Bone marrow lesions can be subtyped into groups with different clinical outcomes using two magnetic resonance imaging (MRI) sequences

Graham G. Giles,David Findlay,Rheza Maulana,Yuanyuan Wang,Flavia M. Cicuttini,Richard O’Sullivan,Anita E. Wluka,Andrew J. Teichtahl,Bonnie M. Liu

doi:10.1186/s13075-015-0780-5

Abstract

IntroductionBone marrow lesions (BMLs) are features detected on MRI that are important in the pathogenesis of knee osteoarthritis. Since BMLs reflect heterogeneous pathologies this prospective cohort study examined whether BMLs detected using different MRI sequences are associated with distinct structural and clinical endpoints.MethodsA total of 297 community-based adults without knee pain were examined to identify BMLs visualised using three-dimensional T1-weighted gradient-echo fat-suppressed (T1-weighted sequences) fat-suppressed and fat-saturated FSE T2-weighted MRI sequences (T2-weighted sequences) at baseline. Cartilage volume was measured at baseline and follow-up, while incident knee pain was assessed at follow-up, an average of 2.3 years later.ResultsAt baseline, 46 BMLs were visualised in 39 participants. Of the 45 BMLs visualised on T2-weighted sequences, 34 (74 %) were also seen on T1-weighted sequences. One BML was seen on only T1-weighted sequences. Knees with BMLs visualised on both T1- and T2-weighted sequences had significantly higher medial tibial cartilage volume loss (45 mm3/annum, standard error of the mean (SEM) 14) than those with BMLs identified on only T2-weighted sequences (−13 mm3/annum SEM 19), after adjustment for age, gender and body mass index (p = 0.01). Incident knee pain was more likely in individuals with BMLs in the medial compartment visualised on both T1- and T2-weighted (eight participants, 53 %) compared to those with BMLs on only T2-weighted sequences (0 %) or no BMLs (76 participants, 31 %, p = 0.02).ConclusionsBMLs present on both T1- and T2-weighted MRI sequences were associated with increased medial tibial cartilage loss and incident knee pain compared with those BMLs seen only on T2-weighted sequences. This suggests that combining different MRI sequences may provide more informative targets in the prevention and treatment of knee osteoarthritis.

Highlights

Bone marrow lesions (BMLs) are features detected on magnetic resonance imaging (MRI) that are important in the pathogenesis of knee osteoarthritis
There were no significant differences in the baseline characteristics of participants according to their grouping
We examined whether the risk of incident knee pain differed according to the presence of BMLs visualised using the different sequences at baseline (Table 4)

Summary

Introduction

Bone marrow lesions (BMLs) are features detected on MRI that are important in the pathogenesis of knee osteoarthritis. Bone marrow lesions (BMLs) are important in the pathogenesis of knee osteoarthritis (OA). BMLs identified by images obtained using STIR, T1- and T2-weighted sequences showed that affected tissue, rather than being oedematous, as was initially proposed [5], consisted of bone necrosis, fibrosis and bone marrow necrosis, with little oedema [9]. In that study of 16 patients with OA, Zanetti et al began to differentiate the underlying histology of BMLs visualised by differing combinations of STIR, T1- and T2-weighted sequences. Use of data obtained using two different sequences has been shown to better discriminate distinct vertebral body marrow and endplate lesions (Modic change) [11], each with characteristic histological and clinical correlates [11,12,13,14,15,16,17,18,19,20]

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