Arts and Sciences X Radiological assessment of joint space width using different weight-bearing radiographic methods for knee osteoarthritis 1 2 1 3 1 3 1 2 3 Key words: knee, osteoarthritis, radiography, joint space Summary We compared three methods (standing with knee extension method, SynaFlexer method, and modified Rosenberg method) of measuring the plateau gap and joint space width using the bilateral weight-bearing plain radiographs of 17 knee osteoarthritis patients (32 knee joints). The maximum value of the plateau gap of the medial knee joint with each method was 5.8 mm, 3.9 mm, and 2.9 mm, respectively, whereas the minimum value of the joint space width was 4.6 mm, 3.6 mm, and 3.1 mm, respectively. With the SynaFlexer method and the modified Rosenberg method, the X-ray beam can pass parallel to the medial tibial plateau, and the area with the most thinning of femoral condylar cartilage can be observed. Therefore, we believe that the SynaFlexer and modified Rosenberg methods are useful for diagnosing early osteoarthritis and for the assessment of disease severity. 17 32 5 12plateau gap SynaFlexer Rosenbergplateau gap 5.8mm 3.9mm 2.9mm 4.6mm 3.6mm 3.1mm SynaFlexer RosenbergX Osteoarthritis OA 800 X2,500 1 OA Masanori Yamaguchi 1 Hironobu Koseki 2 Kousei Enguchi 1 Hitoshi Iwanaga 3 Shunta Kyuma 1 Hiroyuki Shindo 3 1 Department of Radiology, Wajinkai Hospital 2 Department of Locomotive Rehabilitation Science, Unit of Rehabilitation sciences, Nagasaki University Graduate School of Biomedical Sciences 3 Department of Orthopedic Surgery, Wajinkai Hospital MRI OA X OA OA 2 Kellgren and Lawrence 3 OA Rosenberg 4 30 60 Davies 5 30 6 20 OA 22 22 2018. vol.65 no.783
X 4, 6 OA X X 2 3 X OA 17 32 5 10 12 22 55 84 64.7Table 1 X KXO-80G, CR Computed Radiography Table 1 Physical characteristics of the patients Regius model 190 V stage, SynaFlexer TM, Synarc, Inc.SynaFlexer Rosenberg3 2 X Fig.1A SynaFlexer TM Fig.1B 7, 8 10 10 Rosenberg 4 10 20 Fig.1C 50kV 100mA 0.1s 07 A B C Fig.1 Radiographic methods A : Standing with knee extension method B: SynaFlexer method C : Modifi ed Rosenberg method The X-ray beam (arrow) was directed in an anteroposterior direction in the Standing with knee extension method, and in a posteroanterior direction in the SynaFlexer and Modifi ed Rosenberg methods. 23 23
Table 2 Comparisons of the plateau gap and joint space width values with the three methods : P<0.05 compared to the standing with knee extension method Fig.2 Method for measuring plateau gap and joint space width 水準はいずれも 5% 未満とした A: Maximum value of plateau gap B: Minimum value of joint space width Both measurements were made parallel to the tibial axis. 結 果 各撮影法での計測値を Table 2 に示す 脛骨内側関節 は 1m とした 撮影時 患者をリラックスさせながら 面の plateau gap 値は SynaFlexer 法と Rosenberg 両脚に均等に荷重させるように配慮した DICOM 画 変法が立位正面法よりも有意に低値であり P <0.05 像に変換してモニター L1750, HP Inc. サイズ Rosenberg 変法は最も低値であった なお 脛骨外側 関節面の plateau gap 値も SynaFlexer 法で最も低く 立位正面法が最も高い値であったが 3 法間に有意差は 認められなかった 内側関節裂 幅は plateau gap と 同様に Rosenberg 変法で最も狭く 立位正面法で最も 広く描出されていた P <0.05 Fig.3 外側関節裂 幅は SynaFlexer 法で低くなる傾向が見られたが 統計 学的有意差は認められなかった ANOVA P >0.05 なお 全ての計測項目において 3 人の検者間に統計学 17 inch 解像度 1280 1024 に投影し 解析ソフト POP-Net Essential ver. 4.2C, イメージワン を用 いて脛骨関節面の前縁と後縁の距離最大幅 plateau gap 脛骨関節面の後縁と大 骨内側顆部の距離の最 小値 関節裂 幅 を計測した Fig.2 各種計測は 3 人の異なる検者が個別に行い その平均値を計測値 とした 3 種類の撮影法による計測値を集計し 一元 配置分散分析法 ANOVA と Tukey-Kramer 法によ 的有意差は認められなかった る多重比較検定によって統計学的評価を行った 有意 A B C Fig.3 Representative X-rays of a 62-year-old woman taken using the three assessment methods A : Standing with knee extension method Medial plateau gap: 6.4 mm, Medial joint space width: 5.7 mm B : SynaFlexer method Medial plateau gap: 3.6 mm, Medial joint space width: 3.0 mm C : Modified Rosenberg method Medial plateau gap: 2.0 mm, Medial joint space width: 2.6 mm 24 24 日本診療放射線技師会誌 2018. vol.65 no.783
X Arts and Sciences OA X Rosenberg 4 6 Rosenberg SynaFlexer TM Peterfy 9 Rosenberg SynaFlexer Rosenberg 3 OA X plateau gap 3 3 OA plateau gap SynaFlexer Rosenberg Rosenberg OA Rosenberg OA SynaFlexer X OA OA SynaFlexer Rosenberg X SynaFlexer Rosenberg OA Xplateau gap SynaFlexer Rosenberg plateau gap 11 07 25 25
Table 1 Table 2 Fig.1 Fig.2 Fig.3 Plateau gap P<0.05 a b SynaFlexer c Rosenberg X SynaFlexer Rosenberg A Plateau gapb 62 A plateau gap 6.4mm 5.7mm B SynaFlexer plateau gap 3.6mm 3.0mm C Rosenberg plateau gap 2.0mm 2.6mm 1 Yoshimura N, et al.: Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: The Research on Osteoarthritis/ osteoporosis Against Disability (ROAD) study. J Bone Miner Metab, 27, 620-628, 2009. 2 2001. 3 Kellgren JH, Lawrence JS: Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 16, 494-502, 1957. 4 Rosenberg TD, et al.: The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am, 70, 1479-1483, 1988. 5 Davies AP, et al.: Plain radiography in the degenerate knee. A case for change. J Bone Joint Surg Br, 81, 632-635, 1999. 6 X 47 1147-1148, 2004. 7 Charles HC, et al.: Optimization of the fixed-flexion knee radiograph, Osteoarthritis Cartilage, 15, 1221-1224, 2007. 8 Kothari M, et al.: Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol, 14, 1568-1573, 2004. 9 Peterfy C, et al.: Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: testretest reproducibility. Skeletal Radiol, 32, 128-132, 2003. 26 26 2018. vol.65 no.783