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Osteoarthritis of the knee at 3.0 T: comparison of a quantitative and a semi-quantitative score for the assessment of the extent of cartilage lesion and bone marrow edema pattern in a 24-month longitudinal study

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Abstract

Objective

To compare a semi-quantitative and a quantitative morphological score for assessment of early osteoarthritis (OA) evolution.

Materials and methods

3.0 T MRI of the knee was performed in 60 women, 30 with early OA (each 15 with Kellgren–Lawrence grade 2 and 3) and 30 age-matched controls at baseline and at 12 and 24 months. Pathological condition was assessed with the whole-organ magnetic resonance imaging score (WORMS). Cartilage abnormalities and bone marrow edema pattern (BMEP) were also quantified using a previously introduced morphological quantitative score. These data were correlated with changes in clinical parameters and joint space width using generalized estimation equations (GEE).

Results

At baseline, OA patients had significantly (p < 0.05) more and larger cartilage lesions and BMEP. During follow-up, cartilage lesions increased significantly (p < 0.05) in the patients compared with controls: WORMS showed progression only at the lateral patella, whereas the quantitative score revealed progression additionally at the trochlea and at the medial compartment. Both scores showed a significant (p < 0.05) increase in BMEP at the lateral femur in OA patients. In addition, quantitative scores of BMEP of the whole knee decreased significantly (p < 0.05) after 12 months and increased after 24 months in the patients, but showed an increase in controls at all follow-up examinations. Only weak correlations between structural imaging findings and clinical parameters were observed.

Conclusion

Quantitative assessment of cartilage lesions and BMEP is more sensitive to changes during the course of the disease than semi-quantitative scoring. However, structural imaging findings do not correlate well with the clinical progression of OA.

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References

  1. Centers for Disease Control and Prevention (CDC).Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR Morb Mortal Wkly Rep. 2001;50(7):120–5.

    Google Scholar 

  2. Centers for Disease Control and Prevention (CDC). Update: direct and indirect costs of arthritis and other rheumatic conditions--United States, 1997. MMWR Morb Mortal Wkly Rep. 2004;53(18):388–9.

    Google Scholar 

  3. Centers for Disease Control and Prevention (CDC).Racial/ethnic differences in the prevalence and impact of doctor-diagnosed arthritis—United States, 2002. MMWR Morb Mortal Wkly Rep. 2005;54(5):119–23.

    PubMed  Google Scholar 

  4. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: new insights. I. The disease and its risk factors. Ann Intern Med. 2000;133(8):635–46.

    Article  CAS  Google Scholar 

  5. Centers for Disease Control and Prevention (CDC).Prevalence of self-reported arthritis or chronic joint symptoms among adults—United States, 2001. MMWR Morb Mortal Wkly Rep. 2002;51(42):948–50.

    Google Scholar 

  6. Reginster JY. The prevalence and burden of arthritis. Rheumatology (Oxford). 2002;41 [Supp 1]:3–6.

    Article  Google Scholar 

  7. Buckland-Wright JC. Quantitative radiography of osteoarthritis. Ann Rheum Dis. 1994;53(4):268–75.

    Article  CAS  Google Scholar 

  8. Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27(6):1513–7.

    CAS  PubMed  Google Scholar 

  9. Hayes CW, Jamadar DA, Welch GW, Jannausch ML, Lachance LL, Capul DC, et al. Osteoarthritis of the knee: comparison of MR imaging findings with radiographic severity measurements and pain in middle-aged women. Radiology. 2005;237(3):998–1007.

    Article  Google Scholar 

  10. Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003;226(2):373–81.

    Article  Google Scholar 

  11. Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D, et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004;12(3):177–90.

    Article  CAS  Google Scholar 

  12. Garnero P, Peterfy C, Zaim S, Schoenharting M. Bone marrow abnormalities on magnetic resonance imaging are associated with type II collagen degradation in knee osteoarthritis: a three-month longitudinal study. Arthritis Rheum. 2005;52(9):2822–9.

