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Comparative Study
. 2025 Oct:74:152818.
doi: 10.1016/j.semarthrit.2025.152818. Epub 2025 Aug 28.

MRI versus radiography as eligibility screening tool for knee osteoarthritis clinical trials: Data from the osteoarthritis initiative

Ali Guermazi  1 , Frank W Roemer  2 , Erin L Ashbeck  3 , John Lynch  4 , C Kent Kwoh  5 , Mohamed Jarraya  6
Affiliations
Comparative Study

MRI versus radiography as eligibility screening tool for knee osteoarthritis clinical trials: Data from the osteoarthritis initiative

Ali Guermazi et al. Semin Arthritis Rheum. 2025 Oct.

Abstract

Objective: To estimate the prevalence of knee structural pathologies that may warrant exclusion from disease-modifying osteoarthritis drug (DMOAD) trials, based on MRI versus radiography, among participants who would otherwise be considered eligible for enrollment based on commonly used radiographic inclusionary criteria.

Methods: We selected participants from the baseline visit of the Osteoarthritis Initiative that met radiographic structural and clinical eligibility criteria for a DMOAD clinical trial: Radiographic OA (Kellgren-Lawrence grade 2 or 3 with medial minimum joint space width ≥ 1.5 mm); and WOMAC knee pain score between 8 and 18 (0-20 scale). A musculoskeletal radiologist read radiographs and a shortened 3-T MRI protocol for structural pathologies that have been suggested as exclusionary from DMOAD clinical trial participation, as proposed by the Rapid Osteoarthritis MRI Eligibility Score (ROAMES), including meniscal root tears, subchondral insufficiency fractures, osteonecrosis, tumors and bone marrow infiltration, and acute traumatic changes.

Results: Among 380 eligible participants (219 KL2 knees, 161 KL3 knees), structural pathologies that warrant exclusion from clinical trials were found in 38 knees (10 %) based on MRI, versus three knees (0.8 %) on radiography. Based on MRI, the estimated probability of an exclusionary finding in a KL2 knee was 0.06 (95 %CI: 0.03, 0.09), and 0.16 (95 %CI: 0.10, 0.21) in a KL3 knee. The most common finding was complete meniscus posterior root tear (31 knees, 8.2 %).

Conclusion: Structural pathologies that are unlikely to respond to investigational DMOADs were found in ∼10 % of eligible participants based on MRI screening, largely driven by complete meniscal root tears, while these findings were not visible on radiographs.

Keywords: Clinical trial; Eligibility; Knee; MRI; Meniscal root tear; Osteoarthritis; Radiography.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mohamed Jarraya reports financial support was provided by Massachusetts General Hospital. Ali Guermazi reports a relationship with Novartis, ICM, Levicept, Scarcell, Peptinov, Pacira, Coval, 4Moving, Formation Bio, Paradigm, Medipost and TissueGene that includes: consulting or advisory. Ali Guermazi, Frank W Roemer reports a relationship with Boston Imaging Core Lab that includes: equity or stocks. Frank W Roemer reports a relationship with Grünenthal, GmbH that includes: consulting or advisory. C. Kent Kwoh reports a relationship with Apos Health, GSK, Formation Bio, Moebius Sun, Kolon Tissue Gene, Express Scripts, Xalud that includes: consulting or advisory. C. Kent Kwoh reports a relationship with GSK, Cumberland, Artiva and Bristol Myers Squibb that includes: funding grants. C. Kent Kwoh reports a relationship with National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) of the National Institutes of Health that includes: funding grants. Mohamed Jarraya reports a relationship with National Institute of Arthritis and Musculoskeletal and Skin Disease (NIAMS) of the National Institutes of Health that includes: funding grants. Frank W. Roemer is the Editor in Chief of Osteoarthritis Imaging If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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