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Multicenter Study
. 2012 Nov;20(11):1391-8.
doi: 10.1016/j.joca.2012.07.012. Epub 2012 Jul 27.

Predictive validity of within-grade scoring of longitudinal changes of MRI-based cartilage morphology and bone marrow lesion assessment in the tibio-femoral joint--the MOST study

F W Roemer  1 , M C Nevitt, D T Felson, J Niu, J A Lynch, M D Crema, C E Lewis, J Torner, A Guermazi
Affiliations
Multicenter Study

Predictive validity of within-grade scoring of longitudinal changes of MRI-based cartilage morphology and bone marrow lesion assessment in the tibio-femoral joint--the MOST study

F W Roemer et al. Osteoarthritis Cartilage. 2012 Nov.

Abstract

Objective: In order to increase sensitivity to detect longitudinal change, recording of within-grade changes was introduced for cartilage morphology and bone marrow lesion (BML) assessment in semiquantitative magnetic resonance imaging (MRI) scoring of knee osteoarthritis (OA). The aim of this study was to examine the validity provided by within-grade scoring.

Design: The Multicenter Osteoarthritis (MOST) study is a longitudinal study of subjects with or at risk of knee OA. Baseline and 30 months MRIs were read according to the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) system including within-grade changes for cartilage and BMLs. We tested the validity of within-grade changes by whether the 30-month changes in cartilage and BML assessment were predicted by baseline ipsi-compartmental meniscal damage and malalignment, factors known to affect cartilage loss and BMLs, using ordinal logistic regression.

Results: 1867 Knees (from 1411 participants) were included. Severe medial meniscal damage predicted partial grade (adjusted odds ratio (aOR) 4.4, 95% confidence interval (95% CI) 2.2, 8.7) but not ≥full grade (aOR 1.3, 95% CI 0.8, 2.2) worsening of cartilage loss and predicted both, partial grade (aOR 9.6, 95% CI 3.6, 25.1) and ≥full grade (aOR 5.1, 95% CI 3.2, 8.2) worsening of BMLs. Severe, but not moderate, malalignment predicted ipsi-compartmental within-grade (medial cartilage damage: aOR 5.5, 95% CI 2.6, 11.6; medial worsening of BMLs: aOR 4.9, 95% CI 2.0, 12.3) but not full grade worsening of BMLs and cartilage damage.

Conclusions: Within-grade changes in semiquantitative MRI assessment of cartilage and BMLs are valid and their use may increase the sensitivity of semiquantitative readings in detecting longitudinal changes in these structures.

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Figures

Figure 1
Figure 1
Flowchart of knee inclusion.
Figure 2
Figure 2
Axial proton density weighted fat suppressed image shows within-grade progression of BML in posterior subregion of the medial femur. A. At baseline a small grade 1 BML is depicted (arrowheads). B. At 30 months follow-up, same BML shows discrete but definite increase in size, but still does not fulfill criteria for a full grade change (arrows). Increase in size was coded as within-grade change.
Figure 2
Figure 2
Axial proton density weighted fat suppressed image shows within-grade progression of BML in posterior subregion of the medial femur. A. At baseline a small grade 1 BML is depicted (arrowheads). B. At 30 months follow-up, same BML shows discrete but definite increase in size, but still does not fulfill criteria for a full grade change (arrows). Increase in size was coded as within-grade change.
See this image and copyright information in PMC

References

    1. Peterfy CG, Guermazi A, Zaim S, et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004;12:177–190. - PubMed
    1. 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. - PubMed
    1. Hunter DJ, Guermazi A, Lo GH, et al. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score) Osteoarthritis Cartilage. 2011;19:990–1002. - PMC - PubMed
    1. Roemer FW, Guermazi A, Javaid MK, et al. Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: the MOST Study. A longitudinal multicentre study of knee osteoarthritis. Ann Rheum Dis. 2009;68:1461–1465. - PMC - PubMed
    1. Roemer FW, Zhang Y, Niu J, et al. 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. - PMC - PubMed

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