    Article  CAS  Google Scholar 

  13. Phan CM, Link TM, Blumenkrantz G, Dunn TC, Ries MD, Steinbach LS, et al. MR imaging findings in the follow-up of patients with different stages of knee osteoarthritis and the correlation with clinical symptoms. Eur Radiol. 2006;16(3):608–18.

    Article  Google Scholar 

  14. Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, et al. The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum. 2005;52(10):3152–9.

    Article  Google Scholar 

  15. Carbone LD, Nevitt MC, Wildy K, Barrow KD, Harris F, Felson D, et al. The relationship of antiresorptive drug use to structural findings and symptoms of knee osteoarthritis. Arthritis Rheum. 2004;50(11):3516–25.

    Article  Google Scholar 

  16. Felson DT, Niu J, Guermazi A, Roemer F, Aliabadi P, Clancy M, et al. Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum. 2007;56(9):2986–92.

    Article  Google Scholar 

  17. Neogi T, Felson D, Niu J, Lynch J, Nevitt M, Guermazi A, et al. Cartilage loss occurs in the same subregions as subchondral bone attrition: a within-knee subregion-matched approach from the Multicenter Osteoarthritis Study. Arthritis Rheum. 2009;61(11):1539–44.

    Article  CAS  Google Scholar 

  18. Roemer FW, Neogi T, Nevitt MC, Felson DT, Zhu Y, Zhang Y, et al. Subchondral bone marrow lesions are highly associated with, and predict subchondral bone attrition longitudinally: the MOST study. Osteoarthritis Cartilage. 2010;18(1):47–53.

    Article  CAS  Google Scholar 

  19. Eckstein F, Burstein D, Link TM. Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis. NMR Biomed. 2006;19(7):822–54.

    Article  Google Scholar 

  20. Le Graverand MP, Buck RJ, Wyman BT, Vignon E, Mazzuca SA, Brandt KD, et al. Change in regional cartilage morphology and joint space width in osteoarthritis participants versus healthy controls: a multicentre study using 3.0 Tesla MRI and Lyon-Schuss radiography. Ann Rheum Dis. 2010;69(1):155–62.

    Article  Google Scholar 

  21. Stahl R, Krug R, Kelley DA, Zuo J, Ma CB, Majumdar S, et al. Assessment of cartilage-dedicated sequences at ultra-high-field MRI: comparison of imaging performance and diagnostic confidence between 3.0 and 7.0 T with respect to osteoarthritis-induced changes at the knee joint. Skeletal Radiol. 2009;38(8):771–83.

    Article  Google Scholar 

  22. Stahl R, Luke A, Ma CB, Krug R, Steinbach L, Majumdar S, et al. Prevalence of pathologic findings in asymptomatic knees of marathon runners before and after a competition in comparison with physically active subjects—a 3.0 T magnetic resonance imaging study. Skeletal Radiol. 2008;37(7):627–38.

    Article  Google Scholar 

  23. Bauer JS, Barr C, Henning TD, Malfair D, Ma CB, Steinbach L, et al. Magnetic resonance imaging of the ankle at 3.0 Tesla and 1.5 Tesla in human cadaver specimens with artificially created lesions of cartilage and ligaments. Invest Radiol. 2008;43(9):604–11.

    Article  Google Scholar 

  24. Fischbach F, Bruhn H, Unterhauser F, Ricke J, Wieners G, Felix R, et al. Magnetic resonance imaging of hyaline cartilage defects at 1.5 T and 3.0 T: comparison of medium T2-weighted fast spin echo, T1-weighted two-dimensional and three-dimensional gradient echo pulse sequences. Acta Radiol. 2005;46(1):67–73.

    Article  CAS  Google Scholar 

  25. Kijowski R, Blankenbaker DG, Davis KW, Shinki K, Kaplan LD, De Smet AA. Comparison of 1.5- and 3.0-T MR imaging for evaluating the articular cartilage of the knee joint. Radiology. 2009;250(3):839–48.

