Hagiwara Shigeo, Nakamura Junichi, Watanabe Atsuya, Kishida Shunji, Ohtori Seiji, Omae Takanori, Miyamoto Shuichi, Orita Sumihisa, Takahashi Kazuhisa
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba City, Chiba, Japan.
Department of Orthopedic Surgery, Eastern Chiba Medical Center, Okayamadai, Togane City, Chiba, Japan.
J Magn Reson Imaging. 2015 Dec;42(6):1524-31. doi: 10.1002/jmri.24953. Epub 2015 May 27.
The purpose of this diagnostic study was to quantify the effect of high-dose corticosteroid treatment on hip joint cartilage degeneration in patients with systemic lupus erythematosus (SLE), with and without osteonecrosis, using magnetic resonance imaging (MRI).
T2 mapping, with a 3.0 Tesla Discovery MR750 (GE Healthcare) MRI scanner, was performed in 12 volunteers without hip pathology (control group, 12 hips), in 11 patients with SLE without osteonecrosis, who were receiving corticosteroid therapy (corticosteroid-ON group, 17 hips), and in 15 patients with SLE receiving corticosteroids, who had noncollapsed and asymptomatic osteonecrosis (corticosteroid+ON group, 26 hips). The distribution of T2 values in the femoral head and acetabular cartilage were compared among the three groups. Step-wise multiple regression analysis was performed to determine the prognostic factors for T2 values indicative of femoral head cartilage degeneration.
Mean T2 values of femoral head cartilage were significantly higher in the corticosteroid-ON (40.3 ms) and corticosteroid+ON (35.2 ms) groups than in the control group (30.1 ms, P = 0.001). T2 values of acetabular cartilage were significantly higher in the corticosteroid-ON group (41.8 ms) versus the control (33.4 ms) and the corticosteroid+ON groups (37.0 ms; P = 0.001). Low bone mineral density was a significant prognostic factor for high T2 values of cartilage at the femoral head in patients treated with corticosteroids, regardless of whether they had osteonecrosis.
T2 mapping suggests that corticosteroid therapy and osteoporosis are independent risk factors for cartilage degeneration at the femoral head in patients with SLE.
本诊断性研究旨在使用磁共振成像（MRI）量化高剂量皮质类固醇治疗对患有和未患有骨坏死的系统性红斑狼疮（SLE）患者髋关节软骨退变的影响。
使用3.0特斯拉Discovery MR750（GE医疗）MRI扫描仪对12名无髋关节病变的志愿者（对照组，12个髋关节）、11名正在接受皮质类固醇治疗且无骨坏死的SLE患者（皮质类固醇 - 无骨坏死组，17个髋关节）以及15名接受皮质类固醇治疗且有未塌陷和无症状骨坏死的SLE患者（皮质类固醇 + 骨坏死组，26个髋关节）进行T2映射。比较三组股骨头和髋臼软骨中T2值的分布。进行逐步多元回归分析以确定指示股骨头软骨退变的T2值的预后因素。
皮质类固醇 - 无骨坏死组（40.3毫秒）和皮质类固醇 + 骨坏死组（35.2毫秒）的股骨头软骨平均T2值显著高于对照组（30.1毫秒，P = 0.001）。皮质类固醇 - 无骨坏死组（41.8毫秒）的髋臼软骨T2值显著高于对照组（33.4毫秒）和皮质类固醇 + 骨坏死组（37.0毫秒；P = 0.001）。无论是否患有骨坏死，低骨密度都是接受皮质类固醇治疗患者股骨头软骨T2值高的重要预后因素。
T2映射表明，皮质类固醇治疗和骨质疏松是SLE患者股骨头软骨退变的独立危险因素。
