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Published on: May 6, 2020
Bone marrow lesions in knee osteoarthritis assessed by dynamic contrast-enhanced MRI with histopathological
Flemming Kromann Nielsen1, Flemming Brandt Sørensen2, Niels Egund1
1Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
Background:
Bone marrow lesions (BMLs) in knee osteoarthritis (OA) have been assessed histopathologically and by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI); however, a direct comparison of the results has not been reported.
Purpose:
To evaluate and compare the findings by DCE-MRI and histopathology of subchondral BMLs in knee OA.
Material And Methods:
In total, 19 patients with medial tibiofemoral knee OA undergoing total knee arthroplasty were analyzed. Preoperative MRI, including a DCE sequence, was performed, and bone biopsies were obtained from the resected specimens corresponding to BML areas. The contrast enhancement by DCE-MRI was analyzed using semi-quantitative (area under the curve [AUC]), peak enhancement [PE]), and quantitative (Ktrans, Kep) methods. Enhancement in the medial OA compartment was compared with similar areas in a normal lateral compartment, and the DCE characteristics of BMLs were correlated with semi-quantitatively graded histopathological features.
Results:
AUC and PE were significantly higher in medial tibial and femoral BMLs compared with the values in the lateral condyles; Ktrans and Kep were only significantly higher in the tibial plateau. In the tibia, AUC and PE were significantly correlated with the grade of vascular proliferation, and PE also with the degree of marrow fibrosis. There was no significant correlation between AUC/PE and histopathological findings in the femur and no correlation between quantitative DCE parameters and histopathological findings.
Conclusion:
BML characteristics by semi-quantitative DCE in the form of AUC and PE may be used as parameters for the degree of histopathological vascularization in the bone marrow whereas quantitative DCE data were less conclusive.
Insights
Semi-quantitative dynamic contrast-enhanced MRI (DCE-MRI) parameters like AUC and PE show promise for assessing bone marrow lesion (BML) vascularization in knee osteoarthritis (OA). Quantitative DCE-MRI data, however, were less conclusive in this study.
Area of Science:
- Radiology and Imaging
- Orthopedics
- Pathology
Background:
- Bone marrow lesions (BMLs) are a feature of knee osteoarthritis (OA).
- Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and histopathology are used to assess BMLs.
- A direct comparison between DCE-MRI and histopathology for BMLs has not been previously reported.
Purpose of the Study:
- To compare DCE-MRI findings with histopathology in subchondral BMLs of knee OA patients.
- To evaluate the utility of semi-quantitative and quantitative DCE-MRI parameters in assessing BMLs.
Main Methods:
- 19 knee OA patients undergoing total knee arthroplasty were analyzed.
- Preoperative DCE-MRI and bone biopsies from BML areas were obtained.
- DCE-MRI contrast enhancement was analyzed using semi-quantitative (AUC, PE) and quantitative (Ktrans, Kep) methods and correlated with histopathology.
Main Results:
- Semi-quantitative parameters (AUC, PE) were significantly higher in medial tibial and femoral BMLs compared to the lateral condyles.
- AUC and PE in the tibia correlated significantly with vascular proliferation and marrow fibrosis.
- Quantitative DCE parameters (Ktrans, Kep) showed limited correlation with histopathology, especially in the femur.
Conclusions:
- Semi-quantitative DCE-MRI parameters (AUC, PE) may reflect the degree of histopathological vascularization in knee OA BMLs.
- Quantitative DCE-MRI parameters were less conclusive in correlating with histopathological findings.
- DCE-MRI shows potential for non-invasively assessing BML characteristics in knee OA.
