van der Heijden Rianne A, de Vries Bas A, Poot Dirk H J, van Middelkoop Marienke, Bierma-Zeinstra Sita M A, Krestin Gabriel P, Oei Edwin H G
Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
Department of General Practice, Erasmus MC, Rotterdam, The Netherlands.
Quant Imaging Med Surg. 2021 Jan;11(1):133-142. doi: 10.21037/qims-20-441.
Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion.
Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically.
Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median K was 0.017 (0.016) min in control subjects and 0.016 (0.020) min in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only.
The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.
髌股疼痛（PFP）是一种常见的膝关节疾病，可能是膝关节骨关节炎（OA）的先兆。炎症会导致髌下脂肪垫（IPFP）灌注增加或体积增大，进而可能引发膝关节疼痛。本研究的目的是比较定量动态对比增强磁共振成像（DCE-MRI）参数（作为炎症的成像生物标志物）以及PFP患者与对照组之间、有和无IPFP水肿或关节积液的患者之间IPFP的体积。
纳入PFP患者和健康对照者，进行非脂肪抑制三维快速扰相梯度回波（FSPGR）和DCE-MRI检查。应用图像配准来校正运动。使用Horos软件在FSPGR图像上勾勒出IPFP。计算体积，并通过拟合扩展的Tofts药代动力学模型提取定量灌注参数。通过线性回归分析检验患者与对照组之间体积和DCE-MRI参数的差异。对IPFP水肿和积液进行相同的分析。
纳入43名对照者和35名PFP患者。对照者的平均IPFP体积为26.04（4.18）mL，患者为27.52（5.37）mL。对照者的K值中位数为0.017（0.016）min，患者为0.016（0.020）min。体积和灌注参数的差异均无统计学意义。仅在患者中，有积液的膝关节与无积液的膝关节相比，IPFP灌注更高。
IPFP被认为是膝关节疼痛的来源，但较高的DCE-MR血流灌注（一种炎症的成像生物标志物）和更大的体积与PFP无关。有积液的患者膝关节显示出较高的灌注，提示存在炎症。
