Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis

Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
Arthritis research & therapy (Impact Factor: 3.75). 11/2011; 13(6):247. DOI: 10.1186/ar3488
Source: PubMed


Imaging of cartilage has traditionally been achieved indirectly with conventional radiography. Loss of joint space width, or 'joint space narrowing', is considered a surrogate marker for cartilage thinning. However, radiography is severely limited by its inability to visualize cartilage, the difficulty of ascertaining the optimum and reproducible positioning of the joint in serial assessments, and the difficulty of grading joint space narrowing visually. With the availability of advanced magnetic resonance imaging (MRI) scanners, new pulse sequences, and imaging techniques, direct visualization of cartilage has become possible. MRI enables visualization not only of cartilage but also of other important features of osteoarthritis simultaneously. 'Pre-radiographic' cartilage changes depicted by MRI can be measured reliably by a semiquantitative or quantitative approach. MRI enables accurate measurement of longitudinal changes in quantitative cartilage morphology in knee osteoarthritis. Moreover, compositional MRI allows imaging of 'pre-morphologic' changes (that is, visualization of subtle intrasubstance matrix changes before any obvious morphologic alterations occur). Detection of joint space narrowing on radiography seems outdated now that it is possible to directly visualize morphologic and pre-morphologic changes of cartilage by using conventional as well as complex MRI techniques.

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Available from: Daichi Hayashi
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    • "Anatomic imaging techniques, such as radiography and magnetic resonance imaging (MRI), are currently used for epidemiological studies and clinical trials [37] [38]. Plain radiography is the traditional approach to monitoring progression of disease by clinicians; however, the drawbacks of this approach are apparent: insensitivity to change, nonspecificity, susceptibility to measurement error due to change in positioning, and inability to detect early stages of disease [39] [40]. MRI is regarded as sensitive, valid, and reproducible in that it can assess abnormalities of the whole-joint structure including cartilage degeneration [41], subchondral bone marrow lesions [42] [43], meniscal defects "
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    • "In addition, application of MRI biomarkers in predicting clinical outcome and the need of joint replacement have also been addressed [4] [5]. However, MRI is also limited by difficulties with BioMed Research International identical repositioning, different MRI systems and pulse sequences in different centers, lack of consensus definitions of osteoarthritis diagnosis and grading, and expensive cost [1]. "
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    • "It is known that PGs are depleted in the early stages of OA, long before cartilage degeneration is visible as joint space narrowing on radiography [16]. Therefore, radiography is considered an inappropriate imaging tool for detection and follow-up of early-stage OA in clinical research [17]. Moreover, common magnetic resonance imaging (MRI) techniques that assess cartilage morphology alterations have also shown to be insensitive to detect subtle changes in biochemical cartilage composition [18,19]. "
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