From the Department of Orthopaedic Surgery and Traumatology (M.D., M.T.H., J.R., E.T.) and Department of Radiology (A.F.), Kantonsspital Baselland-Bruderholz, Binningen, Switzerland; and Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland (A.H.).
Radiology. 2016 Jan;278(1):223-31. doi: 10.1148/radiol.2015141714. Epub 2015 Jul 8.
To evaluate the correlation of bone tracer uptake as determined with single photon emission computed tomography (SPECT)/computed tomography (CT) and the size and severity of chondral lesions detected with magnetic resonance (MR) imaging of the knee.
MR imaging and SPECT/CT images of 63 knee joints in 63 patients (mean age ± standard deviation, 49.2 years ± 12.7) with chondral or osteochondral lesions were prospectively collected and retrospectively analyzed after approval by the ethics committee. Chondral lesions were graded on MR images by using a modified Noyes grading scale (grade 0, intact; grade 1, fibrillations; grade 2, <50% defect; grade 3, >50% defect; and grade 4, grade three plus subchondral changes) and measured in two dimensions. Technetium 99m hydroxymethane diphosphonate SPECT/CT bone tracer uptake was volumetrically quantified by using validated software. Maximum values of each subchondral area (patellofemoral or medial and lateral femorotibial) were quantified, and a ratio was calculated in relation to a reference region in the femoral shaft, which represented the bone tracer uptake background activity. Grades and sizes of chondral lesions and bone tracer uptake were correlated by using an independent t test and analysis of variance (P < .05).
Bone tracer uptake was low (mean relative uptake, 1.64 ± 0.95) in knees without any present chondral lesion. In knees with grade 3 and 4 chondral lesions, the relative ratio was significantly higher (3.62 ± 2.18, P = .002) than in knees with grade 1 and 2 lesions (2.95 ± 2.07). The larger the diameter of the chondral lesion, the higher the bone tracer uptake. Higher grades of chondral lesions (grades 3 and 4) larger than 4 cm(2) (4.96 ± 2.43) showed a significantly higher bone tracer uptake than smaller lesions (<1 cm(2), 2.72 ± 1.43 [P = .011]; and 1-4 cm(2), 3.28 ± 2.15 [P = .004]).
SPECT/CT findings significantly correlate with the degree and size of chondral lesions on MR images. Grade 3 and 4 chondral lesions of the knee, as well as larger lesions, correlate with a high bone tracer uptake.
评估膝关节磁共振成像(MRI)检测到的软骨病变的大小和严重程度与单光子发射计算机断层扫描(SPECT)/计算机断层扫描(CT)的骨示踪剂摄取之间的相关性。
前瞻性收集了 63 例(平均年龄±标准差,49.2 岁±12.7 岁)膝关节软骨或软骨下骨病变患者的 MRI 和 SPECT/CT 图像,经伦理委员会批准后进行回顾性分析。使用改良的 Noyes 分级系统(0 级,完整;1 级,纤维;2 级,<50%缺损;3 级,>50%缺损;4 级,3 级伴软骨下改变)对 MRI 图像上的软骨病变进行分级,并进行二维测量。使用经过验证的软件对锝 99m 羟甲基二膦酸盐 SPECT/CT 骨示踪剂摄取进行容积定量。对每个软骨下区域(髌股或内外侧股骨胫骨)的最大值进行量化,并计算与代表骨示踪剂摄取背景活动的股骨干参考区域的比值。使用独立 t 检验和方差分析(P<.05)对软骨病变的分级和大小以及骨示踪剂摄取进行相关性分析。
无任何软骨病变的膝关节示踪剂摄取较低(平均相对摄取率,1.64±0.95)。在 3 级和 4 级软骨病变的膝关节中,相对比值明显高于 1 级和 2 级病变(3.62±2.18,P=.002)。软骨病变的直径越大,骨示踪剂摄取越高。较大的(>4cm2)3 级和 4 级软骨病变(4.96±2.43)显示出明显更高的骨示踪剂摄取,而较小的病变(<1cm2,2.72±1.43[P=.011];1-4cm2,3.28±2.15[P=.004])。
SPECT/CT 发现与 MRI 图像上软骨病变的程度和大小具有显著相关性。膝关节 3 级和 4 级软骨病变以及较大的病变与高骨示踪剂摄取相关。