Radiologic Markers of Osteoarthritis Progression

David J. Hunter; Marie-Pierre H. Le Graverand; Felix Eckstein


Curr Opin Rheumatol. 2009;21(2):110-117. 

In This Article

Quantitative MRI-based Cartilage Measurements Evaluating Longitudinal Change in Cartilage Morphometry

More extensive discussion of the technical validity, precision, and sensitivity to change of quantitative measures of cartilage morphology can be found elsewhere.[36] Early longitudinal studies suggested that changes of cartilage volume or thickness of the order of -4 to -6% (SD of -5%) occur per annum in osteoarthritis in most knee compartments followed for periods up to 3 years.[31] The annual changes in cartilage volume/thickness exceeded the precision errors and appeared to be associated with clinical symptoms as well as with time to knee arthroplasty.[52,53] One study[54] detected cartilage volume loss in the absence of change in radiographic JSW, suggesting that MRI has greater sensitivity to change than radiograph.

More recent studies, however, observed smaller rates of change than those quoted above. With rates of about -1 to -3% and standardized response means of -0.3 to -0.5 per year (including The Mechanical Factors in Arthritis of the Knee study,[51] Pfizer,[55] and more recently data from osteoarthritis initiative[56,57]). These more conservative recent estimates have important implications for planning of future clinical trials of disease-modifying treatments for osteoarthritis using MRI techniques.

Conservative study designs based on large MRI progression series currently in the public domain require large sample sizes, if quantitative cartilage morphology measures are used as the end point. If one could confidently design studies based on smaller sample sizes or shorter study durations or both, this would, however, greatly reduce the resource implications for MRI-based interventional studies.

Several studies have suggested that baseline clinical, biomarker, and imaging features are predictive of progression of cartilage loss in the medial compartment of the knee and could be used to provide greater study power by selecting a population at greater risk for more rapid progression. These include increased body mass index (BMI),[58] an increased level of type II collagen C-terminal degradation products detected in the urine (uCTX-II),[59] the presence of varus malalignment at the tibiofemoral joint,[51,60] the presence on MRI of subchondral BMLs,[61] or meniscal abnormalities.[49]


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