WARP-TSE序列评价全膝关节置换术后患者慢性疼痛的临床研究

Evaluation on the chronic knee pain after total knee arthroplasty with WARP-TSE MR

目的比较Turbo-Spin Echo-WARP(TSE-WARP,Siemens,German)序列同常规Turbo-Spin Echo(TSE)序列对全膝关节置换术(total knee arthroplasty,TKA)术区金属伪影的减除效果;根据TSE-WARP磁共振的影像学征象,结合翻修手术记录及病理报告,阐释TKA术后患者疼痛的可能原因。方法连续选取我院2014年8月至2016年8月,为20例TKA手术且术后伴有慢性疼痛的患者行WARP-TSE序列评价。20例患者年龄60~84岁,平均(69.2±6.0)岁;其中,女18例,年龄60~79岁,平均(68.2±5.1)岁;男2例,年龄分别为73岁、84岁,平均(78.5±7.8)岁。采用Siemens Magnetom Espree syngo 1.5 T成像设备(Siemens Healthcare,Erlangen,Germany)对复查患者进行扫描,序列包括常规磁共振(magnetic resonance,MR)TSE序列及TSE-WARP减伪影序列。收集17例TKA术后患者的膝关节常规及减伪影MR图像(其中3例因不能坚持,未行常规TSE序列检查),由2名经验丰富的高年资主治医师分别于阅片工作站上进行图像清晰度评分,及伪影面积测量;由上述医师阅读20例患者的TSE-WARP MR图像,结合翻修手术记录与病理报告,分析致患者TKA术后慢性疼痛的可能原因。结果 (1)WARP T_1 sag序列伪影面积显著小于T_1WI Sag序列伪影面积,χ~2=15.22,P<0.0001;WARP PDWI STIR cor序列伪影面积显著小于PDWI STIR cor序列伪影面积,χ~2=14.85,P=0.0001。(2)WARP T_1WI Sag序列主观评分显著高于T_1 sag序列主观评分,χ~2=16.57,P<0.0001;WARP PDWI STIR cor序列主观评分显著高于PDWI STIR cor序列主观评分,χ~2=14.61,P=0.0001。(3)20例TKA术后膝关节患者中,经TSE-WARP MR诊断:假体周围骨吸收伴滑膜增生1例,经手术证实;关节腔滑膜/瘢痕纤维增生5例,经手术证实5例,病理确诊2例;另诊断鹅足滑囊炎1例,观察到骨髓水肿(骨应力反应)9例,关节腔积液9例。结论相比于常规序列,TSE-WARP MR可显著减除金属伪影;应用TSE-WARP MR复查膝关节术后慢性关节痛患者,可清晰观察到多种阳性表现。TSE-WARP MR拥有广阔的临床应用前途。

Objective To compare the metal artifact reducing effects and the definition of periprosthesis structures between TSE-WARP（ Siemens, Germany） and conventional TSE images in patients with chronic knee pain after total knee arthroplasty（ TKA）; and to interpret the possible causes of chronic knee pain based on TSE-WARP imaging findings, revision surgery record and pathology report. Methods Twenty consecutive patients in our hospital, from Aug. 2014 to Aug. 2016, with post-TKA chronic knee pain for more than 3 months, were enrolled（ mean age, 69.2 ± 6.0 years, range 60-84 years）. Eighteen patients were female and 2 were male. Seventeen patients received MR exam by Siemens Magnetom Espree syngo 1.5 T MR imaging device（ Siemens Healthcare, Erlangen, Germany） with conventional MR sequences and WARP-TSE sequences（ 3 of the patients did not undergo conventional TSE MR exam）. Two senior attending radiologists independently measured the area of metal artifact, evaluated the definition of the periprothesis region, and interpreted the possible causes of chronic knee pain in all patients based on WARP-TSE imaging findings, revision surgery record and pathology report. Results（ 1） Metal artifacts area in WARP T1 sag sequences was significantly smaller than in the T1 WI sag sequences（ χ^2 = 15.22, P〈0.0001）; metal artifacts area in WARP PDWI STIR cor sequences was significantly smaller than in the PDWI STIR cor sequences（ χ^2 = 14.85, P = 0.0001）;（ 2） Definition scores of WARP T1 WI Sag images was significantly higher than the T1 WI sag images（ χ^2 = 16.57, P〈0.0001）; definition scores of WARP PDWI STIR cor images was significantly higher than the PDWI STIR cor images（ χ^2 = 14.61, P = 0.0001）.（ 3） Through TSE-WARP MR sequences, we diagnosed： 1 case of periprosthetic bone resorption with synovial hyperplasia, confirmed by the revision operation; 5 cases of synovial and/or fibrous hyperplasia, all confirmed by the revision operation, and 2 cases confirmed pathologically. We also diagnosed 1 case of pes anserinus bursitis, 9 cases of periprosthesis bone marrow edema, and 9 cases of hydrops articuli. Conclusions Compared to conventional MR, WARP-TSE MR can significantly reduce metal artifacts; WARP-TSE MR can accurately detect many positive findings in post-TKA patients with chronic knee pain. It has wide application prospect in clinical work.