First Central Clinical College, Tianjin Medical University, Tianjin, China.
Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China.
Eur Radiol. 2023 May;33(5):3178-3187. doi: 10.1007/s00330-023-09485-4. Epub 2023 Mar 9.
To explore the different involvement patterns of the knee "synovio-entheseal complex (SEC)" on MRI in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA).
This study retrospectively included 120 patients (male:female, 55:65) with a mean age of 39.20 years diagnosed with SPA (n = 40), RA (n = 40), and OA (n = 40) at the First Central Hospital of Tianjin between January 2020 and May 2022. Six knee entheses were assessed by two musculoskeletal radiologists according to the SEC definition. Bone marrow lesions associated with entheses include bone marrow edema (BME) and bone erosion (BE), which were classified as entheseal or peri-entheseal based on their relationship to the entheses. Three groups (OA, RA, and SPA) were established to characterize the location of enthesitis and the different SEC involvement patterns. Inter-group and intra-group differences were analyzed using the ANOVA or chi-square tests, and the inter-class correlation coefficient (ICC) test was used to determine inter-reader agreement.
The study contained a total of 720 entheses. The SEC-based analysis revealed different involvement patterns in three groups. The OA group had the most abnormal signals in tendons/ligaments (p = 0.002). The RA group had considerably greater synovitis (p = 0.002). The majority of peri-entheseal BE was identified in the OA and RA groups (p = 0.003). Furthermore, entheseal BME in the SPA group was significantly different from those in the other two groups (p < 0.001).
SEC involvement patterns differed in SPA, RA, and OA, which is important for differential diagnosis. SEC should be used as a whole evaluation method in clinical practice.
• The "synovio-entheseal complex (SEC)" explained differences and characteristic alterations in the knee joint in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA). • The various SEC involvement patterns are crucial for differentiating SPA, RA, and OA. • When "knee pain" is the only symptom, a detailed identification of characteristic alterations in the knee joint of SPA patients may help timely treatment and delay the structural damage.
探讨磁共振成像（MRI）中膝关节“滑膜-骨腱复合结构（SEC）”在强直性脊柱炎（SPA）、类风湿关节炎（RA）和骨关节炎（OA）患者中的不同受累模式。
本研究回顾性纳入了 2020 年 1 月至 2022 年 5 月期间在天津市第一中心医院诊断为 SPA（n=40）、RA（n=40）和 OA（n=40）的 120 名患者（男：女，55：65），平均年龄为 39.20 岁。两名肌肉骨骼放射科医生根据 SEC 定义评估了 6 个膝关节附着点。与附着点相关的骨髓病变包括骨髓水肿（BME）和骨侵蚀（BE），根据与附着点的关系将其分类为附着点或附着点周围。建立 OA、RA 和 SPA 三组，以描述附着点炎的位置和不同的 SEC 受累模式。采用方差分析或卡方检验分析组间和组内差异，采用组内相关系数（ICC）检验评价观察者间的一致性。
本研究共包含 720 个附着点。基于 SEC 的分析显示三组的受累模式不同。OA 组的肌腱/韧带异常信号最多（p=0.002）。RA 组的滑膜炎明显更多（p=0.002）。OA 和 RA 组中多数为附着点周围 BE（p=0.003）。此外，SPA 组的附着点内 BME 与其他两组有显著差异（p<0.001）。
SPA、RA 和 OA 中 SEC 的受累模式不同，这对于鉴别诊断很重要。在临床实践中，应将 SEC 作为一种整体评估方法。
•“滑膜-骨腱复合结构（SEC）”解释了 SPA、RA 和 OA 患者膝关节的差异和特征性改变。
•各种 SEC 受累模式对于 SPA、RA 和 OA 的鉴别诊断至关重要。
•当“膝关节疼痛”是唯一症状时，详细识别 SPA 患者膝关节的特征性改变可能有助于及时治疗和延缓结构损伤。
