Publication: Análisis de la respuesta radiológica mediante resonancia magnética tras la terapia con plasma rico en plaquetas en pacientes con condropatía femo ropatelar
Authors
Fuster Such, Carla
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Escuela Internacional de Doctorado
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Lajara Marco, Francisco ; Cegarra Navarro, María Francisca
Publisher
Universidad de Murcia
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DOI
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info:eu-repo/semantics/doctoralThesis
Description
Abstract
Propósito: La condropatía femoropatelar es una causa frecuente de dolor anterior de rodilla y limitación funcional. El plasma rico en plaquetas (PRP) se utiliza como alternativa biológica cuando fracasa el tratamiento conservador, aunque la respuesta es heterogénea. En este contexto, la resonancia magnética (RM), especialmente las técnicas de Mapping, puede aportar biomarcadores para caracterizar el cartílago y predecir la respuesta terapéutica. Esta tesis tuvo cuatro objetivos: 1) comparar la RM morfológica convencional, basada en TrueFISP y la clasificación de Outerbridge, con el T2-Mapping cualitativo y cuantitativo para detectar y graduar alteraciones condrales patelares y femorales; 2) evaluar la respuesta radiológica a los 9 meses tras PRP mediante WORMS-patelofemoral modificado y T2-Mapping; 3) analizar la respuesta clínica a los 9 meses mediante escalas de dolor, función y calidad de vida; y 4) identificar factores asociados a la respuesta clínico-radiológica, con especial atención al valor predictivo del T2-Mapping femoral/troclear basal.
Material y métodos: Se realizó un estudio observacional prospectivo de cohorte en un único centro. Entre enero de 2022 y diciembre de 2023 se incluyeron 45 pacientes con condropatía rotuliana; 19 presentaban afectación bilateral, por lo que el Objetivo 1 se analizó en 64 rodillas con RM basal. Todas las exploraciones se realizaron en 1,5 Tesla e incluyeron secuencia morfológica y T2-Mapping. La rótula se dividió en seis regiones y el fémur/tróclea en cuatro. El Mapping cualitativo se codificó mediante gradación cromática y el cuantitativo mediante regiones de interés con valores T2 en milisegundos. Dos observadores independientes realizaron las lecturas. Para los Objetivos 2, 3 y 4, el seguimiento completo estuvo disponible en 22 pacientes y 32 rodillas; esta reducción no obedeció a pérdidas de seguimiento, sino a limitaciones logístico-económicas. El tratamiento consistió en tres infiltraciones intraarticulares eco-guiadas de PRP separadas una semana. La respuesta estructural se valoró mediante WORMS patelofemoral modificado y T2-Mapping por compartimento índice. La respuesta clínica se evaluó con EVA, Kujala, SF-12 y EQ-5D-3L. En el Objetivo 4 se definieron respondedores mediante MCID y se realizaron análisis bivariantes, modelos logísticos y correlaciones entre T2 basal y mejoría clínica.
Resultados: En el Objetivo 1, la concordancia inter-observador en patela fue casi perfecta para Outerbridge y sustancial para el Mapping cualitativo. Tras equiparar ambas técnicas, el T2-Mapping cualitativo clasificó lesiones de mayor grado que la RM morfológica en una proporción relevante de casos. En fémur, Outerbridge mostró concordancia moderada y el T2-Mapping evidenció mayor severidad en la mayoría de las rodillas. Además, los valores T2 aumentaron conforme lo hacía la severidad cualitativa. En el Objetivo 2, el WORMS-patelofemoral mejoró significativamente a los 9 meses. Aunque el T2-Mapping cuantitativo global no mostró cambios significativos, el compartimento índice patelar presentó una disminución significativa y el Mapping cualitativo mejoró en la rótula, aunque no en el fémur. También se observó reducción del derrame articular. En el Objetivo 3 hubo mejoría significativa en función, dolor y calidad de vida, sin cambios globales en SF-12. En el Objetivo 4, el sexo masculino se asoció con mejor respuesta funcional, una EVA basal más alta con mayor probabilidad de respuesta en dolor y valores basales más elevados de T2 femoral/troclear con menor mejoría clínica.
