Steer K J D, Bostick G P, Woodhouse L J, Nguyen T T, Schankath A, Lambert R G W, Jaremko J L
Department of Radiology and Diagnostic Imaging, Faculty of Medicine, University of Alberta, 2A2.41 WMC, 8440-112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
Skeletal Radiol. 2019 Feb;48(2):227-237. doi: 10.1007/s00256-018-3010-9. Epub 2018 Jul 6.
Intra-articular steroid injection (IASI) is an effective therapy for hip osteoarthritis (OA), but carries risks and provides significant pain relief to only two thirds of patients. We attempted to predict response to IASI in hip OA patients using baseline clinical, ultrasound, and MRI data.
Observational study of 97 subjects with symptomatic hip OA presenting for IASI. At baseline and 8 weeks we obtained hip MRI, grayscale and Doppler ultrasound, clinical range of motion (ROM), timed-up and go test (TUG) scores, and self-reported Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain, stiffness, and function scores. Bone-capsule distance (BCD) measurements of inflammation on hip ultrasound and MRI were measured at three locations: the proximal-most uncovered portion of the femoral head, the superficial-most (apex) portion of the femoral head, and the largest fluid pocket at the femoral neck.
Ultrasound and MRI BCD correlated with each other significantly and strongly at the apex and neck. Power Doppler findings did not correlate significantly with any other imaging indices. Eight weeks post-injection, WOMAC pain, function, and stiffness scores significantly improved and TUG time improved nearly to the level of significance, but there were no significant changes in ultrasound, MRI, or Doppler indices. Baseline variables were not significantly different between responder and nonresponder WOMAC pain or TUG time cohorts.
Basic measures of inflammation on ultrasound and MRI are highly related to each other, but provide little insight into patient function and pain after IASI. Other mechanisms to explain improvement in patient status after IASI are likely at work.
关节内注射类固醇（IASI）是治疗髋骨关节炎（OA）的一种有效疗法，但存在风险，且仅能使三分之二的患者获得显著的疼痛缓解。我们试图利用基线临床、超声和MRI数据预测髋OA患者对IASI的反应。
对97例因IASI就诊的有症状髋OA患者进行观察性研究。在基线和8周时，我们获取了髋部MRI、灰阶和多普勒超声、临床活动范围（ROM）、计时起立行走测试（TUG）评分以及自我报告的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛、僵硬和功能评分。在三个位置测量髋部超声和MRI上炎症的骨-关节囊距离（BCD）：股骨头最近端未覆盖部分、股骨头最浅表（顶点）部分以及股骨颈最大的液性腔。
超声和MRI的BCD在顶点和颈部显著且强烈相关。能量多普勒结果与任何其他影像学指标均无显著相关性。注射后8周，WOMAC疼痛、功能和僵硬评分显著改善，TUG时间改善接近显著水平，但超声、MRI或多普勒指标无显著变化。反应者和无反应者的WOMAC疼痛或TUG时间队列的基线变量无显著差异。
超声和MRI上炎症的基本测量指标彼此高度相关，但对IASI后患者的功能和疼痛了解甚少。IASI后患者状况改善的其他机制可能在起作用。
