 4 周内加载的 TNF-Tg 尾巴的 NMCE 增加了两倍。组织学证实了退行性变化,并且负载诱导的 NMCE 与增加的血管窦组织(35 +/- 3%比 19 +/- 3%;p < 0.01)和细胞数(4,235 +/- 886 比 1,468 +/- 320 个细胞/mm(2);p < 0.01)对应于加载 WT 的分别。然而,微计算机断层扫描(CT)分析未能检测到明显的负载诱导的骨变化。尽管加载 WT 和 TNF-Tg 椎体的骨髓相似,但组织学显示 WT 尾巴中轻度细胞浸润和增加的破骨细胞吸收,而 TNF-Tg 关节中则表现出严重的炎症性侵蚀性关节炎。微 CT 证实未受仪器影响的 TNF-Tg 与 WT 椎体之间皮质和小梁骨体积均有显著(p < 0.05)减少。因此,慢性负荷诱导的 DDD 引起的椎体 BME 信号类似于从 SA 观察到的信号,并且 DDD 和 SA 信号均与从黄骨髓向红骨髓的转化以及血管生成相关。