Research On The Relationship Between Bone Marrow Lesions And Pain In Knee Osteorthritis By DECT

Purpose: To evaluate the diagnostic efficacy of bone marrow lesions(BMLs)in patients with knee osteoarthritis(KOA)by dual energy computed tomography(DECT)post-processing technology virtual noncalcium(VNCa),Compared with magnetic resonance imaging(MRI),and then evaluated the correlation between pain and BMLs with Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and knee injury and Osteoarthritis Outcome Score(KOOS)pain scale.Materials and Methods: From August 2017 to November 2018,24subjects(average age 59.2 ± 7.4 years;age range: 43-76 years)were included in this study,with a total of 28 knee joints and 420 regions.All the subjects were assessed by WOMAC and KOOS pain scale,and the pain was graded in WOMAC scale.All the subjects were scanned with3.0 T high field MRI and DECT(including image post-processing).The Knee Osteoarthritis Scoring System(KOSS)was used to divide the knee joint into 15 areas for BMLs classification,and the total score andclassification of the whole knee joint were carried out.In this study,MRI was used as a reference standard.On the one hand,the effectiveness and advantages of DECT-VNCa image visual qualitative and CT number quantitative diagnosis of BMLs were evaluated.On the other hand,the correlation between pain and the display of BMLs on DECT-VNCa image was analyzed by combining WOMAC and KOOS knee joint pain scale.Results: In the visual qualitative analysis of DECT-VNCa images,the sensitivity,specificity,positive predictive value and negative predictive value for BMLs diagnosis were 83.7%,99.5%,95.3%,97.9%and 89.8%,99.5%,95.7% and 98.7%,respectively.There was good consistency between the observers(Kappa = 0.92).Secondly,in terms of quantitative analysis of CT number,our study showed that the CT number of VNCa images were significantly different between the BMLs group and the non-BMLs group(p < 0.001),the cut-off values were-41 HU and-47 HU,respectively,according to ROC curve,and the further calculation sensitivity and specificity were 87.8%,99.5%,98.0% and 99.5%,respectively.In our experimental study,we also found an association between BMLs of different degrees and pain(p < 0.001).In WOMAC scale,the correlation coefficient between BMLs and pain was 0.803,0.779 and 0.718,respectively,according to MRI and DECT-VNCa.In the KOOS scale,the correlation coefficient between BMLs and pain was-0.711,-0.797 and-0.691,respectively,according to MRI and DECT-VNCa.Conclusion: DECT-VNCa is feasible for the diagnosis of BMLs and the combination of two knee pain scales to predict joint pain.It can be used as an important supplement to MRI,and plays an important role in guiding clinical decision-making and post treatment evaluation.