Li Yitong, Hou Bowen, Zhang Yao, Wang Yi, Chu Yongqiang, Zhang Jing, Li Xiaoming
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
Bone. 2025 May;194:117430. doi: 10.1016/j.bone.2025.117430. Epub 2025 Feb 25.
We quantitatively evaluated proximal femoral cortical bone changes associated with generalized bone loss in axial spondyloarthritis (axSpA) patients using double-echo ultrashort echo time (UTE) MRI. To achieve non-radiation, clinically available visualization of cortical microstructural deterioration in the proximal femur of axSpA and to determine the factors influencing it.
Patients with axSpA (n = 83) and age- and sex-matched healthy controls (n = 61) were recruited and underwent double-echo UTE MR scan of the nondominant proximal femur. Porosity index (PI) and cortical bone thickness (CbTh) were measured by two radiologists and their average measurements were used for subsequent analyses. Additionally, demographic characteristics of all subjects and disease-specific characteristics of axSpA patients were recorded. Proximal femoral cortical bone PI and CbTh values were compared between axSpA patients and healthy controls using independent samples t-test. Correlation analyses (Pearson or Spearman or Point-biserial correlation coefficients) were conducted to investigate factors potentially associated with UTE measurements in axSpA patients, and Bonferroni correction was applied at the α = 0.002 level for more stringent correction. Multiple linear regression analyses were performed to further identify influencing factors of UTE measurements with multiple correlated variables.
A total of 72 axSpA patients and 52 healthy control subjects were finally included. Patients and control subjects were comparable in sex, age, and body mass index (BMI). Proximal femoral cortical PI was higher (p < 0.001) and CbTh was lower (p < 0.001) in axSpA patients than in healthy controls. Sex (p < 0.001), BMI (p = 0.003), disease duration (p = 0.044), onset age (p = 0.01), alkaline phosphatase (ALP) (p < 0.001), radiographic axSpA (r-axSpA) (p = 0.02), Sacroiliac Joint Structural Score (SSS)-backfill (p = 0.03), SSS-ankylosis (p = 0.01), and nonsteroidal anti-inflammatory drugs (NSAIDs) use (p = 0.03) were potentially correlated to proximal femoral cortical PI, and among them, sex (p < 0.001) and BMI (p = 0.01) were independently associated demographic characteristics, and ALP (p = 0.02), SSS-backfill (p = 0.044) and SSS-ankylosis (p = 0.01) were independently associated disease-specific characteristics, and when all types of variables were considered, sex (p < 0.001), BMI (p = 0.016), and SSS-ankylosis (p = 0.042) were independently associated with PI. BMI (p = 0.043) and NSAIDs use (p = 0.041) were potentially negatively associated with CbTh.
Double-echo UTE measurements revealed deteriorated proximal femoral cortical bone microstructure in axSpA patients than controls, potentially associated with sex, BMI, disease duration, onset age, ALP, r-SpA, SSS-backfill, SSS-ankylosis, and NSAIDs use, where sex, BMI, ALP, SSS-backfill and SSS-ankylosis were the independently relevant factors. It offers a novel tool for axSpA's cortical bone assessment.
我们使用双回波超短回波时间（UTE）MRI定量评估了轴性脊柱关节炎（axSpA）患者股骨近端皮质骨变化与全身性骨质流失的相关性。旨在实现无辐射、临床可用的axSpA患者股骨近端皮质微结构恶化可视化，并确定影响其的因素。
招募了axSpA患者（n = 83）和年龄及性别匹配的健康对照者（n = 61），对非优势侧股骨近端进行双回波UTE MR扫描。由两名放射科医生测量孔隙率指数（PI）和皮质骨厚度（CbTh），并将其平均测量值用于后续分析。此外，记录了所有受试者的人口统计学特征和axSpA患者的疾病特异性特征。使用独立样本t检验比较axSpA患者和健康对照者的股骨近端皮质骨PI和CbTh值。进行相关性分析（Pearson或Spearman或点二列相关系数）以研究axSpA患者中可能与UTE测量相关的因素，并在α = 0.002水平应用Bonferroni校正以进行更严格的校正。进行多元线性回归分析以进一步确定具有多个相关变量的UTE测量的影响因素。
最终纳入了72例axSpA患者和52例健康对照者。患者和对照者在性别、年龄和体重指数（BMI）方面具有可比性。axSpA患者的股骨近端皮质PI更高（p < 0.001），CbTh更低（p < 0.001）。性别（p < 0.001）、BMI（p = 0.003）、病程（p = 0.044）、发病年龄（p = 0.01）、碱性磷酸酶（ALP）（p < 0.001）、放射学axSpA（r-axSpA）（p = 0.02）、骶髂关节结构评分（SSS）-回填（p = 0.03）、SSS-融合（p = 0.01）和非甾体抗炎药（NSAIDs）使用情况（p = 0.03）可能与股骨近端皮质PI相关，其中，性别（p < 0.001）和BMI（p = 0.01）是独立相关的人口统计学特征，ALP（p = 0.02）、SSS-回填（p = 0.044）和SSS-融合（p = 0.01）是独立相关的疾病特异性特征，当考虑所有类型的变量时，性别（p < 0.001）、BMI（p = 0.016）和SSS-融合（p = 0.042）与PI独立相关。BMI（p = 0.043）和NSAIDs使用情况（p = 0.041）可能与CbTh呈负相关。
双回波UTE测量显示，axSpA患者股骨近端皮质骨微结构比对照组恶化，可能与性别、BMI、病程、发病年龄、ALP、r-SpA、SSS-回填、SSS-融合和NSAIDs使用情况有关，其中性别、BMI、ALP、SSS-回填和SSS-融合是独立相关因素。它为axSpA的皮质骨评估提供了一种新工具。
