Calcified Tissue International

, Volume 103, Issue 2, pp 131–143 | Cite as

How Do MRI-Detected Subchondral Bone Marrow Lesions (BMLs) on Two Different MRI Sequences Correlate with Clinically Important Outcomes?

  • Siti Maisarah Mattap
  • Dawn Aitken
  • Karen Wills
  • Laura Laslett
  • Changhai Ding
  • Jean-Pierre Pelletier
  • Johanne Martel-Pelletier
  • Stephen E. Graves
  • Michelle Lorimer
  • Flavia Cicuttini
  • Graeme Jones
Original Research


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.


Bone marrow lesions MRI Pain Cartilage Osteoarthritis 







Association National Joint Replacement Registry


Bone marrow lesions


Confidence interval


Coefficient of variation percentage


Global burden of disease


Gradient-recalled echo


Intra-class correlation coefficient


Intermediate weighted fat saturation


Magnetic resonance


Magnetic resonance imaging




Proton density fat saturation


Relative risk


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.

Author Contributions

All authors were involved in drafting the article or revising it for important intellectual content. All authors have approved the final manuscript. SMM ( and DA ( 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.


This work was supported by the National Health and Medical Research Council of Australia; Tasmanian Community Fund; Masonic Centenary Medical Research Foundation; Royal Hobart Hospital Research Foundation; and Arthritis Foundation of Australia. The study sponsor had no role in the design of the study; the collection, analysis, and interpretation of the data; or the writing of the article and the decision to submit it for publication. The researchers work independently of their funders.

Availability of Data and Material

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Siti Maisarah Mattap
    • 1
  • Dawn Aitken
    • 1
  • Karen Wills
    • 1
  • Laura Laslett
    • 1
  • Changhai Ding
    • 1
  • Jean-Pierre Pelletier
    • 2
  • Johanne Martel-Pelletier
    • 2
  • Stephen E. Graves
    • 3
  • Michelle Lorimer
    • 4
  • Flavia Cicuttini
    • 5
  • Graeme Jones
    • 1
  1. 1.Menzies Institute for Medical ResearchUniversity of TasmaniaHobartAustralia
  2. 2.Osteoarthritis Research UnitUniversity of Montreal Hospital Research Centre (CRCHUM)MontrealCanada
  3. 3.Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)AdelaideAustralia
  4. 4.South Australian Health and Medical Research Institute (SAHMRI)AdelaideAustralia
  5. 5.Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia

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