MRI protocols for whole-organ assessment of the knee in osteoarthritis

Synarc Inc., San Francisco, CA 94105, USA.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 02/2006; 14 Suppl A(supplement 1):A95-111. DOI: 10.1016/j.joca.2006.02.029
Source: PubMed


One of the critical challenges in developing structure-modifying therapies for arthritis, especially osteoarthritis (OA), is measuring changes in progression of joint destruction. Magnetic resonance imaging (MRI) offers considerable promise in this regard. Not only can MRI quantify articular cartilage volume and morphology with high precision and accuracy, but it can also examine several other important articular components, and thus offer a unique opportunity to evaluate the knee and other joints as whole organs. On December 5 and 6, 2002, OMERACT (Outcome Measures in Rheumatology Clinical Trials) and OARSI (Osteoarthritis Research Society International), with support from various pharmaceutical companies listed at the beginning of this supplement, held a Workshop for Consensus on Osteoarthritis Imaging in Bethesda, MD. The aim of the Workshop was to provide a state-of-the-art review of imaging outcome measures for OA of the knee to help guide scientists and pharmaceutical companies who want to use MRI in multi-site studies of OA. Applications of MRI were initially reviewed by a multidisciplinary, international panel of expert scientists and physicians from academia, the pharmaceutical industry and regulatory agencies. The findings of the panel were then presented to a wider group of participants for open discussion. The following report summarizes the results of these discussions with respect to MRI acquisition techniques for whole-organ assessment of the knee in OA. The discussion reviews the selection and qualification of imaging sites for clinical trials, designing imaging protocols for whole-organ assessment of OA, and key considerations in image quality (IQ) control and data management.