    Article  Google Scholar 

  26. Masi JN, Sell CA, Phan C, Han E, Newitt D, Steinbach L, et al. Cartilage MR imaging at 3.0 versus that at 1.5 T: preliminary results in a porcine model. Radiology. 2005;236(1):140–50.

    Article  Google Scholar 

  27. Eckstein F, Buck RJ, Burstein D, Charles HC, Crim J, Hudelmaier M, et al. Precision of 3.0 Tesla quantitative magnetic resonance imaging of cartilage morphology in a multicentre clinical trial. Ann Rheum Dis. 2008;67(12):1683–8.

    Article  CAS  Google Scholar 

  28. Eckstein F, Buck RJ, Wyman BT, Kotyk JJ, Le Graverand MP, Remmers AE, et al. Quantitative imaging of cartilage morphology at 3.0 Tesla in the presence of gadopentate dimeglumine (Gd-DTPA). Magn Reson Med. 2007;58(2):402–6.

    Article  Google Scholar 

  29. Eckstein F, Wyman BT, Buck RJ, Wirth W, Maschek S, Hudelmaier M, et al. Longitudinal quantitative MR imaging of cartilage morphology in the presence of gadopentetate dimeglumine (Gd-DTPA). Magn Reson Med. 2009;61(4):975–80.

    Article  CAS  Google Scholar 

  30. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502.

    Article  CAS  Google Scholar 

  31. Doherty M. Risk factors for progression of knee osteoarthritis. Lancet. 2001;358(9284):775–6.

    Article  CAS  Google Scholar 

  32. Issa SN, Sharma L. Epidemiology of osteoarthritis: an update. Curr Rheumatol Rep. 2006;8(1):7–15.

    Article  Google Scholar 

  33. Lohmander LS, Felson D. Can we identify a ‘high risk’ patient profile to determine who will experience rapid progression of osteoarthritis? Osteoarthritis Cartilage. 2004;12(Suppl A):S49–52.

    Article  Google Scholar 

  34. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–40.

    CAS  PubMed  Google Scholar 

  35. Ware J, Snow K, Kosinksi M. SF-36 health survey: manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center; 1993.

    Google Scholar 

  36. Le Graverand MP, Vignon EP, Brandt KD, Mazzuca SA, Piperno M, Buck R, et al. Head-to-head comparison of the Lyon Schuss and fixed flexion radiographic techniques. Long-term reproducibility in normal knees and sensitivity to change in osteoarthritic knees. Ann Rheum Dis. 2008;67(11):1562–6.

    Article  Google Scholar 

  37. Conrozier T, Favret H, Mathieu P, Piperno M, Provvedini D, Taccoen A, et al. Influence of the quality of tibial plateau alignment on the reproducibility of computer joint space measurement from Lyon schuss radiographic views of the knee in patients with knee osteoarthritis. Osteoarthritis Cartilage. 2004;12(10):765–70.

    Article  CAS  Google Scholar 

  38. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.

    Article  CAS  Google Scholar 

  39. Piperno M, Hellio Le Graverand MP, Conrozier T, Bochu M, Mathieu P, Vignon E. Quantitative evaluation of joint space width in femorotibial osteoarthritis: comparison of three radiographic views. Osteoarthritis Cartilage. 1998;6(4):252–9.

    Article  CAS  Google Scholar 

  40. Vignon E, Piperno M, Le Graverand MP, Mazzuca SA, Brandt KD, Mathieu P, et al. Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. Arthritis Rheum. 2003;48(2):378–84.

    Article  Google Scholar 

  41. Ding C, Cicuttini F, Scott F, Cooley H, Boon C, Jones G. Natural history of knee cartilage defects and factors affecting change. Arch Intern Med. 2006;166(6):651–8.

