Diz osteoartritli hastalarda klinik değerlendirme parametreleri ile manyetik rezonans görüntüleme bulgularının ilişkisi

Osteoartrit (OA) agri ve ozurluluge neden olan ve dunyada en sik gorulen kronik eklem hastaligidir. Semptomatik diz osteoartriti, 60 yasin uzerinde toplumun yaklasik % 50'sinde ortaya cikmaktadir. Konvansiyonel grafilerin erken tani koyma, hastalik siddeti ve progresyonunu degerlendirmede yetersiz kaldigi gorulmustur. Osteoartritte eklem kikirdaginin direkt ve noninvaziv olarak degerlendirilmesinde MRG ideal bir yontem olarak gorunmektedir. Bu prospektif klinik calismanin amaci, diz OA'inde MRG ile eklem kikirdagini tum yuzeylerde ve kompartmanlarda degerlendirmek ve bu bulgularin klinik degerlendirme parametreleri ile iliskisini arastirmakti. Bu amaca yonelik, hastalik surecinde hastalik siddetinin degisimiyle MRG bulgularinin degisip degismedigi arastirildi.Bu calismaya Amerikan Romatizma Dernegi tani kriterlerine gore diz osteoartriti tanisi konmus ve Kellgren-Lawrence radyolojik evrelemesine gore Evre1-4 arasinda olan 64 hasta (14 erkek, 50 kadin, ortalama yas 57.5±9.0) alindi. Manyetik rezonans goruntuleri, 1,5 Tesla MRG cihazinda diz koili kullanilarak elde edildi. Diz eklemi 15 kompartmana ( patella medial faset, patella lateral faset, femur medial anterior, femur medial santral, femur medial posterior, femur lateral anterior, femur lateral santral, femur lateral posterior, tibia medial anterior, tibia medial santral, tibia medial posterior, tibia lateral anterior, tibia lateral santral, tibia lateral posterior, tibia subspinoz alan) ayrilarak, kikirdak sinyal, morfoloji ve kalinligi Whole Organ MRI Skorlamasi (WORMS) ile 2 radyolog tarafindan degerlendirildi. Radyolojik degerlendirme ile es zamanli olarak hastalar agri siddeti icin gorsel analog skala (GAS), fonksiyonel durum icin Western Ontario McMaster Universiteleri Osteoartrit Indeksi (WOMAC LK 3.1 versiyonu) ve Lequesne Indeksi ve saglikla iliskili yasam kalitesi icin Nottingham Saglik Profili ve Saglik Degerlendirme Anketi kullanilarak degerlendirildi. Manyetik rezonans goruntuleme ile degerlendirmeler baslangicta ve 6. ayda yapildi.Baslangic degerleriyle karsilastirildiginda 6. ayda agri, fonksiyonel durum ve saglik degerlendirme parametrelerinde olumlu yonde iyilesme oldugu gozlendi. Lequesne indeksinde, WOMAC agri, tutukluk, fonksiyon parametrelerinde ve total WOMAC skorunda, NHP'nin agri ve distres bolumlerinde iyilesme istatistiksel olarak anlamli bulundu. Alti ay arayla cekilen MRG'lerde WORMS skorlamasinda anlamli farklilik gozlenmedi. Hastalardaki kemik iligi degisikligi, subartikuler kist, eklem sivisi ve sinovyal kalinlasma oraninin fazla oldugu gozlendi. Femur lateral anterior'daki MRG skorlarinin erkeklerde daha yuksek oldugu goruldu. Tibia medial santral(TMS) kikirdak MR degerlendiriminin agri, tutukluk, fonksiyon, yasam kalitesi gibi klinik bulgularla ve radyolojik evreleme ile korele oldugu gosterildi. Diger diz kompartmanlari ile klinik parametreler arasindaki iliskili TMS'deki kadar anlamli bulunmadi.Sonuc olarak, 6 ay arayla yapilan MRG'lerde kikirdak sinyal, morfoloji ve kalinliginda farklilik gorulmedi. Tibia medial santraldeki MRG bulgularinin klinik parametreler ile iliskili oldugu ve bu iliskinin istatistiksel olarak anlamli oldugu gosterildi. AbstractOsteoarthritis is the most frequent chronic joint disease in the world causing pain and disability. Symptomatic knee osteoarthritis occurs in approximately 50% of the population after the age of 60. It has been recognised that conventional radiology is inadequate in early diagnosis and evaluating the severity and the progression of disease. Magnetic resonance imaging is considered an ideal method in the direct and noninvasive evaluation of joint cartilage in osteoarthritis. The aim of this prospective clinical study was to evaluate joint cartilage in osteoarthritis in all surfaces and compartments using MRI and to investigate the relation of these findings with clinical evaluation parameters. For this purpose, it was investigated whether MRI findings changed in parallel to the alterations in the severity of disease during disease process.Sixtyfour patients ( 14 male, 50 female, mean age 57.5+-9.0) who diagnosed with knee osteoarthritis according to American College of Rheumatology diagnostic criteria and who were included in stage 1-4 according to Kellgren-Lawrence radiological staging. Magnetic resonance images were obtained using knee coil in 1.5 tesla MRI device. Knee joint was divided into 15 compartments ( patella medial facet, patella lateral facet, femur medial anterior, femur medial central, femur medial posterior, femur lateral anterior, femur lateral central, femur lateral posterior, tibia medial anterior, tibia medial central, tibia medial posterior, tibia lateral anterior, tibia lateral central, tibia lateral posterior, tibia subspinous area) and cartilage signal, morphology and thickness were evaluated by two radiologists using Whole Organ MRI Scoring System (WORMS). The patients were evaluated with visual analog scale (VAS) for pain, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC LK 3.1 version) and Lequesne Index for functional status and Nottingham Health Profile and Health Assessment Questionnaire for quality of life, concurrently with radiological examination. Evaluations with MR imaging were carried out at the baseline and at 6th month.Compared to baseline values, improvement was observed in pain, functional status, and health evaluation parameters at the 6th month. With Lequesne index, improvement in WOMAC pain, stifness, function parameters, and total WOMAC score and in pain and distress part of NHP were found statistically significant.No significant difference was observed in WORMS scoring in sixth month MRI examinations. It was observed that alterations in bone marrow, subarticular cyst, joint fluid and synovial thickening were more pronounced in the patients. It was established that MRI scores in lateral and anterior femur were higher in males. It was also demonstrated that tibia medial central (TMS) cartilage MR evaluation correlated with clinical findings such as pain, stifness, function and quality of life and radiological staging. The relation between other knee compartments and clinical parameters was not found as significant as that found with TMS.In conclusion, no difference was found between cartilage signal, morphology and thickness in MRI after six months . It was shown that MRI findings in tibia medial central were correlated with clinical parameters with a clinical significance.

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