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Arthritis Research & Therapy
Published in: Arthritis Research & Therapy 6/2011

01-12-2011 | Review

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

Authors: Ali Guermazi, Frank W Roemer, Deborah Burstein, Daichi Hayashi

Published in: Arthritis Research & Therapy | Issue 6/2011

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Abstract

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 Detection of joint space narrowing on radiography seems outdated now that it is possible to directly visualize morphologic and pre-morphologic changes of cartilage by using conventional as well as complex MRI techniques.
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Literature
1.
Hunter DJ, Zhang YQ, Tu X, Lavalley M, Niu JB, Amin S, Guermazi A, Genant H, Gale D, Felson DT: Change in joint space width: hyaline articular cartilage loss or alteration in meniscus?. Arthritis Rheum. 2006, 54: 2488-2495. 10.1002/art.22016.CrossRefPubMed
2.
Hellio Le Graverand M-P, Mazzuca S, Duryea J, Brett A: Radiographic-based grading methods and radiographic measurement of joint space width in osteoarthritis. Radiol Clin N Am. 2009, 47: 567-579. 10.1016/j.rcl.2009.04.004.CrossRefPubMed
3.
Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F, Baum T, Mosher TJ, Carrino JA, Guermazi A: Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics. 2011, 31: 37-61. 10.1148/rg.311105084.CrossRefPubMed
4.
5.
Guermazi A, Hunter DJ, Roemer FW: Plain radiography and magnetic resonance imaging diagnostics in osteoarthritis: validated staging and scoring. Bone Joint Surg Am. 2009, 91: 54-62. 10.2106/JBJS.H.01385.CrossRef
6.
Altman RD, Gold GE: Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007, 15 (Suppl A): A1-56.CrossRefPubMed
7.
Duryea J, Neumann G, Niu J, Totterman S, Tamez J, Dabrowski C, Le Graverand MP, Luchi M, Beals CR, Hunter DJ: Comparison of radiographic joint space width with magnetic resonance imaging cartilage morphometry: analysis of longitudinal data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2010, 62: 932-937. 10.1002/acr.20148.CrossRef
8.
Conaghan PG, Hunter DJ, Maillefert JF, Reichmann WM, Losina E: Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group. Osteoarthritis Cartilage. 2011, 19: 606-610. 10.1016/j.joca.2011.02.018.PubMedCentralCrossRefPubMed
9.
Mazzuca SA, Brandt KD, Lane KA, Katz BP: Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees. Arthritis Rheum. 2002, 46: 1223-1227. 10.1002/art.10256.CrossRefPubMed
10.
Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, Stevens R, Peterfy CG: Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol. 2004, 14: 1568-1573.CrossRefPubMed
11.
Mazzuca SA, Brandt KD, Buckland-Wright JC, Buckwalter KA, Katz BP, Lynch JA, Ward RJ, Emsley CL: Field test of the reproducibility of automated measurements of medial tibiofemoral joint space width derived from standardized knee radiographs. J Rheumatol. 1999, 26: 1359-1365.PubMed
12.
Buckland-Wright JC, Macfarlane DG, Williams SA, Ward RJ: Accuracy and precision of joint space width measurements in standard and macroradiographs of osteoarthritic knees. Ann Rheum Dis. 1995, 54: 872-880. 10.1136/ard.54.11.872.PubMedCentralCrossRefPubMed
13.
Guermazi A, Hunter DJ, Li L, Benichou O, Eckstein F, Kwoh CK, Nevitt M, Hayashi D: Different thresholds for detecting osteophytes and joint space narrowing exist between the site investigators and the centralized reader in a multicenter knee osteoarthritis study-data from the Osteoarthritis Initiative. Skeletal Radiol. 2011,
14.
Amin S, LaValley MP, Guermazi A, Grigoryan M, Hunter DJ, Clancy M, Niu J, Gale DR, Felson DT: The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis. Arthritis Rheum. 2005, 52: 3152-3159. 10.1002/art.21296.CrossRefPubMed
