Abstract
Osteoarthritis (OA) is a common degenerative musculoskeletal disease highly prevalent in aging societies worldwide. Traditionally, knee OA is diagnosed using conventional radiography. However, structural changes of articular cartilage or menisci cannot be directly evaluated using this method. On the other hand, ultrasound is a promising tool able to provide direct information on soft tissue degeneration. The aim of our study was to systematically determine the site-specific diagnostic performance of semi-quantitative ultrasound grading of knee femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of joint space narrowing and osteophytes, using MRI as a reference standard. Eighty asymptomatic and 79 symptomatic subjects with mean age of 57.7 years were included in the study. Ultrasound performed best in the assessment of femoral medial and lateral osteophytes, and medial meniscal extrusion. In comparison to radiography, ultrasound performed better or at least equally well in identification of tibio-femoral osteophytes, medial meniscal extrusion and medial femoral cartilage morphological degeneration. Ultrasound provides relevant additional diagnostic information on tissue-specific morphological changes not depicted by conventional radiography. Consequently, the use of ultrasound as a complementary imaging tool along with radiography may enable more accurate and cost-effective diagnostics of knee osteoarthritis at the primary healthcare level.
Highlights
In clinical practice, severity of knee OA is primarily assessed using conventional radiography especially by evaluation of joint space narrowing (JSN) and to some extent by the Kellgren-Lawrence (KL) grading[5]
Little direct information on soft tissue degeneration is revealed by radiography, and some studies reported insensitivity to progression of cartilage thinning[8], JSN is still being widely applied as an indirect indicator of tibio-femoral cartilage loss
In the inter-rater reliability assessment of radiographic Osteoarthritis Research Society International (OARSI) grading, apart from lateral femoral osteophytes (κ w = 0.374), substantial agreements were reached for all measures between two readers
Summary
Severity of knee OA is primarily assessed using conventional radiography especially by evaluation of joint space narrowing (JSN) and to some extent by the Kellgren-Lawrence (KL) grading[5]. It is known that JSN is a surrogate of both cartilage thinning and meniscal extrusion, and there are no means to directly evaluate cartilage and meniscus morphological damage from radiographs[8,9,10,11]. Morphological changes in bone, meniscus and femoral cartilage can be reliably depicted and semi-quantitatively and/or quantitatively assessed as single features[13,14,15,16,17,18]. Systematic feature- and site-specific cross-comparison of ultrasound, radiography and MRI is still missing in the current literature. The aim of our study was to systematically determine the site-specific diagnostic performance of ultrasound for semi-quantitative grading of femoral articular cartilage, osteophytes and meniscal extrusion, and of radiographic assessment of JSN and osteophytes, using MRI as a reference tool
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