Abstract
BackgroundTo determine the validity of a semi-automated segmentation of bone marrow lesions (BMLs) in the knee.MethodsConstruct validity of the semi-automated BML segmentation method was explored in two studies performed using sagittal intermediate weighted, turbo spine echo, fat-suppressed magnetic resonance imaging sequences obtained from the Osteoarthritis Initiative. The first study (n = 48) evaluated whether tibia BML volume was different across Boston Leeds Osteoarthritis Knee Scores (BLOKS) for tibia BMLs (semiquantitative grades 0 to 3). In the second study (n = 40), we evaluated whether BML volume change was associated with changes in cartilage parameters. The knees in both studies were segmented by one investigator. We performed Wilcoxon signed-rank tests to determine if tibia BML volume was different between adjacent BLOKS BML scores and calculated Spearman correlation coefficients to assess the relationship between 2-year BML volume change and 2-year cartilage morphometry change (significance was p ≤ 0.05).ResultsBML volume was significantly greater between BLOKS BML score 0 and 1 (z = 2.85, p = 0.004) and BLOKS BML scores 1 and 2 (z = 3.09, p = 0.002). There was no significant difference between BLOKS BML scores 2 and 3 (z = −0.30, p = 0.77). Increased tibia BML volume was significantly related to increased tibia denuded area (Spearman r = 0.42, p = 0.008), decreased tibia cartilage thickness (Spearman r = −0.46, p = 0.004), increased femur denuded area (Spearman r = 0.35, p = 0.03), and possibly decreased femur cartilage thickness (Spearman r = −0.30, p = 0.07) but this last finding was not statistically significant.ConclusionThe new, efficient, and reliable semi-automated BML segmentation method provides valid BML volume measurements that increase with greater BLOKS BML scores and confirms previous reports that BML size is associated with longitudinal cartilage loss.
Highlights
To determine the validity of a semi-automated segmentation of bone marrow lesions (BMLs) in the knee
To assess the validity of the new semi-automated BML segmentation method we conducted two analyses using images and data obtained from the Osteoarthritis Initiative (OAI) databases, which are available for public access at http://oai.epi-ucsf.org
Study 2: association between BML size and cartilage morphology We evaluated whether data from the new semi-automated BML segmentation method would replicate findings from previous studies that documented an association between BMLs and cartilage parameters [6,10,24,25,26]
Summary
To determine the validity of a semi-automated segmentation of bone marrow lesions (BMLs) in the knee. Several methods can assess BML size in knees including semi-quantitative scoring [8,10], approximating BML size based on linear measurements [5,6,11,12], or manual/semi-automated segmentation [13,14,15,16,17]. One simple approach to measure BML size is to measure the greatest crosssectional diameter of a BML [5]. This method is timeefficient and offers a quantitative outcome; only one dimension is under scrutiny; other changes may occur that go unnoticed. A new quantitative BML measurement would be accurate and time efficient
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