15.
Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D: Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthritis Cartilage. 1999, 7: 526-532. 10.1053/joca.1999.0256.CrossRefPubMed
16.
Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S: Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol. 1999, 54: 502-506. 10.1016/S0009-9260(99)90846-2.CrossRefPubMed
17.
Sharma L: Comment on: Varus malalignment negates the structuremodifying benefits of doxycycline in obese women with knee osteoarthritis. Osteoarthritis Cartilage. 2010, 18: 1006-1007. 10.1016/j.joca.2010.05.010.PubMedCentralCrossRefPubMed
18.
Hayashi D, Guermazi A, Crema MD, Roemer FW: Imaging in osteoar thritis: what have we learned and where are we going?. Minerva Med. 2011, 102: 15-32.PubMed
19.
Hayashi D, Guermazi A, Hunter DJ: Osteoarthritis year 2010 in review: imaging. Osteoarthritis Cartilage. 2011, 19: 354-360. 10.1016/j.joca.2011.02.003.CrossRefPubMed
20.
Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D, Kothari M, Lu Y, Fye K, Zhao S, Genant HK: Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004, 12: 177-190. 10.1016/j.joca.2003.11.003.CrossRefPubMed
21.
Hunter DJ, Lo GH, Gale D, Grainger AJ, Guermazi A, Conaghan PG: The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston Leeds Osteoarthritis Knee Score). Ann Rheum Dis. 2008, 67: 206-211. 10.1136/ard.2006.066183.CrossRefPubMed
22.
Kornaat PR, Ceulemans RY, Kroon HM, Riyazi N, Kloppenburg M, Carter WO, Woodworth TG, Bloem JL: MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS) - inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol. 2005, 34: 95-102. 10.1007/s00256-004-0828-0.CrossRefPubMed
23.
Roemer FW, Guermazi A: MR imaging-based semiquantitative assessment in steoarthritis. Radiol Clin North Am. 2009, 47: 633-654. 10.1016/j.rcl.2009.03.005.CrossRefPubMed
24.
Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW: Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage. 2011, 19: 990-1002. 10.1016/j.joca.2011.05.004.PubMedCentralCrossRefPubMed
25.
Roemer FW, Zhang Y, Niu J, Lynch JA, Crema MD, Marra MD, Nevitt MC, Felson DT, Hughes LB, El-Khoury GY, Englund M, Guermazi A, Multicenter Osteoarthritis Study Investigators: Tibiofemoral joint osteoarthritis: risk factors for MR-depicted fast cartilage loss over a 30-month period in the multicenter osteoarthritis study. Radiology. 2009, 252: 772-780. 10.1148/radiol.2523082197.PubMedCentralCrossRefPubMed
26.
Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Reichmann WM, Losina E: Responsiveness and reliability of MRI in knee osteoarthritis: a meta-analysis of published evidence. Osteoarthritis Cartilage. 2011, 19: 589-605. 10.1016/j.joca.2010.10.030.PubMedCentralCrossRefPubMed
27.
Buck RJ, Wyman BT, Le Graverand MP, Wirth W, Eckstein F: An efficient subset of morphological measures for articular cartilage in the healthy and diseased human knee. Magn Reson Med. 2010, 63: 680-690. 10.1002/mrm.22207.CrossRefPubMed
28.
Buck RJ, Wyman BT, Le Graverand MP, Hudelmaier M, Wirth W, Eckstein F: Does the use of ordered values of subregional change in cartilage thickness improve the detection of disease progression in longitudinal studies of osteoarthritis?. Arthritis Rheum. 2009, 61: 917-924. 10.1002/art.24613.CrossRefPubMed
29.
Wirth W, Buck R, Nevitt M, Le Graverand MP, Benichou O, Dreher D, Davies RY, Lee JH, Picha K, Gimona A, Maschek S, Hudelmaier M, Eckstein F, OAI Investigators: MRI-based extended ordered values more efficiently differentiate cartilage loss in knees with and without joint space narrowing than region-specific approaches using MRI or radiography - data from the OA initiative. Osteoarthritis Cartilage. 2011, 19: 689-699. 10.1016/j.joca.2011.02.011.PubMedCentralCrossRefPubMed
30.
