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Abstract
Background: Bone marrow lesions (BMLs) are associated with osteoarthritis (OA). We assessed the performance of two commonly used MRI sequences, IW-TSE and DESS, for reliability in the detection of BMLs and sensitivity to estimate change over time. We suggested that the IW-TSE would demonstrate higher sensitivity to change than DESS in the assessment of BML prevalence and change over time. This study was performed using a subset of the Osteoarthritis Initiative (OAI) cohort. Methods: A sub-group of 144 patients was selected from the OAI progression cohort who all had IW-TSE and DESS MRI acquisitions at baseline and 24 months. BMLs were assessed using a semi-quantitative scale in the global knee, medial and lateral compartments, and subregions. Intra-reader reliability was assessed on a subset of 51 patients. Results: Intra-reader reliability was substantial for the global knee ≥ 0.64, medial ≥ 0.70, and lateral ≥ 0.63 compartments for IW-TSE and DESS. The prevalence of BML detected at baseline was only slightly greater for IW-TSE compared to DESS. The mean BML score at baseline was significantly higher (p ≤ 0.006) for the IW-TSE than the DESS. However, mean change at 24 months was similar for both sequences for all regions except the medial compartment (p = 0.034) and medial femur (p = 0.015) where they were significantly higher for DESS than IW-TSE. Moreover, the prevalence of BML change at 24 months was similar in all regions except the global knee (p = 0.047) and the lateral tibial plateau (p = 0.031). Conclusion: This study does not suggest superior sensitivity to change of one sequence over the other for almost all the regions. The only difference is a higher BML mean change over time detected by the DESS sequence in the medial compartment and femur. These data bring into perspective that both sequences seem equivalent regarding their use for the assessment of BML in clinical trials.
Highlights
In magnetic resonance imaging (MRI) assessment of knee osteoarthritis (OA), subchondral bone has frequently been found to be the site of signal alterations reflecting the presence of lesions
Intra-reader reliability for both intermediate-weighted turbo spin echo (IW-TSE) and dual echo steady state (DESS) was substantial for the IW-TSE sequence for the global knee and values were 0.64, for the medial compartment 0.73, and for the lateral compartment 0.63; for the DESS sequence values of 0.67, 0.70, and 0.66 were obtained, respectively
The prevalence of BMLs detected at baseline in the global knee was almost identical for the IW-TSE and DESS (80.6% vs. 79.2%) (Figure 1)
Summary
In magnetic resonance imaging (MRI) assessment of knee osteoarthritis (OA), subchondral bone has frequently been found to be the site of signal alterations reflecting the presence of lesions. These lesions were first thought to be only bone marrow edema, as they showed hypersignal in water-sensitive-weighted sequences [1]. We assessed the performance of two commonly used MRI sequences, IW-TSE and DESS, for reliability in the detection of BMLs and sensitivity to estimate change over time.
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