MRI 在膝骨关节炎中的反应性和可靠性：已发表证据的荟萃分析。
Responsiveness and reliability of MRI in knee osteoarthritis: a meta-analysis of published evidence.
机构信息
Rheumatology Department, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, NSW, Australia.
出版信息
Osteoarthritis Cartilage. 2011 May;19(5):589-605. doi: 10.1016/j.joca.2010.10.030. Epub 2011 Mar 23.
OBJECTIVE
To summarize literature on the responsiveness and reliability of MRI-based measures of knee osteoarthritis (OA) structural change.
METHODS
A literature search was conducted using articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance and of these, 243 were selected for data extraction. For this analysis we extracted data on reliability and responsiveness for every reported synovial joint tissue as it relates to MRI measurement in knee OA. Reliability was defined by inter- and intra-reader intra-class correlation (ICC), or coefficient of variation, or kappa statistics. Responsiveness was defined as standardized response mean (SRM) - ratio of mean of change over time divided by standard deviation of change. Random-effects models were used to pool data from multiple studies.
RESULTS
The reliability analysis included data from 84 manuscripts. The inter-reader and intra-reader ICC were excellent (range 0.8-0.94) and the inter-reader and intra-reader kappa values for quantitative and semi-quantitative measures were all moderate to excellent (range 0.52-0.88). The lowest value (kappa=0.52) corresponded to semi-quantitative synovial scoring intra-reader reliability and the highest value (ICC=0.94) for semi-quantitative cartilage morphology. The responsiveness analysis included data from 42 manuscripts. The pooled SRM for quantitative measures of cartilage morphometry for the medial tibiofemoral joint was -0.86 (95% confidence intervals (CI) -1.26 to -0.46). The pooled SRM for the semi-quantitative measurement of cartilage morphology for the medial tibiofemoral joint was 0.55 (95% CI 0.47-0.64). For the quantitative analysis, SRMs are negative because the quantitative value, indicating a loss of cartilage, goes down. For the semi-quantitative analysis, SRMs indicating a loss in cartilage are positive (increase in score).
CONCLUSION
MRI has evolved substantially over the last decade and its strengths include the ability to visualize individual tissue pathologies, which can be measured reliably and with good responsiveness using both quantitative and semi-quantitative techniques.
目的
总结基于 MRI 的膝关节骨关节炎（OA）结构变化测量的反应性和可靠性的文献。
方法
使用截至搜索时（2009 年 4 月）发表的文章进行文献检索。对此次搜索获得的 1338 篇摘要进行初步筛选，以确定相关性，其中 243 篇被选中用于提取数据。在这项分析中，我们提取了与膝关节 OA 的 MRI 测量相关的每个报告滑膜关节组织的可靠性和反应性的数据。可靠性通过读者间和读者内的组内相关系数（ICC）、变异系数或kappa 统计量来定义。反应性定义为标准化反应均值（SRM）-变化时间平均值与变化标准差之比。使用随机效应模型对来自多个研究的数据进行汇总。
结果
可靠性分析包括 84 篇文献的数据。读者间和读者内的 ICC 非常好（范围 0.8-0.94），定量和半定量测量的读者间和读者内的 kappa 值均为中度至非常好（范围 0.52-0.88）。最低值（kappa=0.52）对应于半定量滑膜评分的读者内可靠性，而最高值（ICC=0.94）对应于半定量软骨形态的读者内可靠性。反应性分析包括 42 篇文献的数据。内侧胫骨股骨关节定量软骨形态测量的汇总 SRM 为-0.86（95%置信区间（CI）-1.26 至-0.46）。内侧胫骨股骨关节软骨形态半定量测量的汇总 SRM 为 0.55（95%CI 0.47-0.64）。对于定量分析，SRM 为负值，因为定量值表示软骨丢失，数值会降低。对于半定量分析，指示软骨丢失的 SRM 为正值（分数增加）。
结论
MRI 在过去十年中得到了很大的发展，其优势包括能够可视化个体组织病理学，使用定量和半定量技术可以可靠且具有良好的反应性进行测量。
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