Jin Wook, Woo Dong-Cheol, Jahng Geon-Ho
Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University.
J Appl Clin Med Phys. 2016 Mar 8;17(2):561-572. doi: 10.1120/jacmp.v17i2.6144.
In vivo proton (1H) magnetic resonance spectroscopy (MRS) has not yet been systematically used to study joint fluids in human knees. The objective of this study, therefore, was to assess the ability of proton MRS to identify the apparent heterogeneous characteristics of metabolic spectra in the joint fluid regions in human knees using a high-field MRI system. Eighty-four patients with effusion lesions who were referred for routine knee MR imaging underwent proton MRS with point-resolved, single-voxel MR spectroscopy using a clinical 3.0 Tesla MRI system. Thirty-eight patients were confirmed to have the following: degenerative osteoarthritis, 21 patients (Group 1); traumatic diseases, 12 patients (Group 2); infectious diseases, 4 patients and an inflammatory disease, 1 patient (Group 3). Spectroscopy data were analyzed using the public jMRUI freeware software to obtain lipid metabolites. Nonparametric statistical comparisons were performed to investigate any differences in metabolites among the three disease groups. The major metabolites were vinylic CH=CH lipids around 5.1-5.5 ppm, CH2 lipids around 1.1-1.5 ppm, and CH3 lipids around 0.7-1.0 ppm. Each patient had either a CH=CH lipid peak, CH2 and CH3 lipid peaks, or all three peaks. There were no significant differences among the three groups for the CH3 (p = 0.9019), CH2 (p= 0.6406), and CH=CH lipids (p = 0.5467) and water (p = 0.2853); none of the metabolites could differentiate between any of the three types of diseases. The CH2 lipids in the 38 patients who had confirmed fluid characteristics were significantly correlated with CH3 lipids (rho = 0.835, p < 0.0001). The ratio of CH3 to CH2 was highest in the degenerative disease. In both the degenerative and traumatic diseases, metabolite peaks of the vinylic CH=CH lipids around 5.1-5.5 ppm and of the sum of the CH2 and CH3 lipids around 0.7-1.5 ppm were observed, but in the infectious disease, only a metabolite peak of the sum of the CH2 and CH3 lipids was detected. Although none of the metabolites could statistically significantly differentiate between the three types of diseases, the different lipid metabolite peaks and their ratios in the three disease groups may give us a hint at the different mechanisms of joint fluids in the infectious, degenerative, and traumatic diseases.
体内质子（1H）磁共振波谱（MRS）尚未被系统地用于研究人类膝关节的关节液。因此，本研究的目的是使用高场MRI系统评估质子MRS识别人类膝关节关节液区域代谢谱明显异质性特征的能力。84例因常规膝关节MR成像而转诊的积液病变患者，使用临床3.0特斯拉MRI系统，通过点分辨单体素磁共振波谱进行质子MRS检查。38例患者被确诊患有以下疾病：退行性骨关节炎，21例（第1组）；创伤性疾病，12例（第2组）；感染性疾病，4例，炎性疾病，1例（第3组）。使用公共的jMRUI免费软件对波谱数据进行分析以获取脂质代谢物。进行非参数统计比较以研究三个疾病组之间代谢物的任何差异。主要代谢物为5.1 - 5.5 ppm附近的乙烯基CH=CH脂质、1.1 - 1.5 ppm附近的CH2脂质以及0.7 - 1.0 ppm附近的CH3脂质。每位患者要么有CH=CH脂质峰、CH2和CH3脂质峰，要么有所有三个峰。三组之间CH3（p = 0.9019）、CH2（p = 0.6406）、CH=CH脂质（p = 0.5467）和水（p = 0.2853）均无显著差异；没有任何一种代谢物能够区分这三种疾病类型中的任何一种。38例具有确诊积液特征的患者中，CH2脂质与CH3脂质显著相关（rho = 0.835，p < 0.0001）。CH3与CH2的比值在退行性疾病中最高。在退行性和创伤性疾病中，均观察到5.1 - 5.5 ppm附近的乙烯基CH=CH脂质以及0.7 - 1.5 ppm附近的CH2和CH3脂质总和的代谢物峰，但在感染性疾病中，仅检测到CH2和CH3脂质总和的代谢物峰。虽然没有一种代谢物能够在统计学上显著区分这三种疾病类型，但三个疾病组中不同的脂质代谢物峰及其比值可能为我们提示感染性、退行性和创伤性疾病中关节液的不同机制。