Ding C, Cicuttini F, Jones G: Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults?. Am J Med. 2009, 122: 836-842. 10.1016/j.amjmed.2009.03.022.CrossRefPubMed
31.
Berry PA, Maciewicz RA, Cicuttini FM, Jones MD, Hellawell CJ, Wluka AE: Markers of bone formation and resorption identify subgroups of patients with clinical knee osteoarthritis who have reduced rates of cartilage loss. J Rheumatol. 2010, 37: 1252-1259. 10.3899/jrheum.091055.CrossRefPubMed
32.
Berry PA, Maciewicz RA, Wluka AE, Downey-Jones MD, Forbes A, Hellawell CJ, Cicuttini FM: Relationship of serum markers of cartilage metabolism to imaging and clinical outcome measures of knee joint structure. Ann Rheum Dis. 2010, 69: 1816-1822. 10.1136/ard.2009.124420.CrossRefPubMed
33.
Wildi LM, Raynauld JP, Martel-Pelletier J, Abram F, Dorais M, Pelletier JP: Relationship between bone marrow lesions, cartilage loss and pain in knee osteoarthritis: results from a randomised controlled clinical trial using MRI. Ann Rheum Dis. 2010, 69: 2118-2124. 10.1136/ard.2009.127993.CrossRefPubMed
34.
Burstein D, Gray M, Mosher T, Dardzinski B: Measures of molecular composition and structure in osteoarthritis. Radiol Clin North Am. 2009, 47: 675-686. 10.1016/j.rcl.2009.04.003.CrossRefPubMed
35.
Menezes NM, Gray ML, Hartke JR, Burstein D: T2 and T1rho MRI in articular cartilage systems. Magn Reson Med. 2004, 51: 503-509. 10.1002/mrm.10710.CrossRefPubMed
36.
Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S: T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology. 2004, 232: 592-598. 10.1148/radiol.2322030976.PubMedCentralCrossRefPubMed
37.
Jones EF, Schooler J, Miller DC, Drake CR, Wahnishe H, Siddiqui S, Li X, Majumdar S: Characterization of Human Osteoarthritic Cartilage Using Optical and Magnetic Resonance Imaging. Mol Imaging Biol. 2011,
38.
Welsch GH, Mamisch TC, Domayer SE, Dorotka R, Kutscha-Lissberg F, Marlovits S, White LM, Trattnig S: Cartilage T2 assessment at 3-T MR imaging: in vivo differentiation of normal hyaline cartilage from reparative tissue after two cartilage repair procedures - initial experience. Radiology. 2008, 247: 154-161. 10.1148/radiol.2471070688.CrossRefPubMed
39.
Borthakur A, Mellon E, Niyogi S, Witschey W, Kneeland JB, Reddy R: Sodium and T1rho MRI for molecular and diagnostic imaging of articular cartilage. NMR Biomed. 2006, 19: 781-821. 10.1002/nbm.1102.PubMedCentralCrossRefPubMed
40.
Souza RB, Stehling C, Wyman BT, Hellio Le Graverand MP, Li X, Link TM, Majumdar S: The effects of acute loading on T1rho and T2 relaxation times of tibiofemoral articular cartilage. Osteoarthritis Cartilage. 2010, 18: 1557-1563. 10.1016/j.joca.2010.10.001.CrossRefPubMed
41.
Williams A, Sharma L, McKenzie CA, Prasad PV, Burstein D: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage in knee osteoarthritis: findings at different radiographic stages of disease and relationship to malalignment. Arthritis Rheum. 2005, 52: 3528-3535. 10.1002/art.21388.CrossRefPubMed
42.
Bashir A, Gray ML, Hartke J, Burstein D: Nondestructive imaging of human cartilage glycosaminoglycan concentration by MRI. Magn Reson Med. 1999, 41: 857-865. 10.1002/(SICI)1522-2594(199905)41:5<857::AID-MRM1>3.0.CO;2-E.CrossRefPubMed
43.
Watanabe A, Wada Y, Obata T, Ueda T, Tamura M, Ikehira H, Moriya H: Delayed gadolinium-enhanced MR to determine glycosaminoglycan concentration in reparative cartilage after autologous chondrocyte implantation: preliminary results. Radiology. 2006, 239: 201-208. 10.1148/radiol.2383050173.CrossRefPubMed
44.
Owman H, Tiderius CJ, Neuman P, Nyquist F, Dahlberg LE: Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis. Arthritis Rheum. 2008, 58: 1727-1730. 10.1002/art.23459.CrossRefPubMed
45.
