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1 Vol. 11, No. 4, December, 2004 Objective: Ultrasonography (USG) of joints has a unique position for the diagnosis of joint diseases. Bone surface, cartilage, periarticular soft tissue and their pathologic changes can be assessed by USG. This study was aimed to compare the radiographic and ultrasonographic findings in osteoarthritis (OA) of the knee joint and to evaluate the usefulness of each modality to evaluate the disease early and determine the severity of the arthritis. Methods: Fifty osteoarthritis patients classified by the American College of Rheumatology (ACR) clinical criteria from December 2002 to April 2003 were included in the study. Routine radiography (standing anteroposterior, lateral, skyline view) and systemic USG examination of both knee were performed. We compared the incidence of the radiographic and ultrasonographic abnormality related to the pathologic change of the knee OA and suggesting the severity of the OA which would help to decide the therapeutic modality. Results: In patient with knee OA, plain radiography showed abnormal findings in 37/50 (74%) patients, but USG showed at least five abnormal findings in all 50 patients. The abnormal findings detected only by plain radiography were subchondral sclerosis and subchondral cyst (14% and 4% each). But, the thinning of cartilage (94%), Baker's cyst (94%), cartilage degeneration (54%), , Tel032) , Fax032) , parkwon@inha.ac.kr 2004 (INHA-31539). 379

2 meniscal protrusion (44%), meniscal tear (34%), meniscal cyst (32%), and the pannus (22%) were detected only by USG. Among the findings shared by both method, joint space narrowing was detected better by plain radiography than USG, but fluid accumulation, spur, meniscal calcification and osteochondroma were detected more frequently by USG. Conclusion: USG is more sensitive to find the pathologic changes related to the knee OA and to diagnose OA than the plain radiography. But each of the plain radiography and USG have their own unique value for the evaluation of OA in the knee. So the USG supplements the plain radiography in the examination of the knee OA. Key Words: Ultrasonography, Radiography, Osteoarthritis 380

박보형 외 : 슬관절의 골관절염 평가에서 초음파 영상의 유용성 전 상태에서 종축으로 내측과 외측에서 골돌기의 유 없으며 초음파가 심부 투과가 잘 되지 않으므로, 대 무, 관절강의 협착을 검사하였고, 반월상 연골의 변 퇴골과 경골이 서로 거의 닿거나 혹은 닿아 있는 경 화(석회화, 낭종

관절강의 협 출은 대퇴골과 경골을 잇는 선을 벗어나 측부인대 착은 아직 초음파상의 정확한 기준을 제시한 연구가 (collateral ligament) 등 주위 조직을 압박하여 변형을 Fig. 1.

The synovial fluid amount is measured as a fluid thickness at a thickest site in the suprapatellar pouch (arrow).

The coronal ultrasonography scan of medial compartment of the knee. This scan shows spur, medial meniscus protrusion and joint space narrowing.

3 박보형 외 : 슬관절의 골관절염 평가에서 초음파 영상의 유용성 전 상태에서 종축으로 내측과 외측에서 골돌기의 유 없으며 초음파가 심부 투과가 잘 되지 않으므로, 대 무, 관절강의 협착을 검사하였고, 반월상 연골의 변 퇴골과 경골이 서로 거의 닿거나 혹은 닿아 있는 경 화(석회화, 낭종 형성, 돌출, 열상)를 관찰하였으며, 우나, 대퇴골과 경골의 골돌기가 서로 닿아 있는 경 반월상 연골의 열상이 있는 경우는 탐촉자를 횡축으 우 협착으로 판정하였다(그림 3). 반월상 연골의 돌 로 돌려 다시 확인하였다(그림 2A, B). 관절강의 협 출은 대퇴골과 경골을 잇는 선을 벗어나 측부인대 착은 아직 초음파상의 정확한 기준을 제시한 연구가 (collateral ligament) 등 주위 조직을 압박하여 변형을 Fig. 1. The sagittal ultrasonography scan shows synovial fluid and synovial thickening. The synovial fluid amount is measured as a fluid thickness at a thickest site in the suprapatellar pouch (arrow). Synovial thickening may be the pannus, and power doppler image shows increased blood flow in the thickened synovium. Fig. 3. The coronal ultrasonography scan of medial compartment of the knee. This scan shows spur, medial meniscus protrusion and joint space narrowing. Medial collateral ligament is displaced by the protruded meniscus and the spur. The femur is in contact with tibia. A B Fig. 2. (A) The coronal ultrasonography scan of medial compartment of the knee demonstrates spur, space narrowing, meniscal protrusion and meniscal tear (arrow). (B) Axial ultrasonography scan in the same patient shows the extent of the tear in the periphery of the meniscus extending into the inner part (arrow). 381

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슬라이드 1

슬라이드 1 Examination of the Knee 기능해부학 functional anatomy Knee joint 의구성 - distal of femur + med, lat epicondyle of tibia - meniscus : fibroscartliage : knee joint에내, 외측에부착된연골륜 : 외측 < 내측, 내측이외상받기쉽다 http://www.eorthopod.com/images/contentimages/knee/knee_anatomy/knee_anatomy01.jpg