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
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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ABSTRACT: Purpose To assess whether magnetic resonance (MR) imaging-based cross-sectional measures of structural joint damage can be used to predict knee replacement during the following year. Materials and Methods Participants were drawn from the Osteoarthritis Initiative, a longitudinal observational study that includes 4796 participants who have knee osteoarthritis or are at risk. The HIPAA-compliant protocol was approved by the institutional review boards of all participating centers, and written informed consent was obtained from all participants. During the 5 years of follow-up, 199 knees underwent knee replacement and were matched with 199 control knees that did not undergo knee replacement. Knees were matched according to radiographic disease stage and patient sex and age. All knees that underwent knee replacement and had MR images available from the year before surgery were included. MR images were assessed for cartilage damage, bone marrow lesions, meniscal damage, meniscal extrusion, synovitis, and effusion prior to reported knee replacement. Conditional logistic regression was applied to assess the risk of knee replacement. Analyses were performed on a compartmental and knee level. Results Participants had a mean age ± standard deviation of 64.2 years ± 8.4 (range, 47-82 years) and were predominantly women (232 of 398 participants, 58.3%). Risk for knee replacement was significantly increased for knees that exhibited two or more subregions with severe cartilage loss (odds ratio [ OR odds ratio ], 16.5; 95% confidence interval [ CI confidence interval ]: 3.96, 68.76), more than two subregions with bone marrow lesions ( OR odds ratio , 4.00; 95% CI confidence interval : 1.75, 9.16), medial meniscal maceration ( OR odds ratio , 1.84; 95% CI confidence interval : 1.13, 2.99), effusion ( OR odds ratio , 4.75; 95% CI confidence interval : 2.55, 8.85), or synovitis ( OR odds ratio , 2.17; 95% CI confidence interval : 1.33, 3.56), but not extrusion ( OR odds ratio , 1.00; 95% CI confidence interval : 0.60,1.67), when compared with knees that did not exhibit these features as the reference standard. Conclusion Apart from meniscal extrusion, all features of tissue abnormalities at MR imaging were related to clinical prognosis and could be used to predict knee replacement in the following year. © RSNA, 2014 Online supplemental material is available for this article.Radiology 10/2014; 274(3):140991. DOI:10.1148/radiol.14140991 · 6.21 Impact Factor
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ABSTRACT: Objective: To determine patterns of synovitis on contrast-enhanced magnetic resonance images and its relation to pain and severity of radiographic OA. Methods: 86 patients (mean age 62 years, 66% woman, median BMI 29 kg/mm(2) and Kellgren-Lawrence score 3 ) with symptomatic knee OA were included. T1-weighted Gd-chelate-enhanced MRI with fat-suppression (3T) were used to semi-quantitatively score synovitis at 11 sites (range 0-22). Self-reported pain was assessed by standardized questionnaires. With principal component analysis (PCA) patterns of synovitis as assessed by location and severity were investigated. Subsequently, patterns were associated with pain measures and radiographic severity in adjusted logistic regression models. Results: Synovitis was observed in 85 patients and generally mild (median(range) 7.0 (0-16)). Median (range) VAS pain was 53.0 (0-96), KOOS pain 51.4 (2.8-97.2), ICOAP constant pain 35.0 (0-75) and ICOAP intermittent pain 40.6 (0-87.5). PCA resulted in extraction of 3 components, explaining 53.4% of variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with KOOS pain and ICOAP constant pain. Component 2 was characterized by synovitis at 4 sites (mainly site adjacent to the anterior cruciate ligament), but did not associate with pain measures nor with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly by loose bodies), was associated with radiographic severity. Conclusion: Different patterns of synovitis in knee OA were observed. The pattern including several patellar sites was associated with pain, whereas other patterns were not, suggesting a localized response in pain perception in knee OA patients. This article is protected by copyright. All rights reserved. Copyright © 2014 American College of Rheumatology.11/2014; DOI:10.1002/art.38965
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ABSTRACT: It is well documented that meniscal tears may be found frequently by MRI as an incidental finding in asymptomatic knees. We aim to review the literature regarding the ability of MRI to differentiate between asymptomatic and symptomatic meniscal tears. Ovid MEDLINE, MEDLINE inProcess, Cochrane reviews, Web of Science, Embase and CINAHL were systematically searched. A total of 1251 publications were screened based on their titles, abstracts and full texts, of which 1213 publications were excluded because they did not address the relationship between synovitis and meniscal tears, were case reports or reviews, concerned atypical patient populations or reported surgical research. Of the 38 retained publications, only two reported results specific to perimeniscal synovitis, while 36 discussed less specific but relevant findings. The small number of heterogeneous results describing perimeniscal synovitis precluded meta-analysis. In the symptomatic knee, identification of the likelihood of a meniscal tear contributing to the patient's pain is of significance to the orthopaedic surgeon. In our literature review, we have identified that localised synovitis and displacement of the meniscus are two features that may assist in identifying the subgroup of patients that may benefit from meniscal intervention.Journal of Medical Imaging and Radiation Oncology 10/2014; 59(1). DOI:10.1111/1754-9485.12240 · 0.95 Impact Factor