全膝关节置换术后软骨下骨长度的生存分析。
Survival analysis on subchondral bone length for total knee replacement.
机构信息
Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
Sargent College, Boston University, Boston, MA, USA.
出版信息
Skeletal Radiol. 2024 Aug;53(8):1541-1552. doi: 10.1007/s00256-024-04627-1. Epub 2024 Feb 22.
OBJECTIVE
Use subchondral bone length (SBL), a new MRI-derived measure that reflects the extent of cartilage loss and bone flattening, to predict the risk of progression to total knee replacement (TKR).
METHODS
We employed baseline MRI data from the Osteoarthritis Initiative (OAI), focusing on 760 men and 1214 women with bone marrow lesions (BMLs) and joint space narrowing (JSN) scores, to predict the progression to TKR. To minimize bias from analyzing both knees of a participant, only the knee with a higher Kellgren-Lawrence (KL) grade was considered, given its greater potential need for TKR. We utilized the Kaplan-Meier survival curves and Cox proportional hazards models, incorporating raw and normalized values of SBL, JSN, and BML as predictors. The study included subgroup analyses for different demographics and clinical characteristics, using models for raw and normalized SBL (merged, femoral, tibial), BML (merged, femoral, tibial), and JSN (medial and lateral compartments). Model performance was evaluated using the time-dependent area under the curve (AUC), Brier score, and Concordance index to gauge accuracy, calibration, and discriminatory power. Knee joint and region-level analyses were conducted to determine the effectiveness of SBL, JSN, and BML in predicting TKR risk.
RESULTS
The SBL model, incorporating data from both the femur and tibia, demonstrated a predictive capacity for TKR that closely matched the performance of the BML score and the JSN grade. The Concordance index of the SBL model was 0.764, closely mirroring the BML's 0.759 and slightly below JSN's 0.788. The Brier score for the SBL model stood at 0.069, showing comparability with BML's 0.073 and a minor difference from JSN's 0.067. Regarding the AUC, the SBL model achieved 0.803, nearly identical to BML's 0.802 and slightly lower than JSN's 0.827.
CONCLUSION
SBL's capacity to predict the risk of progression to TKR highlights its potential as an effective imaging biomarker for knee osteoarthritis.
目的
使用软骨下骨长度（SBL）这一新型 MRI 衍生指标来反映软骨损失和骨面变平的程度，预测全膝关节置换（TKR）的进展风险。
方法
我们利用 Osteoarthritis Initiative（OAI）的基线 MRI 数据，重点关注 760 名男性和 1214 名女性的骨髓病变（BML）和关节间隙狭窄（JSN）评分，以预测 TKR 的进展。为了最大限度地减少分析参与者双膝的偏倚，仅考虑 Kellgren-Lawrence（KL）分级较高的膝关节，因为其更有可能需要 TKR。我们使用 Kaplan-Meier 生存曲线和 Cox 比例风险模型，将 SBL、JSN 和 BML 的原始值和归一化值作为预测因子。研究包括不同人口统计学和临床特征的亚组分析，使用原始和归一化 SBL（合并、股骨、胫骨）、BML（合并、股骨、胫骨）和 JSN（内侧和外侧隔间）的模型。使用时间依赖性曲线下面积（AUC）、Brier 评分和一致性指数来评估模型性能，以衡量准确性、校准和区分能力。进行膝关节和区域水平分析，以确定 SBL、JSN 和 BML 在预测 TKR 风险方面的有效性。
结果
纳入股骨和胫骨数据的 SBL 模型在预测 TKR 方面具有与 BML 评分和 JSN 分级相当的能力。SBL 模型的一致性指数为 0.764，与 BML 的 0.759 非常接近，略低于 JSN 的 0.788。SBL 模型的 Brier 评分值为 0.069，与 BML 的 0.073 相当，略低于 JSN 的 0.067。AUC 方面，SBL 模型达到 0.803，与 BML 的 0.802 几乎相同，略低于 JSN 的 0.827。
结论
SBL 预测 TKR 进展风险的能力突出了其作为膝关节骨关节炎有效影像学生物标志物的潜力。
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