能谱CT物质分离技术对膝关节骨性关节炎髌下脂肪垫物质的相关性研究

Characterization of Infrapatellar Fat Pad in the Keen Osteoarthritis Patients Using Dual-energy Spectral CT Imaging

目的利用能谱CT水脂分离技术对膝关节骨性关节炎患者进行髌下脂肪垫水脂定量分析的相关性研究,探讨髌骨下脂肪垫在骨性关节炎中的病理变化。方法对临床已进行WOMA疼痛评分的176膝患者进行分组,研究组A组为疼痛评分>40分的骨性关节炎患者98膝,对照组B组为疼痛评分<40分且无临床症状的78膝患者均行膝关节Gemstone Spectral Image(GSI)扫描,所得原始数据进行单能量60KeV及层厚1.25mm重建,利用GSI viewer软件进行分析,分别记录髌骨下内侧、中间及外侧脂肪垫的水基值及脂基值并取其平均值。对组间数据进行独立样本t检验,组内数据采进行皮尔逊相关性R检验。结果A、B两组患者年龄无统计学差异,P>0.05,58.62±8.13 vs 56.56±7.99岁。组内脂基值及水基值数据均呈明显的负相关,P<0.05,A组r=-0.93,B组r=-0.90;组间脂基值及水基值P<0.05,有统计学差异。结论膝关节骨性关节炎的患者其髌骨下脂肪垫的水含量(炎性水肿)增高,相对脂肪含量降低。

Objective The infrapatellar fat pad(IPFP)is rich in nerve fiber structure and adipose derived stem cells.The purpose of this study was to characterize IPFP in patients with keen osteoarthritis(OA)using dualenergy spectral CT imaging.Methods 176 keen osteoarthritis patients were randomized to 2 groups:group A(n=98)with clinical WOMA pain score>40 points,group B(n=78)with clinical WOMA pain score<40 points,All keen OA patients(without other knee disease)were enrolled for this study and underwent dualenergy spectral CT.The material decomposition images using fat and water as the basis material pair were reconstructed with a standard reconstruction kernel at thickness of 1.25mm.Region-of-interest was placed on IPFP on both on the water-based and fat-based images to quantify the water density and fat density,respectively.Results The average water density on IPFP for keen OA patients was 131.57±25.15mg/mL,and the average fat density was 824.65±26.35 mg/mL.There was significant difference between the water density and fat density(P<0.05,R=0.93),and there was also significant negative correlation between the two sets of values.The lipid base value and water base value between groups P<0.05,there is a statistical difference.Conclusion The water density on the infrapatellar fat pad of patients with knee osteoarthritis increased indicating inflammatory edema and its relative fat density decreased.Dual-energy spectral CT imaging may be used to characterize IPFP in patients with keen osteoarthritis.