How Do MRI-Detected Subchondral Bone Marrow Lesions (BMLs) on Two Different MRI Sequences Correlate with Clinically Important Outcomes?
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The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50–80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70; all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (β = 1.12 to 1.37, respectively; p < 0.05) and worsening stiffness (β = 0.45 to 0.52, respectively; all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63; all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (β = − 174.77 to − 140.67; p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.
KeywordsBone marrow lesions MRI Pain Cartilage Osteoarthritis
Association National Joint Replacement Registry
Bone marrow lesions
Coefficient of variation percentage
Global burden of disease
Intra-class correlation coefficient
Intermediate weighted fat saturation
Magnetic resonance imaging
Proton density fat saturation
Spoiled gradient-recalled acquisition in steady state
Short tau inversion recovery
- T1-w GRE
T1-weighted fat-suppressed 3D gradient-recalled acquisition MRI
- T2-w FSE
T2-weighted fat-suppressed 2D fast spin-echo MRI
Tasmanian Older Adult Cohort
Total knee replacement
Western Ontario and McMaster Universities OA Index
We thank the participants who made this study possible, and Catrina Boon and Pip Boon for their role in collecting the data, and André Pelletier and Josée Thériault for their expertise in MRI reading.
All authors were involved in drafting the article or revising it for important intellectual content. All authors have approved the final manuscript. SMM (email@example.com) and DA (firstname.lastname@example.org) take responsibility for the integrity of the work as a whole, from inception to finished article. KW participated in analysis and interpretation of the data, and critically revised the manuscript. LL participated in interpretation of the data, and critically revised the manuscript. SG and MH carried out data collection and critically revised the manuscript. CD, JP, and JM-P participated in the study planning, carried out data collection, and critically revised the manuscript. FC designed and carried out the study planning, participated in interpretation of data, and critically revised the manuscript. GJ designed and carried out the study planning, participated in analysis and interpretation of the analysis, and critically revised the manuscript.
Compliance with ethical standards
Conflict of interest
Jean-Pierre Pelletier, Johanne Martel-Pelletier are shareholders in ArthroLab. Siti Maisarah Mattap, Dawn Aitken, Karen Wills, Laura Laslett, Changhai Ding, Stephen E. Graves, Michelle Lorimer, Flavia Cicuttini, Graeme Jones have declared no competing interests.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Southern Tasmanian Health and Medical Human Research Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All subjects gave informed written consent.
- 10.Raynauld J-P, Martel-Pelletier J, Haraoui B, Choquette D, Dorais M, Wildi LM et al (2011) Risk factors predictive of joint replacement in a 2-year multicentre clinical trial in knee osteoarthritis using MRI: results from over 6 years of observation. Ann Rheum Dis 70(8):1382–1388CrossRefPubMedGoogle Scholar
- 11.Hayashi D, Guermazi A, Kwoh CK, Hannon MJ, Moore C, Jakicic JM et al (2011) Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: a comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences. BMC Musculoskelet Disord 12(1):1–9CrossRefGoogle Scholar
- 15.Yoshioka H, Stevens K, Hargreaves BA, Steines D, Genovese M, Dillingham MF et al (2004) Magnetic resonance imaging of articular cartilage of the knee: comparison between fat-suppressed three-dimensional SPGR imaging, fat-suppressed FSE imaging, and fat-suppressed three-dimensional DEFT imaging, and correlation with arthroscopy. J Magn Reson Imaging 20(5):857–864CrossRefPubMedGoogle Scholar
- 20.Raynauld J-P, Wildi LM, Abram F, Moser T, Pelletier J-P, Martel-Pelletier J (2013) Reliability and sensitivity to change of IW-TSE versus DESS magnetic resonance imaging sequences in the assessment of bone marrow lesions in knee osteoarthritis patients: Longitudinal data from the Osteoarthritis Initiative (OAI) cohort. J Biomed Sci Eng 6(03):9CrossRefGoogle Scholar
- 22.Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 15(Supplement 1):A1-A56Google Scholar
- 27.Raynauld JP, Martel-Pelletier J, Berthiaume MJ, Labonte F, Beaudoin G, de Guise JA et al (2004) Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes. Arthritis Rheum 50(2):476–487CrossRefPubMedGoogle Scholar
- 28.Raynauld JP, Kauffmann C, Beaudoin G, Berthiaume MJ, de Guise JA, Bloch DA et al (2003) Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees. Osteoarthr Cartil 11:351–360CrossRefPubMedGoogle Scholar
- 29.Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labonte F, Beaudoin G, Bloch DA et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 64(4):556–563CrossRefPubMedGoogle Scholar
- 30.Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMedGoogle Scholar
- 32.Australian Orthopaedic Association National Joint Replacement Registry. Annual Report—2016. Adelaide: 2016 1445–3657Google Scholar
- 33.Zhang M, Driban JB, Price LL, Lo GH, McAlindon TE (2015) Magnetic resonance image sequence influences the relationship between bone marrow lesions volume and pain: data from the Osteoarthritis initiative. Biomed Res Int 2015:5Google Scholar