الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
The structural changes in knee OA are characterized mainly by the progressive erosion and loss of articular cartilage (Martel et al., 2005). These changes are often associated with additional structural changes such as subchondral bone lesions, which include remodeling and cysts, and alterations in the menisci, which include degeneration, tear, and extrusion (Berthiaume et al., 2005).
The use of x-rays to assess and quantify structural changes over time does present some serious limitations, including the fact that this technology does not permit direct visualization of cartilage (Raynauld et al., 2006).
MRI now allows not only the direct visualization of joint structure but also the quantitative assessment of changes over time. A number of semiquantitative scoring systems and quantitative technologies have been developed to achieve this goal (Eckstein et al., 2009).
The aim of this study is to assess magnetic resonance imaging findings in patients with knee osteoarthritis and to determine whether these findings are correlated or not with various demographic, clinical and radiographic variables.
This study was carried out on forty patients with painful knees and then most painful knee in each patient was selected. Those patients were selected from the attendants of the out-patients clinics of Rheumatology and Rehabilitation Department Banha and Bab-Elsharia University Hospitals.
These patients were divided into 2 groups. Group I Included 20 patients with symptomatic and radiological findings of knee OA defined according to ACR criteria for knee OA (Altman et al., 2004) while Group II Included 20 patients with knee pain but without radiological findings of OA matched for age and sex with the first group.
All patients were subjected to a full clinical examination including; history taking, general examination, assessment of body mass index, pain assessment using visual analogue scale (VAS) and examination of the knee joints with assessment severity of knee symptoms using WOMAC QUESTIONNAIRE.
Laboratory investigations were done including; CBC, ESR, SUA and CRP.
Radiological investigations were done including Plain X Rays of the knees which were classified according to Kellgren-Lawrence classification for all participants and MRI of knees for all patients and control groups to detect: cartilage morphology, synovial thickening, effusion and meniscal status.
The results of our study showed the following:
• In group I males were 5 (25%) while females were 15 (75%), the patient’s age ranged between 39 and 56 years (47.55±5.246 years) and BMI ranged between 26.3 and 38.8 (34.47±4.016). WOMAC score ranged between 1 and 3 with 2 patients had grade 1, 10 patients had grade 2 and 8 patients had grade 3. VAS ranged between5 and 8 with 3 (15%) patients were 5, 9 (45%) were 6, 6 (30%) were 7 and 2 (10%) were 8.
• In group II males were 7 (35%) while females were 13 (65%), the patient’s age ranged between 36 and 55 years (45.6±6.11 years) and BMI ranged between 26.7 and 37.5 (32.75±3.16). WOMAC score ranged between 0 and 1with 7 patients had grade 0 and 13 patients had grade 1. VAS was ranged between5-8 with 3 (15%) patients were 5, 4 (20%) were 6, 10 (50%) were 7 and 3(15%) were 8.
• There were no statistical significance differences regarding age, sex, BMI and VAS between the patients of both groups (p>0.05).
• There was a significant statistical difference between the two groups regarding WOMAC as p<0.05.
• All the patients (100%) in group I had OA while in group II thirteen patients (65%) had OA and seven patients (35%) had no OA.
• Laboratory investigations of all patients were within the normal ranges.
• There was no statistically significant differences between two groups regarding laboratory results p>0.05
• All patients in group I had radiographically OA according to KL score, four patients (20%) were grad 2, eleven patients (55%) were grad 3 and five patient (25%) were grad 4.
• According to the KL score in group I four female patients were graded 2 with their age ranged from 39 to 49 years, eleven patients (8 females and 3 males) were graded 3 with their age ranged from 40 to 55 years and five patients (3 females and 2 males) were graded 4 with their age ranged from 46 to 56 years.
• A significant statistical difference as regard age and sex in correlation with KL score in group I was observed as p<0.05.
• All patients in group II had no radiological findings of OA and according to KL score its radiological grade was zero.
MRI was done on the more painful knee in each patient on which plain x-ray was carried out and it showed the followings:
• As regards articular cartilage all patients in group I had abnormal articular cartilage (six patients were grade II a. nine patients were grade II b and five patients were grade III) while in group II seventeen patients had abnormal articular cartilage (five had grade I and twelve had grade II a).
• There was significant statistical increase in cartilage lesions with increase in WOMAC score as p<0.05.
• There was significant statistical difference as regard cartilage lesions and KL score in group I as p<0.05 and the severity of cartilage lesions increase with increasing KL score.
• As regards BME; fourteen (70%) patients in group I had BME graded (four had mild BME, six had moderate BME and four had severe BME) while in group II, Thirteen (65%) patients had BME (four had mild BME, seven had moderate BME and two had severe BME).
• There was no significant statistical correlation between WOMAC score and BME as p>0.05.
• There was significant statistical increase in BME with increase in KL score as p<0.05.
• As regards synovial thickening: twelve (60%) patients in group I, had synovial thickening (five had mild synovial thickening, seven had moderate synovial thickening) while in group II, twelve (60%) patients had mild synovial thickening.
• A significant statistical increase in synovial membrane thickening with increase in both WOMAC and KL score was observed as p<0.05.
• As regards joint effusion: fourteen patients in group I, had knee effusion (nine had mild knee effusion and five had moderate knee effusion) and fifteen patients in group II, had knee effusion (twelve had mild knee effusion and three had moderate knee effusion.
• A significant statistical increase in knee effusion pattern with increase in both WOMAC & KL score was observed as p<0.05.
• As regards meniscal status: thirteen (65%) patients in group I, had meniscal abnormality (Five patients had meniscal tear and eight patients had intrasubstance degeneration) and six (30%) patients in group II, had meniscal abnormality (four patients had meniscal tear and two patients had intrasubstance degeneration).
• A significant statistical correlation between meniscal status and WOMAC score was observed in group I as p<0.05. But There was no significant statistical correlation between meniscal status and WOMAC score in group II as p>0.05
• There was no significant statistical correlation between meniscal status and KL score as p>0.05.
Interpretation of the results:
1- KL score correlated will with age, sex and BMI (p<0.05) but not correlated with WOMAC score (p>0.05).
2- Some MRI findings (joint cartilage, effusion and synovial thinking) correlated significantly with WOMAC score (p<0.05) while other (BME and meniscal status) correlated none significantly with WOMC score (p>0.05).
3- There was significant statistical correlation between KL score and MRI findings (joint cartilage, BME, effusion and synovial thickening) (p<0.05) but there was no significant statistical correlation between WOMC score and MRI finding (meniscal status) (p>0.05).
Conclusion:
• Laboratory investigations are insignificant in diagnosis of knee OA.
• Plain x-ray is inefficient in early diagnosis of knee OA.
• Using of MRI in OA studies has allowed us to gain an early diagnosis and a much wider knowledge of the different structures in the knee joint that are involved in OA.
• Recommendation:
MRI is a good technique for early diagnosis of knee OA so proper treatment is carried out to protect against different disabilities resulting from disease progression.