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Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain
Published on: August 8, 2019
Assessment of bone marrow oedema-like lesions using MRI in patellofemoral knee osteoarthritis: comparison of
Henry Noorveriandi1, Matthew J Parkes2, Michael J Callaghan3,4
1Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester, United Kingdom.
Objective:
To compare bone marrow oedema-like lesion (BML) volume in subjects with symptomatic patellofemoral (PF) knee osteoarthritis (OA) using four different MRI sequences and to determine reliability of BML volume assessment using these sequences and their correlation with pain.
Methods:
76 males and females (mean age 55.8 years) with symptomatic patellofemoral knee OA had 1.5 T MRI scans. PD fat suppressed (FS), STIR, contrast-enhanced (CE) T1W FS, and 3D T1W fast field echo (FFE) sequences were obtained. All sequences were assessed by one reader, including repeat assessment of 15 knees using manual segmentation and the measurements were compared. We used random-effects panel linear regression to look for differences in the log-transformed BML volume (due to positive skew in the BML volume distribution) between sequences and to determine associations between BML volumes and knee pain.
Results:
58 subjects had PF BMLs present on at least one sequence. Median BML volume measured using T1W FFE sequence was significantly smaller (224.7 mm3, interquartile range [IQR] 82.50-607.95) than the other three sequences. BML volume was greatest on the CE sequence (1129.8 mm3, IQR 467.28-3166.02). Compared to CE sequence, BML volumes were slightly lower when assessed using PDFS (proportional difference = 0.79; 95% confidence interval [CI] 0.62, 1.01) and STIR sequences (proportional difference = 0.85; 95% CI 0.67, 1.08). There were strong correlations between BML volume on PDFS, STIR, and CE T1W FS sequences (ρs = 0.98). Correlations were lower between these three sequences and T1W FFE (ρs = 0.80-0.81). Intraclass correlation coefficients were excellent for proton density fat-suppressed, short-tau inversion recovery, and CE T1W FS sequences (0.991-0.995), while the ICC for T1W FFE was good at 0.88. We found no significant association between BML volumes assessed using any of the sequences and knee pain.
Conclusion:
T1W FFE sequences were less reliable and measured considerably smaller BML volume compared to other sequences. BML volume was larger when assessed using the contrast enhanced T1W FS though not statistically significantly different from BMLs when assessed using PDFS and STIR sequences.
Advances In Knowledge:
This is the first study to assess BMLs by four different MRI pulse sequences on the same data set, including different fluid sensitive sequences and gradient echo type sequence.
Insights
This study compared MRI sequences for measuring bone marrow oedema-like lesions (BMLs) in knee osteoarthritis (OA). The 3D T1W FFE sequence underestimated BML volume and was less reliable than other sequences, with no sequence correlating to pain.
Area of Science:
- Radiology and Imaging
- Orthopedics
- Biomedical Engineering
Background:
- Bone marrow oedema-like lesions (BMLs) are key indicators of knee osteoarthritis (OA) severity.
- Accurate BML volume assessment is crucial for understanding OA progression and treatment response.
- Different MRI sequences may yield varying BML volume measurements.
Purpose of the Study:
- To compare BML volume measurements across four distinct MRI sequences in patients with symptomatic patellofemoral (PF) knee OA.
- To evaluate the reliability of BML volume assessment using these sequences.
- To determine the correlation between BML volumes and knee pain.
Main Methods:
- Seventy-six participants with symptomatic PF knee OA underwent 1.5 T MRI scans.
- Scans included PD fat-suppressed (FS), STIR, contrast-enhanced (CE) T1W FS, and 3D T1W fast field echo (FFE) sequences.
- BML volumes were assessed via manual segmentation, with inter-reader reliability and correlation to pain analyzed.
Main Results:
- 58 subjects presented with PF BMLs on at least one sequence.
- The 3D T1W FFE sequence measured significantly smaller BML volumes compared to the other three sequences.
- Excellent reliability (ICC > 0.99) was observed for PDFS, STIR, and CE T1W FS sequences, while T1W FFE showed good reliability (ICC = 0.88).
- No significant association was found between BML volumes and knee pain across any sequence.
Conclusions:
- 3D T1W FFE sequences are less reliable and underestimate BML volume in knee OA compared to PDFS, STIR, and CE T1W FS sequences.
- CE T1W FS sequences measured the largest BML volumes, though not significantly different from PDFS and STIR.
- BML volume measurements did not correlate with reported knee pain in this cohort.
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