McAlindon TE, Nuite M, Krishnan N, Ruthazer R, Price LL, Burstein D, Griffith J, Flechsenhar K: Change in knee osteoarthritis cartilage detected by delayed gadolinium enhanced magnetic resonance imaging following treatment with collagen hydrolysate: a pilot randomized controlled trial. Osteoarthritis Cartilage. 2011, 19: 399-405. 10.1016/j.joca.2011.01.001.CrossRefPubMed
46.
Wang L, Wu Y, Chang G, Oesingmann N, Schweitzer ME, Jerschow A, Regatte RR: Rapid isotropic 3D-sodium MRI of the knee joint in vivo at 7T. J Magn Reson Imaging. 2009, 30: 606-614. 10.1002/jmri.21881.PubMedCentralCrossRefPubMed
47.
Wheaton AJ, Borthakur A, Shapiro EM, Regatte RR, Akella SV, Kneeland JB, Reddy R: Proteoglycan loss in human knee cartilage: quantitation with sodium MR imaging - feasibility study. Radiology. 2004, 231: 900-905. 10.1148/radiol.2313030521.CrossRefPubMed
48.
Borthakur A, Shapiro EM, Beers J, Kudchodkar S, Kneeland JB, Reddy R: Sensitivity of MRI to proteoglycan depletion in cartilage: comparison of sodium and proton MRI. Osteoarthritis Cartilage. 2000, 8: 288-293. 10.1053/joca.1999.0303.CrossRefPubMed
49.
Burstein D, Gray ML, Hartman AL, Gipe R, Foy BD: Diffusion of small solutes in cartilage as measured by nuclear magnetic resonance (NMR) spectroscopy and imaging. J Orthop Res. 1993, 11: 465-478. 10.1002/jor.1100110402.CrossRefPubMed
50.
Mamisch TC, Menzel MI, Welsch GH, Bittersohl B, Salomonowitz E, Szomolanyi P, Kordelle J, Marlovits S, Trattnig S: Steady-state diffusion imaging for MR in-vivo evaluation of reparative cartilage after matrix-associated autologous chondrocyte transplantation at 3 tesla - preliminary results. Eur J Radiol. 2008, 65: 72-79. 10.1016/j.ejrad.2007.09.015.CrossRefPubMed
51.
Hunter DJ, Zhang W, Conaghan PG, Hirko K, Menashe L, Li L, Reichmann WM, Losina E: Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage. 2011, 19: 557-588. 10.1016/j.joca.2010.10.029.PubMedCentralCrossRefPubMed
52.
Barr C, Bauer JS, Malfair D, Ma B, Henning TD, Steinbach L, Link TM: MR imaging of the ankle at 3 Tesla and 1.5 Tesla: protocol optimization and application to cartilage, ligament and tendon pathology in cadaver specimens. Eur Radiol. 2007, 17: 1518-1528. 10.1007/s00330-006-0446-4.CrossRefPubMed
53.
Bauer JS, Barr C, Henning TD, Malfair D, Ma CB, Steinbach L, Link TM: 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: 604-611. 10.1097/RLI.0b013e31817e9ada.CrossRefPubMed
54.
Roemer FW, Kwoh CK, Hannon MJ, Crema MD, Moore CE, Jakicic JM, Green SM, Guermazi A: Semiquantitative assessment of focal cartilage damage at 3T MRI: A comparative study of dual echo at steady state (DESS) and intermediate-weighted (IW) fat suppressed fast spin echo sequences. Eur J Radiol. 2011, 80: e126-131. 10.1016/j.ejrad.2010.07.025.CrossRefPubMed
55.
Bauer JS, Krause SJ, Ross CJ, Krug R, Carballido-Gamio J, Ozhinsky E, Majumdar S, Link TM: Volumetric cartilage measurements of porcine knee at 1.5-T and 3.0-T MR imaging: evaluation of precision and accuracy. Radiology. 2006, 241: 399-406. 10.1148/radiol.2412051330.CrossRefPubMed
56.
Eckstein F, Burstein D, Link TM: Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis. NMR Biomed. 2006, 19: 822-854. 10.1002/nbm.1063.CrossRefPubMed
57.
Hayashi D, Roemer FW, Guermazi A: Choice of pulse sequences for magnetic resonance imaging-based semiquantitative assessment of cartilage defects in osteoarthritis research: comment on the article by Dore et al. Arthritis Rheum. 2010, 62: 3830-3831. 10.1002/art.27731. author reply 3831-3832CrossRefPubMed
Metadata
Title
Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis
Authors
Ali Guermazi
Frank W Roemer
Deborah Burstein
Daichi Hayashi
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Arthritis Research & Therapy / Issue 6/2011
Electronic ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar3488

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