골관절염 무릎 관절의 활액막 비후에 관한자기공명영상과 활액막 생검 소견의 상관성 (Correlation Between Synovial Biopsy and MRI of Synovial Hypertrophy in Knee Osteoarthritis)

서지정보

· 발행기관 : 고신대학교(의대) 고신대학교 의과대학 학술지
· 수록지 정보 : 고신대학교 의과대학 학술지 / 23권 / 2호 / 1 ~ 8페이지
· 저자명 : 김철민, 허방

초록

Background : Synovium is a main target of rheumatoid arthritis. Synovial changes, however, have been overlooked in degenerative osteoarthritis (OA). In intraarticular tissues, especially cartilage, pain conducting fibers or vasculatures are normally absent, therefore, periarticular soft tissue changes, such as synovial pathology may be an important clue to understand the progression of OA. In addition. MRI was established as an excellent modality to characterize the articular changes of OA. However, synovial changes detected by MRI have not been evaluated based on histopathologic features of synovium.
Methods and Materials : Total twenty six patients (male 11, female 15) of OA involving knee joint were collected in Kupo Sumgsim Hospital. MRI features of 24 cases were reviewed and its severity including synovial thickening and joint effusion were graded as 3 groups. Through arthroscopic examination, synovial biopsy was performed. Histologic features of the synovium, emphasizing on the synovial cell hyperplasia, inflammatory cell infiltration, fibrosis and vascularity were evalutated in accordance with MRI severity.
Results : 1) Considrable MRI changes, joint effusion, and synovial hypertrophy (≥2mm) were noted in 12 cases (50.0%), 16 cases (66.7%), and 20 cases (83.3%) respectively. In 12 of 13 Gd-DTPA contrast studies, T1 enhanced image was achieved, and irregular or villous pattern was noted in 8 cases (40.0%) of 20 hypertrophied synovium. 2) Synovial cell hyperplasia (>2 cells in layer) was noted in 9 cases (34.6%) and lymphocytic infiltration (with minimal or mild degree) was noted in 11 cases (42.3%). Microvessel density was variable from case to case (MVD=12.4±2.7, Nikon Labophot, area=0.73 mm2, x200) and pattern of collagen deposition (loose or dense) was in equal proportion.
3) Although MRI changes and synovial hypertrophy were not correlated with various histopathologic changes, such as synovial cell hyperplasia, lymphocytic infiltration, collagen deposition and vascular proliferation, joint effusion was significantly correlated with TGF-α expression of synovial cells, collagen deposition and microvessel density. 4) Degree of MRI was more severe in female than male, in old than young age group, and in long duration (>1 year).
Conclusion : Synovial hypertrophy detected by MRI is not correlated with histopathologic changes of synovium in knee OA. Both synovial effusion and hypertrophy, however, are correlated with vascular proliferation in some degree, which is remained to be clarified in more accumulated cases.

영어초록

Background : Synovium is a main target of rheumatoid arthritis. Synovial changes, however, have been overlooked in degenerative osteoarthritis (OA). In intraarticular tissues, especially cartilage, pain conducting fibers or vasculatures are normally absent, therefore, periarticular soft tissue changes, such as synovial pathology may be an important clue to understand the progression of OA. In addition. MRI was established as an excellent modality to characterize the articular changes of OA. However, synovial changes detected by MRI have not been evaluated based on histopathologic features of synovium.
Methods and Materials : Total twenty six patients (male 11, female 15) of OA involving knee joint were collected in Kupo Sumgsim Hospital. MRI features of 24 cases were reviewed and its severity including synovial thickening and joint effusion were graded as 3 groups. Through arthroscopic examination, synovial biopsy was performed. Histologic features of the synovium, emphasizing on the synovial cell hyperplasia, inflammatory cell infiltration, fibrosis and vascularity were evalutated in accordance with MRI severity.
Results : 1) Considrable MRI changes, joint effusion, and synovial hypertrophy (≥2mm) were noted in 12 cases (50.0%), 16 cases (66.7%), and 20 cases (83.3%) respectively. In 12 of 13 Gd-DTPA contrast studies, T1 enhanced image was achieved, and irregular or villous pattern was noted in 8 cases (40.0%) of 20 hypertrophied synovium. 2) Synovial cell hyperplasia (>2 cells in layer) was noted in 9 cases (34.6%) and lymphocytic infiltration (with minimal or mild degree) was noted in 11 cases (42.3%). Microvessel density was variable from case to case (MVD=12.4±2.7, Nikon Labophot, area=0.73 mm2, x200) and pattern of collagen deposition (loose or dense) was in equal proportion.
3) Although MRI changes and synovial hypertrophy were not correlated with various histopathologic changes, such as synovial cell hyperplasia, lymphocytic infiltration, collagen deposition and vascular proliferation, joint effusion was significantly correlated with TGF-α expression of synovial cells, collagen deposition and microvessel density. 4) Degree of MRI was more severe in female than male, in old than young age group, and in long duration (>1 year).
Conclusion : Synovial hypertrophy detected by MRI is not correlated with histopathologic changes of synovium in knee OA. Both synovial effusion and hypertrophy, however, are correlated with vascular proliferation in some degree, which is remained to be clarified in more accumulated cases.

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