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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 545 -552. doi: 10.3877/cma.j.issn.1674-134X.2024.04.015

综述

膝骨关节炎半定量磁共振评分研究进展
庄若语1, 杭明辉2, 李文华2, 张霆2, 侯炜2,()   
  1. 1. 201203 上海中医药大学针灸推拿学院
    2. 200032 上海中医药大学附属龙华医院
  • 收稿日期:2024-06-07 出版日期:2024-08-01
  • 通信作者: 侯炜
  • 基金资助:
    上海市卫生健康委员会项目(202140369)

Research progress on semi-quantitative MRI assessment of knee osteoarthritis

Ruoyu Zhuang1, Minghui Hang2, Wenhua Li2, Ting Zhang2, Wei Hou2,()   

  1. 1. School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
    2. Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
  • Received:2024-06-07 Published:2024-08-01
  • Corresponding author: Wei Hou
引用本文:

庄若语, 杭明辉, 李文华, 张霆, 侯炜. 膝骨关节炎半定量磁共振评分研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 545-552.

Ruoyu Zhuang, Minghui Hang, Wenhua Li, Ting Zhang, Wei Hou. Research progress on semi-quantitative MRI assessment of knee osteoarthritis[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 545-552.

半定量磁共振成像(MRI)评分是膝骨关节炎(KOA)MRI影像评估中关键一环。目前已开发出多种通用膝关节评分系统,包括全器官磁共振成像评分(WORMS)、磁共振成像骨关节炎膝关节评分(MOAKS)等,以及针对滑膜炎或特定情况专用系统。观察研究与临床试验表明,半定量MRI评分有利于了解疾病自然史,在早期诊断、疗效评价、资格筛查、安全评估等方面作用日益重要,结合人工智能可进一步提高其在图像处理、表型分类、风险预测等领域性能。

Semi-quantitative magnetic resonance imaging (MRI) assessment forms a key part of MRI imaging evaluation of knee osteoarthritis (KOA). Several generalized knee scoring systems have been developed, including the Whole Organ Magnetic Resonance Imaging Score (WORMS) and the MRI Osteoarthritis Knee Score (MOAKS), and systems for synovitis or specific conditions. Observational studies and clinical trials have shown that semi-quantitative MRI assessment contributes to the understanding of the natural history of disease and plays an increasing role in early diagnosis, efficacy assessment, eligibility screening and safety evaluation. Artificial intelligence can further improve its performance in the fields of image processing, phenotypic categorization, and risk prediction.

表1 KOA主要半定量MRI评分系统评分项汇总
Table 1 Summary of scored features of major semi-quantitative MRI scoring systems for KOA
评分系统 评分项及其分级
软骨损伤 骨髓病变 软骨下囊肿 半月板撕裂 骨赘 积液与滑膜 关节周围特征 游离体 韧带/肌腱 半月板突出 关节面损伤
WORMS 0~6大小与深度 0~3面积占比 0~3 0~4 0~7 0~3 0~3关节周围囊肿 0~3 0~1前/后十字韧带、内/外侧副韧带 / 0~3
KOSS 0~3大小、深度 0~3大小 0~3 0~3 0~3 0~3积液
0~1滑膜增厚
0~3腘窝囊肿 / / 0~3 /
BLOKS 0~3缺损面积占比(任意程度、全层)、具体位点损伤程度 0~3大小、面积占比、非囊肿病变占比 0~1半月板形态(半月板信号、撕裂、浸渍、半月板囊肿,各项独立评分) 0~3 0~3积液、脂肪垫滑膜炎
0~1其他区域滑膜炎
0~1关节周围囊肿、滑囊,独立评分 0~1 0~1前/后十字韧带、髌腱 0~3 /
MOAKS 0~3缺损面积占比(任意程度、全层) 0~3体积占比、非囊肿病变占比 0~1半月板形态(半月板信号、撕裂、浸渍、半月板囊肿、半月板肥大,各项独立评分) 0~3 0~3积液滑膜炎、脂肪垫滑膜炎 0~1关节周围囊肿、滑囊,独立评分 0~1 0~1前/后十字韧带、髌腱 0~3 /
ACLOAS 0~6深度与面积占比 0~3体积占比(区分外伤性与退化性) 0~8半月板形态(半月板信号、撕裂、半月板修补、浸渍) 0~7 0~3积液滑膜炎、脂肪垫滑膜炎 / / 0~3前/后十字韧带、内/外侧副韧带、移植物 0~2 0~4
CROAKS 全关节评分同MOAKS
KIMRISS / 0~1切片扇区 / / 0~4积液深度 / / / / /
ROAMES 0~3大小与深度 0~3体积占比、非囊肿病变占比 0~4(半月板信号、撕裂、浸渍) 0~3 0~3积液滑膜炎、脂肪垫滑膜炎 / / / 0~2 /
表2 KOA主要半定量MRI评分系统特点与局限
Table 2 Characteristics and limitations of major semi-quantitative MRI scoring systems for KOA
评分系统(发布年份) 特点 局限
通用:
WORMS(2004) 全关节通用,最早全器官评分系统,较简便,具有关节面损伤评分 无半月板形态、半月板突出评分
KOSS(2005) 全关节通用,较简便,相较WORMS加入半月板突出评分,简化骨赘分级 无半月板形态、游离体、韧带评分
BLOKS(2008) 全关节通用,较全面,吸纳WORMS和KOSS内容,软骨损伤、半月板形态评分详细 软骨损伤、骨髓病变计算复杂
MOAKS(2011) 全关节通用,较全面,基于BLOKS精简,加入半月板肥大评分 软骨损伤、骨髓病变计算复杂
CROAKS(2014) 全关节通用,全面,等于MOAKS合并MOCART,兼顾评价手术疗效功能 涉及两种评分系统,使用繁琐
专用:
Rhodes等(2005);
Baker等(2010);
Guermazi等(2011)
滑膜炎专用,多区域评分,数量分别为4(Rhodes)、8(Baker)、11(Guermazi) 仅限于滑膜炎
MOCART(2006,2021)* 手术疗效评价专用,较全面,针对软骨损伤修复 不适用非软骨修复手术
ACLOAS(2014) 前交叉韧带损伤评价专用,区分外伤性与退化性骨髓损伤,韧带、关节面损伤评分详细 无关节周围特征、游离体评分
KIMRISS(2017,2023)* 骨髓病变、滑膜炎积液专用,相较MOAKS易用 基于网页开发,需要注册联网使用
ROAMES(2021) 临床筛查排除专用,相较MOAKS简化软骨损伤、骨髓病变、半月板形态评分,可供表型分类 无关节周围特征、游离体、韧带评分
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