Conclusiones: En RM de 1,5 Tesla, el T2-Mapping tiende a detectar alteraciones condrales con mayor sensibilidad y severidad que la RM morfológica convencional. Tras el tratamiento con PRP se observaron mejoras clínicas y cambios estructurales detectables mediante WORMS, junto con reducción del derrame. El hallazgo de mayor interés traslacional es el posible valor pronóstico del T2-Mapping cuantitativo femoral/troclear basal, que podría contribuir a estratificar pacientes y optimizar la indicación terapéutica. Se precisan estudios con muestras mayores y protocolos estandarizados para confirmar estos resultados
Purpose: Patellofemoral chondropathy is a common cause of anterior knee pain and functional limitation. Platelet-rich plasma (PRP) is used as a biological alternative when conservative treatment fails, although response is heterogeneous. In this context, magnetic resonance imaging (MRI), particularly mapping techniques, may provide biomarkers to characterize cartilage status and predict therapeutic response. This thesis had four objectives: (1) to compare conventional morphological MRI, based on TrueFISP and the Outerbridge classification, with qualitative and quantitative T2 Mapping for detecting and grading patellar and femoral cartilage abnormalities; (2) to evaluate radiological response at 9 months after PRP using modified patellofemoral WORMS and T2 Mapping; (3) to analyze 9-month clinical response using pain, function, and quality-of-life scales; and (4) to identify factors associated with clinicoradiological response, with particular emphasis on the predictive value of baseline femoral/trochlear T2 Mapping. Materials and methods: A prospective single-center observational cohort study was conducted. Between January 2022 and December 2023, 45 patients with patellar chondropathy were included; 19 had bilateral involvement, so Objective 1 was analyzed in 64 knees with baseline MRI. All examinations were performed on a 1.5-Tesla MRI system and included a morphological sequence and T2 Mapping. The patella was divided into six regions and the femur/trochlea into four. Qualitative mapping was coded using color-based grading, and quantitative mapping was obtained by region-of-interest measurements with T2 values expressed in milliseconds. Two independent readers performed the assessments. For Objectives 2, 3, and 4, complete follow-up was available in 22 patients and 32 knees; this reduction was not due to loss to follow-up, but to logistical and economic limitations. Treatment consisted of three ultrasound-guided intra-articular PRP injections administered one week apart. Structural response was assessed using modified patellofemoral WORMS and T2 Mapping of the index compartment. Clinical response was evaluated using VAS, Kujala, SF-12, and EQ-5D-3L. In Objective 4, responders were defined according to MCID, and bivariate analyses, logistic models, and correlations between baseline T2 values and clinical improvement were performed. Results: In Objective 1, interobserver agreement in the patella was almost perfect for Outerbridge and substantial for qualitative Mapping. After establishing equivalence between both techniques, qualitative T2 Mapping classified lesions as more severe than morphological MRI in a relevant proportion of cases. In the femur, Outerbridge showed moderate agreement, whereas T2 Mapping demonstrated greater severity in most knees. In addition, T2 values increased with greater qualitative severity. In Objective 2, modified patellofemoral WORMS improved significantly at 9 months. Although global quantitative T2 Mapping showed no significant changes, the patellar index compartment showed a significant decrease, and qualitative Mapping improved in the patella, but not in the femur. A reduction in joint effusion was also observed. In Objective 3, there was significant improvement in function, pain, and quality of life, with no overall changes in SF-12. In Objective 4, male sex was associated with better functional response, higher baseline VAS with a greater likelihood of pain response, and higher baseline femoral/trochlear T2 values with less clinical improvement. Conclusions: On 1.5-Tesla MRI, T2 Mapping tends to detect cartilage abnormalities with greater sensitivity and severity than conventional morphological MRI. After PRP treatment, clinical improvement and structural changes detectable by WORMS were observed, together with reduced effusion. The finding of greatest translational interest is the potential prognostic value of baseline quantitative femoral/trochlear T2 Mapping, which could help stratify patients and optimize treatment indication. Studies with larger samples and standardized protocols are needed to confirm these results.
