natural history and clinical significance of mri-detected bone marrow lesions at the knee a prospective study in community dwelling older adults自然历史和mri-detected骨髓病变的临床意义膝盖社区老年人居住的前瞻性研究.pdfVIP

Dore et al. Arthritis Research Therapy 2010, 12:R223 /content/12/6/R223 RESEARCH ARTICLE Open Access Natural history and clinical significance of MRI-detected bone marrow lesions at the knee: a prospective study in community dwelling older adults 1* 1 1,2 1 3 2 Dawn Dore , Stephen Quinn , Changhai Ding , Tania Winzenberg , Guangju Zhai , Flavia Cicuttini , Graeme Jones1 Abstract Introduction: There are conflicting data on the natural history and clinical significance of bone marrow lesions (BMLs). The aims of this study were to describe the natural history of MRI-detected BMLs at the knee using a quantitative measure and examine the association of BMLs with pain, function and stiffness scores, and total knee replacement (TKR) surgery. Methods: A total of 395 older males and females were randomly selected from the general population (mean age 63 years, range 52 to 79) and measured at baseline and approximately 2.7 years later. BMLs were determined using T2-weighted fat saturation MRI by measuring the maximum area of the lesion. Reproducibility was excellent (intraclass correlation coefficient (ICC): 0.97). Pain, function, and stiffness were assessed by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. X-ray was used to assess radiographic osteoarthritis (ROA) at baseline. Results: At baseline, 43% (n = 168/395) had a BML. Of these 25% decreased in size and 24% increased. Of the remaining sample (n = 227), 7% developed a new BML. In a multivariable model, a change in BML size was associated with a change in pain and function scores (b = 1.13 to 2.55 per 1 SD increase, all P 0.05), only in those participants without ROA. Lastly, baseline BML severity predicted TK