Claessen K M J A, Canete A Navas, de Bruin P W, Pereira A M, Kloppenburg M, Kroon H M, Biermasz N R
Departments of Endocrinology & Metabolic Diseases and Center for Endocrine Tumors Leiden.
Departments of Radiology.
Eur J Endocrinol. 2017 Jun;176(6):779-790. doi: 10.1530/EJE-16-1073. Epub 2017 Mar 27.
Arthropathy is a prevalent and invalidating complication of acromegaly with a characteristic radiographic phenotype. We aimed to further characterize cartilage and bone abnormalities associated with acromegalic arthropathy using magnetic resonance imaging (MRI).
Twenty-six patients (23% women, mean age 56.8 ± 13.4 years), with active ( = 10) and controlled acromegaly ( = 16) underwent a 3.0 T MRI of the right knee. Osteophytes, cartilage defects, bone marrow lesions and subchondral cysts were assessed by the Knee Osteoarthritis Scoring System (KOSS) method. Cartilage thickness and cartilage T2 relaxation times, in which higher values reflect increased water content and/or structural changes, were measured. Twenty-five controls (52% women, mean age: 59.6 ± 8.0 years) with primary knee OA were included for comparison.
Both in active and controlled acromegaly, structural OA defects were highly prevalent, with thickest cartilage and highest cartilage T2 relaxation times in the active patients. When compared to primary OA subjects, patients with acromegaly seem to have less cysts (12% vs 48%, = 0.001) and bone marrow lesions (15% vs 80%, = 0.006), but comparable prevalence of osteophytosis and cartilage defects. Patients with acromegaly had 31% thicker total joint cartilage ( < 0.001) with higher cartilage T2 relaxation times at all measured sites than primary OA subjects ( < 0.01).
Patients with active acromegaly have a high prevalence of structural OA abnormalities in combination with thick joint cartilage. In addition, T2 relaxation times of cartilage are high in active patients, indicating unhealthy cartilage with increased water content, which is (partially) reversible by adequate treatment. Patients with acromegaly have a different distribution of structural OA abnormalities visualized by MRI than primary OA subjects, especially of cartilage defects.
关节病是肢端肥大症常见且导致功能丧失的并发症，具有特征性的影像学表型。我们旨在利用磁共振成像（MRI）进一步明确与肢端肥大症关节病相关的软骨和骨异常。
26例患者（女性占23%，平均年龄56.8±13.4岁），其中10例为活动期肢端肥大症患者，16例为病情得到控制的肢端肥大症患者，接受了右膝3.0T MRI检查。采用膝关节骨关节炎评分系统（KOSS）方法评估骨赘、软骨缺损、骨髓病变和软骨下囊肿。测量软骨厚度和软骨T2弛豫时间，T2弛豫时间越高反映含水量增加和/或结构改变。纳入25例原发性膝关节骨关节炎对照者（女性占52%，平均年龄：59.6±8.0岁）进行比较。
在活动期和病情得到控制的肢端肥大症患者中，结构性骨关节炎缺损均非常普遍，活动期患者的软骨最厚，软骨T2弛豫时间最长。与原发性骨关节炎患者相比，肢端肥大症患者似乎囊肿较少（12%对48%，P=0.001）和骨髓病变较少（15%对80%，P=0.006），但骨赘形成和软骨缺损的患病率相当。肢端肥大症患者的全关节软骨总厚度比原发性骨关节炎患者厚31%（P<0.001），在所有测量部位软骨T2弛豫时间均更高（P<0.01）。
活动期肢端肥大症患者结构性骨关节炎异常的患病率较高，同时伴有关节软骨增厚。此外，活动期患者软骨的T弛豫时间较高，表明软骨不健康且含水量增加，通过适当治疗（部分）可逆转。与原发性骨关节炎患者相比，肢端肥大症患者MRI显示的结构性骨关节炎异常分布不同，尤其是软骨缺损。
