Lansdown Drew A, Wang Kevin, Cotter Eric, Davey Annabelle, Cole Brian J
Department of Orthopedic Surgery, Sports Medicine & Shoulder Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Orthopaedic Surgery, Sports Medicine & Shoulder Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2018 Apr 10;6(4):2325967118765448. doi: 10.1177/2325967118765448. eCollection 2018 Apr.
Treatment of articular cartilage injuries remains a clinical challenge, and the optimal tools to monitor and predict clinical outcomes are unclear. Quantitative magnetic resonance imaging (qMRI) allows for a noninvasive biochemical evaluation of cartilage and may offer advantages in monitoring outcomes after cartilage repair surgery.
qMRI sequences will correlate with early pain and functional measures.
Systematic review; Level of evidence, 3.
A PubMed search was performed with the following search terms: knee AND (cartilage repair OR cartilage restoration OR cartilage surgery) AND (delayed gadolinium-enhanced MRI OR t1-rho OR T2 mapping OR dgemric OR sodium imaging OR quantitative imaging). Studies were included if correlation data were included on quantitative imaging results and patient outcome scores.
Fourteen articles were included in the analysis. Eight studies showed a significant relationship between quantitative cartilage imaging and patient outcome scores, while 6 showed no relationship. T2 mapping was examined in 11 studies, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in 4 studies, sodium imaging in 2 studies, glycosaminoglycan chemical exchange saturation transfer (gagCEST) in 1 study, and diffusion-weighted imaging in 1 study. Five studies on T2 mapping showed a correlation between T2 relaxation times and clinical outcome scores. Two dGEMRIC studies found a correlation between T1 relaxation times and clinical outcome scores.
Multiple studies on T2 mapping, dGEMRIC, and diffusion-weighted imaging showed significant correlations with patient-reported outcome measures after cartilage repair surgery, although other studies showed no significant relationship. qMRI sequences may offer a noninvasive method to monitor cartilage repair tissue in a clinically meaningful way, but further refinements in imaging protocols and clinical interpretation are necessary to improve utility.
关节软骨损伤的治疗仍是一项临床挑战，目前尚不清楚用于监测和预测临床结果的最佳工具。定量磁共振成像（qMRI）可对软骨进行无创生化评估，在监测软骨修复手术后的结果方面可能具有优势。
qMRI序列将与早期疼痛和功能指标相关。
系统评价；证据等级，3级。
在PubMed上进行检索，检索词如下：膝关节 AND（软骨修复 OR 软骨重建 OR 软骨手术）AND（延迟钆增强磁共振成像 OR t1-rho OR T2图谱 OR dgemric OR 钠成像 OR 定量成像）。如果研究包含定量成像结果与患者结局评分的相关性数据，则纳入该研究。
14篇文章纳入分析。8项研究显示定量软骨成像与患者结局评分之间存在显著关系，而6项研究未显示相关性。11项研究检测了T2图谱，4项研究检测了软骨延迟钆增强磁共振成像（dGEMRIC），2项研究检测了钠成像，1项研究检测了糖胺聚糖化学交换饱和转移（gagCEST），1项研究检测了扩散加权成像。5项关于T2图谱的研究显示T2弛豫时间与临床结局评分之间存在相关性。2项dGEMRIC研究发现T1弛豫时间与临床结局评分之间存在相关性。
多项关于T2图谱、dGEMRIC和扩散加权成像的研究显示与软骨修复手术后患者报告的结局指标存在显著相关性，尽管其他研究未显示显著关系。qMRI序列可能提供一种以临床有意义的方式监测软骨修复组织的无创方法，但成像方案和临床解读的进一步完善对于提高实用性是必要的。
