Methodenvergleich von Kernspintomografie, Arthroskopie und Nah-Infrarot-Spektroskopie (NIRS) bei der Bestimmung des Arthrosegrads des Kniegelenks

 

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Zusammenfassung

Zielsetzung: Anliegen der vorliegenden Untersuchung war es, den MRT-Arthrosescore WORMS (Whole-Organ Magnetic Resonance Imaging) und den arthroskopische Arthrosescore WOAKS (Whole-Organ Arthroscopic Knee Score) mit spektroskopischen Verfahren (NIRS, Nah-Infrarot-Spektroskopie) zu vergleichen. Material und Methode: Bei insgesamt 49 Patienten erfolgte die MRT-Diagnostik nach einem einheitlichen Untersuchungsprotokoll. Bei dieser wurde der WORMS zur Beurteilung des Arthrosegrads des gesamten Gelenks ermittelt. Unmittelbar danach erfolgte die Arthroskopie mit standardisierter Knorpeldiagnostik zur Bestimmung des arthroskopischen Arthrosescores (WOAKS). Schließlich erfolgte an insgesamt 14 definierten Gelenkarealen eine spektroskopische Untersuchung, in deren Rahmen der WOAKS_NIRS bestimmt wurde. Ergebnisse: Bei allen 3 Methoden zeigte sich: Die stärksten degenerativen Veränderungen lagen im Bereich der Patella vor, gefolgt vom medialen Kompartiment. Dabei betrug der relative WORMS des gesamten Gelenks 3,7 % (95 %-KI 2,8–4,6; 0–15,6 %). Der arthroskopisch bestimmte Score WOAKS lag bei 15,2 % (95 %-KI 13,2–17,2; 5–39 %). Der höchste Degenerationsgrad wurde durch spektroskopische Messungen ermittelt. Der durchschnittliche WOAKS_NIRS betrug 50,9 % (95 %-KI 48,1–53,7). Die Unterschiede zwischen den einzelnen Scores sind signifikant (p < 0,001). Schlussfolgerung: Durch die MRT werden leichtere Knorpelschäden im Vergleich zur arthroskopischen Evaluation oftmals unterbewertet bzw. gar nicht erkannt. Insbesondere jedoch für eine Frühdiagnostik der Arthrose erscheint die Standard-MRT mit den derzeitigen Möglichkeiten begrenzt zu sein. Dies trifft in ähnlicher Weise auch für die Standardarthroskopie zu. Nach den vorliegenden Untersuchungen scheint es jedoch so zu sein, dass die Spektroskopie ein wirklich objektives Verfahren ist, welches in der Lage ist, sehr genau degenerativ veränderte Gelenkareale zu identifizieren und damit eine Aussage in Bezug auf den wirklichen Degenerationsgrad des Gelenks zuzulassen.

Abstract

Purpose: This study was aimed to evaluate the meaningfulness of the MRI Score WORMS (Whole Organ Magnetic Resonance Imaging), the arthroscopic WOAKS (Whole Organ Arthroscopic Knee Score) and the result of NIRS (near-infrared spectroscopy) measurements. Materials and methods: A total of 49 patients with knee pain (> 3 months) underwent MRI with a standardised protocol. In the results the WORMS was calculated. The WOAKS was calculated from the results of an arthroscopic evaluation. In the same procedure, NIRS measurements were performed in the identical 14 regions of interest. From these measurements, the WOAKS_NIRS was calculated. Results: The highest grade of degeneration in all evaluations was found in the patella. The medial compartment showed moderate lesions compared with the lateral compartment. The relative WORMS was only 3.7 % (95 % CI 2.8–4.6; 0–15.6 %). During arthroscopy, we calculated a mean WOAKS of 15.2 % (95 % CI 13.2–17.2; 5–39 %). The degree of joint degeneration was highest in NIRS measurements. The mean WOAKS_NIRS was 50.9 % (95 % CI 48.1–53.7 %). These differences are significant (p < 0.001). Conclusion: The methods to detect early cartilage degenerations in MRI are flawed. Thus in our patients, we detected a full grade of degeneration in only 3.7 % of the patients. Arthroscopy mostly gives higher damage within the knee joint. The initial stages of cartilage lesion are usually undetectable. Spectroscopy has the best sensitivity for the evaluation of early degeneration within the hyaline cartilage. The clinical relevance of our results is still unclear. Further outcome studies are needed.

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