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Published on: November 28, 2025
Are magnetic resonance imaging features associated with intermittent and constant pain in knee osteoarthritis? A
Di Zhang1,2,3, Inoshi Atukorala2,4, Leticia A Deveza2,5
1National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, PR China.
Objective:
This study aims to explore the relationship between MRI structural morphotypes and intermittent and constant pain in knee osteoarthritis (KOA).
Method:
This cross-sectional study utilised data from the osteoarthritis initiative 48-month visit, including 6631 knees from 3494 individuals. Pain was assessed using the ICOAP Score and categorized into four types (no pain (NP), constant pain (CP), intermittent (IP), both intermittent and constant pain (IACP)). MRI images were acquired using 3T scanner and assessed by ROAMES. MRNet CNN and deep learning methods were used to calculate the probability of bone, meniscus/cartilage, inflammatory and hypertrophic structural morphotypes. The predictive model was based on the best subset algorithm.
Result:
Structural morphotypes, T2 relaxation times and cartilage thickness varied significantly among the NP, IP, CP, and IACP groups. Structural phenotypes probabilities generally increased from NP to IP to CP, being highest in IACP group. The inflammatory morphotype was associated with all pain subgroups, the bone morphotype was mainly associated with IP, the meniscus/cartilage morphotype was associated with IP and IACP, and the hypertrophic morphotype was more strongly associated with CP than IP. ROC analyses showed modest discriminatory performance, with AUCs up to 0.70 for bone and 0.73 for hypertrophic morphotype probability.
Conclusion:
Pain types in OA were associated with MRI structural morphotypes. The probability of the hypertrophic morphotype can be used to distinguish between IP and CP subgroups. A predictive model that incorporates the bone morphotype, inflammatory morphotype, and hypertrophic morphotype can effectively predict the presence or absence of pain.
