对比增强和非对比 MRI 检查在膝关节骨关节炎中的滑膜炎症反映：观察性研究的荟萃分析。
Are contrast-enhanced and non-contrast MRI findings reflecting synovial inflammation in knee osteoarthritis: a meta-analysis of observational studies.
机构信息
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC, Baltimore, MD, 21287, USA; Department of Internal Medicine, St Agnes Hospital, 900 Caton Avenue, Baltimore, MD, 21229, USA.
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St, JHOC, Baltimore, MD, 21287, USA.
出版信息
Osteoarthritis Cartilage. 2020 Feb;28(2):126-136. doi: 10.1016/j.joca.2019.10.008. Epub 2019 Oct 31.
OBJECTIVE
To determine the correlation between knee synovitis assessed on contrast-enhanced (CE) and non-contrast enhanced (NCE) magnetic resonance imaging (MRI) with histology in patients with knee osteoarthritis.
METHODS
A comprehensive literature search was performed, and related articles published through July 2018 were extracted. Spearman correlation coefficients of MRI-based scores with histology reports were pooled using random effects model. To evaluate presence of publication bias, Egger test was performed.
RESULTS
Of 2377 identified records, eight studies consisting of 246 MRI exams were included. Two studies reported results of dynamic CE (DCE)-MRI examinations (81 knees) and two studies reported results of NCE-MRI. There were moderate positive correlations between CE-MRI scores and macroscopic (r = 0.53 (95% Confidence Interval (CI):0.37-0.66), P < 0.001) as well as microscopic (r = 0.56 (0.39-0.69), P < 0.001) histology. DCE-MRI were strongly correlated (r = 0.71 (0.58-0.80), P-value<0.001), with microscopic histology reports, while the correlation for NCE-MRI was low positive (r = 0.44 (0.20-0.63), P < 0.001). Meta-regression analysis showed that pooled correlation coefficients of DCE-MRI were significantly higher than CE-MRI (Slope = 0.29, SE = 0.13, P-value = 0.02). CE-MRI were also correlated with inflammatory infiltrate (r = 0.42), while the correlations for cell number of synovial lining (r = 0.27) and level of fibrosis (r = 0.29, P < 0.001) were very low.
CONCLUSION
Static and dynamic CE-MRI evaluation of knee synovitis were positively correlated with macroscopic and microscopic features of synovial membrane inflammation. Among the features of synovial tissue inflammation, CE-MRI scores correlated best with the inflammatory infiltrates of synovial tissue. Paucity of current evidence warrants further studies to assess performance of NCE-MRI on determining knee synovitis.
目的
确定膝关节骨关节炎患者关节造影增强（CE）和非增强（NCE）磁共振成像（MRI）与组织学之间的相关性。
方法
进行了全面的文献检索，并提取了截至 2018 年 7 月发表的相关文章。使用随机效应模型汇总基于 MRI 的评分与组织学报告的 Spearman 相关系数。为了评估是否存在发表偏倚，进行了 Egger 检验。
结果
在 2377 条鉴定记录中，有 8 项研究包括 246 次 MRI 检查，共 81 个膝关节被纳入。有两项研究报告了动态 CE（DCE）-MRI 检查结果（81 个膝关节），两项研究报告了 NCE-MRI 结果。CE-MRI 评分与大体（r = 0.53（95%置信区间（CI）：0.37-0.66），P < 0.001）和微观（r = 0.56（0.39-0.69），P < 0.001）组织学具有中度正相关性。DCE-MRI 与微观组织学报告具有强烈相关性（r = 0.71（0.58-0.80），P 值<0.001），而 NCE-MRI 的相关性为低度正相关（r = 0.44（0.20-0.63），P < 0.001）。Meta 回归分析表明，DCE-MRI 的合并相关系数明显高于 CE-MRI（斜率= 0.29，SE = 0.13，P 值= 0.02）。CE-MRI 也与炎症浸润有关（r = 0.42），而与滑膜衬里细胞数（r = 0.27）和纤维化程度（r = 0.29，P < 0.001）的相关性非常低。
结论
膝关节造影增强和动态 CE-MRI 评估与滑膜炎症的大体和微观特征呈正相关。在滑膜组织炎症的特征中，CE-MRI 评分与滑膜组织的炎症浸润相关性最好。目前证据有限，需要进一步研究来评估 NCE-MRI 对膝关节滑膜炎的诊断性能。
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