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Available from: Bernard Dardzinski, Oct 08, 2014
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    • "A board-certified radiologist (WV) with 7 years of experience and a fourth-year radiology resident (LN) with 3 years of experience read the images independently and graded meniscus, cartilage, and bone marrow lesions. Cartilage and bone marrow lesions were assessed in five compartments (patella, medial femur, medial tibia, lateral femur, and lateral tibia) by using a modified semi-quantitative WORMS [16,26,27], and the highest grade of lesion was recorded for each region. In case of disagreement, a consensus reading was performed with a musculoskeletal radiologist with 22 years of experience (TML). "
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    ABSTRACT: The goals of this study were (i) to compare the prevalence of focal knee abnormalities, the mean cartilage T2 relaxation time, and the spatial distribution of cartilage magnetic resonance (MR) T2 relaxation times between subjects with and without risk factors for Osteoarthritis (OA), (ii) to determine the relationship between MR cartilage T2 parameters, age and cartilage morphology as determined with whole-organ magnetic resonance imaging scores (WORMS) and (iii) to assess the reproducibility of WORMS scoring and T2 relaxation time measurements including the mean and grey level co-occurrence matrix (GLCM) texture parameters. Subjects with risk factors for OA (n = 92) and healthy controls (n = 53) were randomly selected from the Osteoarthritis Initiative (OAI) incidence and control cohorts, respectively. The specific inclusion criteria for this study were (1) age range 45-55 years, (2) body mass index (BMI) of 19-27 kg/m2, (3) Western Ontario and McMaster University (WOMAC) pain score of zero and (4) Kellgren Lawrence (KL) score of zero at baseline. 3.0 Tesla MR images of the right knee were analyzed using morphological gradings of cartilage, bone marrow and menisci (WORMS) as well as compartment specific cartilage T2 mean and heterogeneity. Regression models adjusted for age, gender, and BMI were used to determine the difference in cartilage parameters between groups. While there was no significant difference in the prevalence of knee abnormalities (cartilage lesions, bone marrow lesions, meniscus lesions) between controls and subjects at risk for OA, T2 parameters (mean T2, GLCM contrast, and GLCM variance) were significantly elevated in those at risk for OA. Additionally, a positive significant association between cartilage WORMS score and cartilage T2 parameters was evident. Overall, this study demonstrated that subjects at risk for OA have both higher and more heterogeneous cartilage T2 values than controls, and that T2 parameters are associated with morphologic degeneration.
    Arthritis research & therapy 09/2011; 13(5):R153. DOI:10.1186/ar3469 · 3.75 Impact Factor
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    • "They are identified as foci of markedly increased signal in the subchondral bone with well delineated margins and no evidence of internal marrow tissue or trabecular bone. Semiquantitative assessment of subchondral BMLs and cysts is commonly performed on FSE sequences such as T2-weighted (T2W), intermediate-weighted (IW) or proton density-weighted (PDW) fs sequences [5] or short-tau inversion recovery (STIR) sequence [6]. However, BMLs have also been assessed on gradient recalled echo (GRE)-type sequences such as Fast Low Angle Shot (FLASH) or Spoiled Gradient Recalled (SPGR) [7] that are commonly used for quantitative assessment of cartilage volume and thickness due to their high contrast of cartilage to subchondral bone [8]. "
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    ABSTRACT: Choice of appropriate MR pulse sequence is important for any research studies using imaging-derived data. The aim of this study was to compare semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts using intermediate-weighted (IW) fat-suppressed (fs) spin echo and Dual Echo Steady State (DESS) sequences on 3 T MRI. Included were 201 subjects aged 35-65 with frequent knee pain. 3T MRI was performed with the same sequence protocol as in the Osteoarthritis Initiative (OAI). In a primary reading subchondral bone marrow edema-like lesions were assessed according to the WORMS system. Two hundred subregions with such lesions were randomly chosen. The extent of subchondral bone marrow edema-like lesions was re-evaluated separately using sagittal IW fs and DESS sequences according to WORMS. Lesion size and confidence of the differentiation between subchondral bone marrow edema-like lesions and subchondral cysts located within or adjacent to them was rated from 0 to 3. Wilcoxon signed-rank tests and chi-square statistics were used to examine differences between the two sequences. Of 200 subchondral bone marrow edema-like lesions detected by IW fs sequence, 93 lesions (46.5%) were not depicted by the DESS sequence. The IW fs sequence depicted subchondral bone marrow edema-like lesions to a larger extent than DESS (p < 0.0001), and the opposite was true for subchondral cysts. Confidence scores for differentiation of the two types of lesions were not significantly different between the two sequences. In direct comparison the IW fs sequence depicts more subchondral bone marrow edema-like lesions and better demonstrate the extent of their maximum size. The DESS sequence helps in the differentiation of subchondral bone marrow edema-like lesions and subchondral cysts. The IW fs sequence should be used for determination of lesion extent whenever the size of subchondral bone marrow edema-like lesions is the focus of attention.
    BMC Musculoskeletal Disorders 09/2011; 12(1):198. DOI:10.1186/1471-2474-12-198 · 1.72 Impact Factor
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    • "Quantitative work performed on cartilage with MRI between 1994 and 2006 has been summarized previously [8, 9, 63] and will not be repeated in this paper. Briefly, for quantifying cartilage morphology, water-excitation (or fat-suppressed) T1-weighted spoiled gradient recalled echo acquisition in the steady state (SPGR) or fast low angle shot (FLASH) at 1.5 T or 3 T represent the current gold standard [9, 64, 65] for quantitative cartilage imaging. Double-echo steady-state imaging (DESS) with water excitation has recently gained interest because of the faster acquisition time and lower slice thickness that can be achieved (Figure 2) [33, 36, 66–68]. "
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    ABSTRACT: Quantitative measures of cartilage morphology (i.e., thickness) represent potentially powerful surrogate endpoints in osteoarthritis (OA). These can be used to identify risk factors of structural disease progression and can facilitate the clinical efficacy testing of structure modifying drugs in OA. This paper focuses on quantitative imaging of articular cartilage morphology in the knee, and will specifically deal with different cartilage morphology outcome variables and regions of interest, the relative performance and relationship between cartilage morphology measures, reference values for MRI-based knee cartilage morphometry, imaging protocols for measurement of cartilage morphology (including those used in the Osteoarthritis Initiative), sensitivity to change observed in knee OA, spatial patterns of cartilage loss as derived by subregional analysis, comparison of MRI changes with radiographic changes, risk factors of MRI-based cartilage loss in knee OA, the correlation of MRI-based cartilage loss with clinical outcomes, treatment response in knee OA, and future directions of the field.
    01/2011; 2011(2090-1984):475684. DOI:10.1155/2011/475684
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