    Article  Google Scholar 

  42. Brem MH, Schlechtweg PM, Bhagwat J, Genovese M, Dillingham MF, Yoshioka H, et al. Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee. Acta Radiol. 2008;49(9):1031–7.

    Article  CAS  Google Scholar 

  43. Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med. 2001;134(7):541–9.

    Article  CAS  Google Scholar 

  44. Felson DT, McLaughlin S, Goggins J, LaValley MP, Gale ME, Totterman S, et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med. 2003;139(5 Pt 1):330–6.

    Article  Google Scholar 

  45. Kornaat PR, Kloppenburg M, Sharma R, Botha-Scheepers SA, Le Graverand MP, Coene LN, et al. Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. Eur Radiol. 2007;17(12):3073–8.

    Article  Google Scholar 

  46. Raynauld JP, Martel-Pelletier J, Berthiaume MJ, Beaudoin G, Choquette D, Haraoui B, et al. Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: correlation with clinical symptoms and radiographic changes. Arthritis Res Ther. 2006;8(1):R21.

    Article  Google Scholar 

  47. Roemer FW, Guermazi A, Javaid MK, Lynch JA, Niu J, Zhang Y, et al. Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study. A longitudinal multicentre study of knee osteoarthritis. Ann Rheum Dis. 2009;68(9):1461–5.

    Article  CAS  Google Scholar 

  48. Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, et al. Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology. 2006;239(3):811–7.

    Article  Google Scholar 

  49. Hunter DJ, March L, Sambrook PN. The association of cartilage volume with knee pain. Osteoarthritis Cartilage. 2003; 11(10):725–729.

    Article  CAS  Google Scholar 

  50. Wong S, Steinbach L, Zhao J, Stehling C, Ma CB, Link TM. Comparative study of imaging at 3.0 T versus 1.5 T of the knee. Skeletal Radiol. 2009;38(8):761–9.

    Article  Google Scholar 

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Acknowledgement

This work was supported by Pfizer Inc., Eastern Point Road, Groton, CT, 06340, USA. We are grateful to the dedicated group of A9001140 investigators: Cecil Charles, Julia Crim, David Hunter, Gary Hutchins, Chris Jackson, Virginia Byers Kraus, Steve Mazzuca, Prasad Pottumarthi, Thomas Schnitzer, Mihra Taljanovic, and Berchman Vaz. Also to the dedicated study coordinators whose skills were essential in ensuring the successful conduct of this research: Emily Brown, Sandra Chapman, Eugene Dunkle, Kristen Fredley, Donna Gilmore, Joyce Goggins, Mohsen Haddad-Kaveh, Norine Hall, Thelma Munoz, and Kim Tally. We would also like to express our thanks to the dedicated MRI technologists, the Duke Image Analysis Laboratory staff: Cecil Charles, Maureen Ainslie, April Davis, Allison Fowlkes, Mark Ward, Scott White, and the Pfizer A9001140 Team: Lydia Brunstetter, Peggy Coyle, Yevgenia Davidoff, Charles Packard, Ann Remmers, Mark Tengowski, Jeff Evelhoch (now Merck,West Point, PA, USA), and John Kotyk (now Washington University, St. Louis, MI, USA).

Conflicts of interest/funding and grants

Dr. Hellio Le Graverand-Gastineau and B. Wyman are employees of Pfizer. Drs. Majumdar and Link were partially funded by Pfizer. All investigators worked under grants received by Pfizer to conduct the A9001140 study.

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Correspondence to Robert Stahl.

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Stahl, R., Jain, S.K., Lutz, J. et al. Osteoarthritis of the knee at 3.0 T: comparison of a quantitative and a semi-quantitative score for the assessment of the extent of cartilage lesion and bone marrow edema pattern in a 24-month longitudinal study. Skeletal Radiol 40, 1315–1327 (2011). https://doi.org/10.1007/s00256-011-1156-9

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  • DOI: https://doi.org/10.1007/s00256-011-1156-9

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