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How important is MRI for detecting early osteoarthritis?

Nature Clinical Practice Rheumatology volume 4, pages 4–5 (2008)Cite this article

Osteoarthritis (OA) is a major public health problem. Plain radiography, which mainly depicts joint-space narrowing and osteophytes, is useful for defining OA, but has weak associations with symptoms, limited sensitivity to change, as well as poor prediction of cartilage loss and the need for joint replacement.1 In addition, considerable changes occur before the development of the first radiographic abnormalities; for example, >10% of knee cartilage volume is lost and a >40% prevalence of knee cartilage defects is observed2 by the time the earliest radiographic changes are present. MRI, with standard techniques such as fat-saturated, T1-weighted, spoiled gradient echo sequences and T2-weighted, proton-density-weighted fast-spin echo sequences, has been utilized to directly assess knee structural alterations, such as cartilage volume, cartilage defects, subchondral bone changes and meniscal lesions, which has increased our understanding of early joint changes.

Substantial cartilage loss is present in most established OA (as assessed by MRI), and the rate of cartilage loss is a significant predictor of joint replacement.1 Subjects with knee OA lose knee cartilage volume by up to 5% per year, and 60% is lost by the end stage.1 Cartilage loss is normally distributed and seems to start around the age of 40 years, even though X-ray changes are uncommon at this time. In people without established knee OA, the annual loss of tibial cartilage is 2–3% in those with cartilage defects compared with 1–2% in those without defects,3 which suggests that there is a continuum in cartilage loss. Given the lack of a bimodal curve, OA could be defined using artificial cutoff points (as is done for bone mineral density) where the normalization of cartilage volume to the joint surface area can increase the discriminatory power.4 An apparent increase in cartilage volume due to swelling at an early stage, however, is likely to limit its application to defining early OA.

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Authors and Affiliations

  1. C Ding is a Senior Research Fellow and G Jones is a Professor at the Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.,

    Changhai Ding & Graeme Jones

  2. F Cicuttini is a Professor at the Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia.,

    Flavia Cicuttini

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  1. Changhai Ding
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  2. Flavia Cicuttini
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  3. Graeme Jones
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Correspondence to Changhai Ding.

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Ding, C., Cicuttini, F. & Jones, G. How important is MRI for detecting early osteoarthritis?. Nat Rev Rheumatol 4, 4–5 (2008). https://doi.org/10.1038/ncprheum0676

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