本文選題：T2mapping + 骨性關(guān)節(jié)炎�。� 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：研究目的： 探討不同程度的骨關(guān)節(jié)炎（OA）患者與健康受試者相比，股骨及脛骨軟骨T2值的差異，并討論將膝關(guān)節(jié)軟骨T2值作為國人骨性關(guān)節(jié)炎早期診斷方法的應(yīng)用價值。 研究方法： 對53名臨床診斷為骨性關(guān)節(jié)炎的患者及7名健康受試者進行MRI掃描。臨床診斷依據(jù)于2003年中華醫(yī)學(xué)會風(fēng)濕病學(xué)分會頒布的骨關(guān)節(jié)炎診治指南，即膝關(guān)節(jié)骨性關(guān)節(jié)炎的診斷標準為近1個月內(nèi)反復(fù)膝關(guān)節(jié)疼痛；X線片（站立或負重位）示關(guān)節(jié)間隙變窄、軟骨下骨硬化和（或）囊性變，關(guān)節(jié)緣骨贅形成；關(guān)節(jié)液（至少兩次）清亮、粘稠，WBC≤2000個/ml；④中老年患者（年齡≥38歲）；⑤晨僵≤3min，活動時有骨擦音（感）。滿足①+②或者①+③+⑤+⑥條或①+④+⑤+⑥條即可診斷。入選的患者均有膝關(guān)節(jié)疼痛癥狀，活動部分受限。 對60名受試對象進行膝關(guān)節(jié)MR（TRUE fisp及T2mapping）掃描。按照國際軟骨修復(fù)協(xié)會（ICRS）標準及TRUE fisp圖像請兩位放射科醫(yī)師對受試者軟骨損傷程度進行分級。ICRS標準將關(guān)節(jié)軟骨損傷分為五級：0級，關(guān)節(jié)軟骨無明顯形態(tài)學(xué)及信號改變，表面光滑；Ⅰ級，軟骨內(nèi)信號異常，，但軟骨形常態(tài)正常；Ⅱ級軟骨表面輕度不規(guī)則和/或局部軟骨缺損深度未達全層厚度的50%；Ⅲ級，軟骨表面重度不規(guī)則，軟骨缺損深度達全層厚度的50%以上，但尚未累及全層軟骨；Ⅳ級，全層剝脫、缺損，軟骨下骨暴露伴或不伴軟骨下骨質(zhì)信號改變。 根據(jù)分級結(jié)果，將受試者分為三組：輕度OA組、重度OA組及對照組。其中，輕度OA組對應(yīng)ICRS標準I級和II級，重度OA組對應(yīng)ICRS標準III級和IV級，對照組對應(yīng)ICRS標準0級。膝關(guān)節(jié)MRI掃描后，其中五例患者所得圖像偽影較重，不符合入組標準，最終入組受試者55例：其中輕度OA組入組受試者20例，包括17名女性及名男性；重度OA組入組受試者28例，包括14名女性和14名男性；對照組入組受試者7例，包括包括3名女性和4名男性。 采用3.0T磁共振（MAGNETOM Skyra system，Siemens）對受試者進行膝關(guān)節(jié)掃描，使用膝關(guān)節(jié)專用線圈，仰臥位，腳先進，膝關(guān)節(jié)屈曲約20°。 將受得到的受試者T2偽彩圖上受試者的股骨及脛骨軟骨分為四個軟骨區(qū)，即股骨內(nèi)側(cè)軟骨區(qū)、股骨外側(cè)軟骨區(qū)、脛骨內(nèi)側(cè)軟骨區(qū)及脛骨外側(cè)軟骨區(qū)。對三個組股骨及脛骨T2弛豫時間的平均值以及股骨內(nèi)側(cè)軟骨區(qū)、股骨外側(cè)軟骨區(qū)、脛骨內(nèi)側(cè)軟骨區(qū)、脛骨外側(cè)軟骨區(qū)的T2弛豫時間進行統(tǒng)計學(xué)分析。 研究結(jié)果： 1.OA患者軟骨全層、股骨及脛骨內(nèi)側(cè)區(qū)軟骨的T2值較健康對照組增加，P＜0.05，差別具有統(tǒng)計學(xué)意義。 2.除了脛骨外側(cè)區(qū)軟骨外，對于其余的軟骨區(qū)，患者有輕度和重度OA受試者的T2值均較健康受試組有顯著增加，P0.05，差別具有統(tǒng)計學(xué)意義。 3.輕度及重度OA患者之間的平均T2值未見顯著差異，即P＞0.05，差別不具有統(tǒng)計學(xué)意義。 結(jié)論： 1.骨性關(guān)節(jié)炎患者早期膝關(guān)節(jié)軟骨形態(tài)未發(fā)生改變或輕度改變時，其關(guān)節(jié)軟骨T2值即增高，提示T2mapping成像可以作為早期診斷診斷骨性關(guān)節(jié)炎的標準。 2.關(guān)節(jié)軟骨的T2分布具有一定的空間分布特點，提示關(guān)節(jié)軟骨的T2值可能與負重有關(guān)。 3.不同程度骨性關(guān)節(jié)炎患者關(guān)節(jié)軟骨T2值未見統(tǒng)計學(xué)差異，提示關(guān)節(jié)軟骨T2值不能對骨性關(guān)節(jié)炎進行分期。
[Abstract]:The purpose of the study is:
To explore the difference in the T2 value of the femoral and tibial cartilage compared with the healthy subjects in different degrees of osteoarthritis (OA) and the healthy subjects, and to discuss the value of the T2 value of the articular cartilage of the knee as an early diagnostic method for Chinese osteoarthritis.
