Association of quantitative measures of medial meniscal extrusion with structural and symptomatic knee osteoarthritis progression - Data from the OAI FNIH biomarker study

Osteoarthritis Year in Review 2024: Imaging

OBJECTIVE

To review recent literature evidence describing imaging of osteoarthritis (OA) and to identify the current trends in research on OA imaging.

METHOD

This is a narrative review of publications in English, published between April, 2023, and March, 2024. A Pubmed search was conducted using the following search terms: osteoarthritis/OA, radiography, ultrasound/US, computed tomography/CT, magnetic resonance imaging/MRI, DXA/DEXA, and artificial intelligence/AI/deep learning. Most publications focus on OA imaging in the knee and hip. Imaging of OA in other joints and OA imaging with artificial intelligence (AI) are also reviewed.

RESULTS

Compared to the same period last year (April 2022 - March 2023), there has been no significant change in the number of publications utilizing CT, MRI, and artificial intelligence. A notable reduction in the number of OA research papers using radiography and ultrasound is noted. There were several observational studies focusing on imaging of knee OA, such as the Multicenter Osteoarthritis Study, Rotterdam Study, Strontium ranelate efficacy in knee OA (SEKOIA) study, and the Osteoarthritis Initiative FNIH Biomarker study. Hip OA observational studies included, but not limited to, Cohort Hip and Cohort Knee study and UK Biobank study. Studies on emerging applications of AI in OA imaging were also covered. A small number of OA clinical trials were published with a focus on imaging-based outcomes.

CONCLUSION

MRI-based OA imaging research continues to play an important role compared to other modalities. Usage of various AI tools as an adjunct to human assessment is increasingly applied in OA imaging research.

The design of a sample rapid magnetic resonance imaging (MRI) acquisition protocol supporting assessment of multiple articular tissues and pathologies in knee osteoarthritis

Objective

This expert opinion paper proposes a design for a state-of-the-art magnetic resonance image (MRI) acquisition protocol for knee osteoarthritis clinical trials in early and advanced disease. Semi-quantitative and quantitative imaging endpoints are supported, partly amendable to automated analysis. Several (peri-) articular tissues and pathologies are covered, including synovitis.

Method

A PubMed literature search was conducted, with focus on the past 5 years. Further, osteoarthritis imaging experts provided input. Specific MRI sequences, orientations, spatial resolutions and parameter settings were identified to align with study goals. We strived for implementation on standard clinical scanner hardware, with a net acquisition time ≤30 ​min.

Results

Short- and long-term longitudinal MRIs should be obtained at ≥1.5T, if possible without hardware changes during the study. We suggest a series of gradient- and spin-echo-sequences, supporting MOAKS, quantitative analysis of cartilage morphology and T2, and non-contrast-enhanced depiction of synovitis. These sequences should be properly aligned and positioned using localizer images. One of the sequences may be repeated in each participant (re-test), optimally at baseline and follow-up, to estimate within-study precision. All images should be checked for quality and protocol-adherence as soon as possible after acquisition. Alternative approaches are suggested that expand on the structural endpoints presented.

Conclusions

We aim to bridge the gap between technical MRI acquisition guides and the wealth of imaging literature, proposing a balance between image acquisition efficiency (time), safety, and technical/methodological diversity. This approach may entertain scientific innovation on tissue structure and composition assessment in clinical trials on disease modification of knee osteoarthritis.

Imaging Biomarkers of Osteoarthritis

Currently no disease-modifying osteoarthritis drug has been approved for the treatment of osteoarthritis (OA) that can reverse, hold, or slow the progression of structural damage of OA-affected joints. The reasons for failure are manifold and include the heterogeneity of structural disease of the OA joint at trial inclusion, and the sensitivity of biomarkers used to measure a potential treatment effect.This article discusses the role and potential of different imaging biomarkers in OA research. We review the current role of radiography, as well as advances in quantitative three-dimensional morphological cartilage assessment and semiquantitative whole-organ assessment of OA. Although magnetic resonance imaging has evolved as the leading imaging method in OA research, recent developments in computed tomography are also discussed briefly. Finally, we address the experience from the Foundation for the National Institutes of Health Biomarker Consortium biomarker qualification study and the future role of artificial intelligence.