Plain radiography and magnetic resonance imaging diagnostics in osteoarthritis: validated staging and scoring

Osteoarthritis is the most common joint disorder worldwide, and it has an enormous socioeconomic impact both in the United States and throughout the world. Conventional radiography is the simplest and least expensive imaging method for assessing osteoarthritis of the knee. Radiography is able to directly visualize osseous features of osteoarthritis, including marginal osteophytes, subchondral sclerosis, and subchondral cysts, and it is used in clinical practice to confirm the diagnosis of osteoarthritis and to monitor progression of the disease. However, the assessment of joint-space width provides only an indirect estimate of cartilage thickness and meniscal integrity. Magnetic resonance imaging, with its unique ability to examine the joint as a whole organ, holds great promise with regard to the rapid advancement of knowledge about the disease and the evaluation of novel treatment approaches. Magnetic resonance imaging has been applied widely in quantitative morphometric cartilage assessment, and compositional measures have been introduced that evaluate chondral integrity. In addition, magnetic resonance imaging-based validated semiquantitative whole-organ scoring methods have been applied for cross-sectional and longitudinal joint evaluation. This review describes currently applied radiographic and magnetic resonance imaging staging and scoring methods for the assessment of osteoarthritis of the knee and focuses on the strengths and weaknesses of the two modalities with regard to their use in clinical trials and epidemiologic studies.