The relationship between cartilage loss on magnetic resonance imaging and radiographic progression in men and women with knee osteoarthritis.

OBJECTIVE To determine the relationship between radiographic progression of joint space narrowing and cartilage loss on magnetic resonance imaging (MRI) in patients with symptomatic knee osteoarthritis (OA), and to investigate the location of MRI-based cartilage loss in the knee and its relation to radiographic progression. METHODS Two hundred twenty-four men and women (mean age 66 years) were studied. Radiographs and MRI of the more symptomatic knee were obtained at baseline and at 15- and 30-month followup. Radiographs of the knee (with weight-bearing) were read for joint space narrowing (scale 0-3), with progression defined as any worsening in score. We used a semiquantitative method to score cartilage morphology in all 5 regions of the tibiofemoral joint, and defined cartilage loss as an increase in score (scale 0-4) at any region. We examined the relationship between progression of joint space narrowing on radiographic images and cartilage loss on MRI, using a generalized estimating equation proportional odds logistic regression, adjusted for baseline cartilage score, age, body mass index, and sex. The medial and lateral compartments were analyzed separately. RESULTS In the medial compartment, 104 knees (46%) had cartilage loss detected by MRI. The adjusted odds ratio was 3.7 (95% confidence interval 2.2-6.3) for radiographic progression being predictive of cartilage loss on MRI. However, there was still a substantial proportion of knees (80 of 189 [42%]) with cartilage loss visible on MRI when no radiographic progression was apparent. Cartilage loss occurred frequently in the central regions of the femur and tibia as well as the posterior femur region, but radiographic progression was less likely to be observed when posterior femur regions showed cartilage loss. Radiographic progression appeared specific (91%) but not sensitive (23%) for cartilage loss. Overall findings were similar for the lateral compartment. CONCLUSION While our results provide longitudinal evidence that radiographic progression of joint space narrowing is predictive of cartilage loss assessed on MRI, radiography is not a sensitive measure, and if used alone, will miss a substantial proportion of knees with cartilage loss.

[1]  M Lequesne,et al.  Atlas of individual radiographic features in osteoarthritis. , 1995, Osteoarthritis and cartilage.

[2]  Trevor Hastie,et al.  Risk factors for progressive cartilage loss in the knee: a longitudinal magnetic resonance imaging study in forty-three patients. , 2002, Arthritis and rheumatism.

[3]  Johanne Martel-Pelletier,et al.  Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes. , 2004, Arthritis and rheumatism.

[4]  F. Cicuttini,et al.  Comparison and reproducibility of fast and conventional spoiled gradient‐echo magnetic resonance sequences in the determination of knee cartilage volume , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[5]  L. Sharma,et al.  The role of knee alignment in disease progression and functional decline in knee osteoarthritis. , 2001, JAMA.

[6]  P. Wolf,et al.  The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. , 1994, American journal of public health.

[7]  M. Dougados,et al.  Arthroscopic evaluation of chondropathy in osteoarthritis of the knee. , 1996, The Journal of rheumatology.

[8]  F. Cicuttini,et al.  Longitudinal study of changes in tibial and femoral cartilage in knee osteoarthritis. , 2004, Arthritis and rheumatism.

[9]  S. Eustace,et al.  Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. , 1999, Clinical radiology.

[10]  H K Genant,et al.  Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity. , 1991, AJR. American journal of roentgenology.

[11]  J. Kellgren,et al.  Radiological Assessment of Osteo-Arthrosis , 1957, Annals of the rheumatic diseases.

[12]  Jh. Kellgren.  Radiological assessment of osteoarthrosis , 1957 .

[13]  H. Genant,et al.  Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. , 2004, Osteoarthritis and cartilage.

[14]  L. Kazis,et al.  The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis , 2001, Annals of Internal Medicine.

[15]  Wei Li,et al.  Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis , 2003, Annals of Internal Medicine.

[16]  T. Hangartner,et al.  X-ray technologists' reproducibility from automated measurements of the medial tibiofemoral joint space width in knee osteoarthritis for a multicenter, multinational clinical trial. , 2003, The Journal of rheumatology.

[17]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.

[18]  L. Sharma,et al.  Erratum: The role of knee alignment in disease progression and functional decline in knee osteoarthritis (Journal of the American Medical Association (July 11, 2001) 284 (188-195)) , 2001 .

[19]  R Burgkart,et al.  Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value. , 2001, Arthritis and rheumatism.

[20]  M. Dougados,et al.  Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI. , 2003, Osteoarthritis and cartilage.

[21]  P A Dieppe,et al.  No loss of cartilage volume over three years in patients with knee osteoarthritis as assessed by magnetic resonance imaging. , 2002, Osteoarthritis and cartilage.

[22]  J. Lynch,et al.  Joint space width measures cartilage thickness in osteoarthritis of the knee: high resolution plain film and double contrast macroradiographic investigation. , 1995, Annals of the rheumatic diseases.