Purpose: Patellofemoral chondropathy is a common cause of anterior knee pain and functional limitation. Platelet-rich plasma (PRP) is used as a biological alternative when conservative treatment fails, although response is heterogeneous. In this context, magnetic resonance imaging (MRI), particularly mapping techniques, may provide biomarkers to characterize cartilage status and predict therapeutic response. This thesis had four objectives: (1) to compare conventional morphological MRI, based on TrueFISP and the Outerbridge classification, with qualitative and quantitative T2 Mapping for detecting and grading patellar and femoral cartilage abnormalities; (2) to evaluate radiological response at 9 months after PRP using modified patellofemoral WORMS and T2 Mapping; (3) to analyze 9-month clinical response using pain, function, and quality-of-life scales; and (4) to identify factors associated with clinicoradiological response, with particular emphasis on the predictive value of baseline femoral/trochlear T2 Mapping. Materials and methods: A prospective single-center observational cohort study was conducted. Between January 2022 and December 2023, 45 patients with patellar chondropathy were included; 19 had bilateral involvement, so Objective 1 was analyzed in 64 knees with baseline MRI. All examinations were performed on a 1.5-Tesla MRI system and included a morphological sequence and T2 Mapping. The patella was divided into six regions and the femur/trochlea into four. Qualitative mapping was coded using color-based grading, and quantitative mapping was obtained by region-of-interest measurements with T2 values expressed in milliseconds. Two independent readers performed the assessments. For Objectives 2, 3, and 4, complete follow-up was available in 22 patients and 32 knees; this reduction was not due to loss to follow-up, but to logistical and economic limitations. Treatment consisted of three ultrasound-guided intra-articular PRP injections administered one week apart. Structural response was assessed using modified patellofemoral WORMS and T2 Mapping of the index compartment. Clinical response was evaluated using VAS, Kujala, SF-12, and EQ-5D-3L. In Objective 4, responders were defined according to MCID, and bivariate analyses, logistic models, and correlations between baseline T2 values and clinical improvement were performed. Results: In Objective 1, interobserver agreement in the patella was almost perfect for Outerbridge and substantial for qualitative Mapping. After establishing equivalence between both techniques, qualitative T2 Mapping classified lesions as more severe than morphological MRI in a relevant proportion of cases. In the femur, Outerbridge showed moderate agreement, whereas T2 Mapping demonstrated greater severity in most knees. In addition, T2 values increased with greater qualitative severity. In Objective 2, modified patellofemoral WORMS improved significantly at 9 months. Although global quantitative T2 Mapping showed no significant changes, the patellar index compartment showed a significant decrease, and qualitative Mapping improved in the patella, but not in the femur. A reduction in joint effusion was also observed. In Objective 3, there was significant improvement in function, pain, and quality of life, with no overall changes in SF-12. In Objective 4, male sex was associated with better functional response, higher baseline VAS with a greater likelihood of pain response, and higher baseline femoral/trochlear T2 values with less clinical improvement. Conclusions: On 1.5-Tesla MRI, T2 Mapping tends to detect cartilage abnormalities with greater sensitivity and severity than conventional morphological MRI. After PRP treatment, clinical improvement and structural changes detectable by WORMS were observed, together with reduced effusion. The finding of greatest translational interest is the potential prognostic value of baseline quantitative femoral/trochlear T2 Mapping, which could help stratify patients and optimize treatment indication. Studies with larger samples and standardized protocols are needed to confirm these results.
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