Glückert K, Blank-Schäl A, Hofmann G, Kladny B, Willauschus W, Wirtz P
Abteilung für Orthopädische Rheumatologie, Orthopädische Universitätsklinik und Poliklinik im Waldkrankenhaus St. Marien, Erlangen.
Orthopade. 1990 Feb;19(1):50-7.
Today early detection of osteoarthrosis (OA) must imply the recognition of initial changes of articular cartilage before radiological signs appear. A noninvasive imaging technique must meet the demands of imaging the articular cartilage layer with high contrast and surface irregularities (fibrillation) and changes within the substance. This can only be achieved by magnetic resonance imaging (MRI) with optimized conditions (3D-gradient echo sequence). In 80 patients, 62% of them without radiological signs of OA, articular cartilage of the knee joint was prospectively (70 patients) and retrospectively (10 patients) investigated with MRI and compared with the arthroscopic findings. Normal cartilage could be distinguished from pathological conditions with a specificity of more than 90% when evaluating surface morphology, signal homogeneity and, above all, signal intensity (40 patients). Full-thickness defects were identified in all cases. Cartilage fibrillation of differing depths (grades 1-3) could not be differentiated with a sufficient degree of reliability and requires a more subtle evaluation method by means of improved software. Thus, the noninvasive recognition of early pathological changes of articular cartilage in patients without radiological signs of OA has become possible.
如今，骨关节炎（OA）的早期检测必然意味着在放射学征象出现之前识别关节软骨的初始变化。一种非侵入性成像技术必须满足以高对比度成像关节软骨层以及表面不规则（纤维性变）和软骨实质内变化的要求。这只能通过在优化条件下（三维梯度回波序列）的磁共振成像（MRI）来实现。在80例患者中，其中62%无OA的放射学征象，对膝关节的关节软骨进行了前瞻性研究（70例患者）和回顾性研究（10例患者），并将MRI结果与关节镜检查结果进行了比较。在评估表面形态、信号均匀性，尤其是信号强度时（40例患者），正常软骨与病理状态的区分特异性超过90%。所有病例均识别出全层缺损。不同深度（1 - 3级）的软骨纤维性变无法以足够的可靠性进行区分，需要借助改进的软件采用更精细的评估方法。因此，在无OA放射学征象的患者中对关节软骨早期病理变化进行非侵入性识别已成为可能。
