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Assessment of synovitis with contrast-enhanced MRI using a whole-joint semiquantitative scoring system in people with, or at high risk of, knee osteoarthritis: The MOST study

Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
Annals of the rheumatic diseases (Impact Factor: 10.38). 12/2010; 70(5):805-11. DOI: 10.1136/ard.2010.139618
Source: PubMed

ABSTRACT To introduce a comprehensive and reliable scoring system for the assessment of whole-knee joint synovitis based on contrast-enhanced (CE) MRI.
Multicenter Osteoarthritis Study (MOST) is a cohort study of people with, or at high risk of, knee osteoarthritis (OA). Subjects are an unselected subset of MOST who volunteered for CE-MRI. Synovitis was assessed at 11 sites of the joint. Synovial thickness was scored semiquantitatively: grade 0 (<2 mm), grade 1 (2-4 mm) and grade 2 (>4 mm) at each site. Two musculoskeletal radiologists performed the readings and inter- and intrareader reliability was evaluated. Whole-knee synovitis was assessed by summing the scores from all sites. The association of Western Ontario and McMaster Osteoarthritis Index pain score with this summed score and with the maximum synovitis grade for each site was assessed.
400 subjects were included (mean age 58.8±7.0 years, body mass index 29.5±4.9 kg/m(2), 46% women). For individual sites, intrareader reliability (weighted κ) was 0.67-1.00 for reader 1 and 0.60-1.00 for reader 2. Inter-reader agreement (κ) was 0.67-0.92. For the summed synovitis scores, intrareader reliability (intraclass correlation coefficient ( ICC)) was 0.98 and 0.96 for each reader and inter-reader agreement (ICC) was 0.94. Moderate to severe synovitis in the parapatellar subregion was associated with the higher maximum pain score (adjusted OR (95% CI), 2.8 (1.4 to 5.4) and 3.1 (1.2 to 7.9), respectively).
A comprehensive semiquantitative scoring system for the assessment of whole-knee synovitis is proposed. It is reliable and identifies knees with pain, and thus is a potentially powerful tool for synovitis assessment in epidemiological OA studies.

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    • "The PCL is a very strong ligament uncommonly affected by incidental or traumatic pathology [28] [29]. Although synovitis around the ACL and PCL is often observed in OA, synovitis in these locations does not seem to be associated with knee pain [17]. A recent study by Baker et al. [30] examined the relation of synovitis to "
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    • "The most commonly used methods define synovitis according to the extent of synovial cavity distension or total synovial volume. These systems have been mostly applied to non-contrast imaging, but more recent studies have incorporated the use of contrast-enhanced MR imaging techniques to distinguish synovial thickening from effusion [31] [39]. For example, in a recent study by Roemer et al. [85], the authors used both contrast-enhanced and non-enhanced images to examine a group of subjects with knee OA, and noted that synovitis was present in over 95% of the knee joints with an effusion, but also in 70% of knee joints in patients without an effusion. "
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