Research methods:
53 patients with osteoarthritis and 7 healthy subjects were scanned by MRI. The clinical diagnosis was based on the guidelines for the diagnosis and treatment of osteoarthritis issued by the Chinese Medical Association of China in 2003. The diagnostic criteria for osteoarthritis of the knee are repeated knee pain within 1 months, and the X-ray (standing or weight negative) shows the joint. Interspace narrowing, subchondral osseosclerosis and (or) cystic degeneration, joint margin osteophyte formation; joint fluid (at least two times) clear, sticky, WBC less than 2000 /ml; (4) elderly patients (age 38 years old); 5 morning stiffness less than 3min, bone fricative (sense) during activity. There is a pain in the knee joint, and the active part is limited.
The knee joint MR (TRUE FISP and T2mapping) scan was performed on 60 subjects. According to the International Cartilage Repair Association (ICRS) standard and TRUE FISP image, two radiologists were asked to classify articular cartilage damage into grade five: grade 0. There were no obvious morphological and signal changes in articular cartilage. Smooth; grade I, abnormal cartilage signal, but normal cartilaginous normal state, mild irregular and / or local cartilage defect depth of 50%; grade III, severe irregular cartilage surface, more than 50% of total thickness of cartilage defect, but still not involved in whole layer cartilage; grade IV, full layer exfoliation, defect, soft Subchondral bone exposure with or without subchondral bone signal changes.
According to the classification results, the subjects were divided into three groups: mild OA group, severe OA group and control group. Among them, the mild OA group corresponds to the ICRS standard I grade and II grade, the severe OA group corresponds to the ICRS standard III grade and IV, the control group corresponds to the ICRS standard. After the knee joint MRI scan, the image artifact obtained in five cases is heavier and does not conform to the standard of entry group, final entry In the group of 55 subjects, there were 20 subjects in the mild OA group, including 17 women and male, 28 subjects in the severe OA group, including 14 women and 14 men, and 7 subjects in the control group, including 3 women and 4 men.
The subjects were scanned by 3.0T magnetic resonance (MAGNETOM Skyra system, Siemens), using special coils of the knee joint, supine position, advanced foot, and knee flexion about 20 degrees.
The femoral and tibial cartilage was divided into four cartilaginous regions, namely, the medial femur area, the lateral cartilaginous area of the femur, the medial tibial cartilage area and the lateral tibial cartilage area. The mean value of the T2 relaxation time of the femur and tibia and the medial femoral cartilage area, the lateral cartilaginous area of the femur, the tibia and the tibia in the three group of the subjects were divided into four cartilaginous regions. T2 relaxation time in lateral cartilage area and lateral tibial cartilage area was statistically analyzed.
The results of the study:
In 1.OA patients, the T2 value of cartilage layer, femur and medial tibia cartilage was increased compared with healthy control group, P < 0.05, the difference was statistically significant.
2. in addition to the cartilage in the lateral tibia, for the rest of the cartilage, the T2 values of the patients with mild and severe OA were significantly higher than those in the healthy subjects, P0.05, and the difference was statistically significant.
3. there was no significant difference in mean T2 between mild and severe OA patients, that is, P > 0.05, and the difference was not statistically significant.
Conclusion:
The T2 value of articular cartilage increased when the cartilage of 1. osteoarthritis patients had not changed or changed slightly at early stage, suggesting that T2mapping imaging could be used as a standard for early diagnosis and diagnosis of osteoarthritis.
2. the T2 distribution of articular cartilage has some spatial distribution characteristics, suggesting that the T2 value of articular cartilage may be related to weight bearing.
3. there was no statistical difference in the T2 value of articular cartilage in patients with osteoarthritis of different degrees, suggesting that the T2 value of articular cartilage can not be staged in osteoarthritis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R684.3

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