The Design of a Sample Rapid Magnetic Resonance Imaging (MRI) Acquisition Protocol Supporting Assessment of Multiple Articular Tissues and Pathologies in Knee Osteoarthritis

Overview

Journal Osteoarthr Cartil Open

Date 2024 Aug 26

PMID 39183946

Authors

Felix Eckstein

Thula Cannon Walter-Rittel

Akshay S Chaudhari

Nicholas M Brisson

Tazio Maleitzke

Georg N Duda

Anna Wisser

Wolfgang Wirth

Tobias Winkler

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Clinical validation of fully automated cartilage transverse relaxation time (T2) and thickness analysis using quantitative DESS magnetic resonance imaging.

Wirth W, Herger S, Maschek S, Wisser A, Bieri O, Eckstein F MAGMA. 2025; .

PMID: 39992574 DOI: 10.1007/s10334-025-01227-5.

References

Hunter D, Altman R, Cicuttini F, Crema M, Duryea J, Eckstein F . OARSI Clinical Trials Recommendations: Knee imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage. 2015; 23(5):698-715. DOI: 10.1016/j.joca.2015.03.012. View

Hunter D, Nevitt M, Losina E, Kraus V . Biomarkers for osteoarthritis: current position and steps towards further validation. Best Pract Res Clin Rheumatol. 2014; 28(1):61-71. PMC: 4010869. DOI: 10.1016/j.berh.2014.01.007. View

Eckstein F, Ateshian G, Burgkart R, Burstein D, Cicuttini F, Dardzinski B . Proposal for a nomenclature for magnetic resonance imaging based measures of articular cartilage in osteoarthritis. Osteoarthritis Cartilage. 2006; 14(10):974-83. DOI: 10.1016/j.joca.2006.03.005. View

Smith S, Bahouth S, Duryea J . Quantitative bone marrow lesion, meniscus, and synovitis measurement: current status. Skeletal Radiol. 2023; 52(11):2123-2135. DOI: 10.1007/s00256-023-04311-w. View

Liess C, Lusse S, Karger N, Heller M, Gluer C . Detection of changes in cartilage water content using MRI T2-mapping in vivo. Osteoarthritis Cartilage. 2002; 10(12):907-13. DOI: 10.1053/joca.2002.0847. View

Yoo H, Hong S, Oh H, Choi J, Chae H, Ahn J . Diagnostic Accuracy of a Fluid-attenuated Inversion-Recovery Sequence with Fat Suppression for Assessment of Peripatellar Synovitis: Preliminary Results and Comparison with Contrast-enhanced MR Imaging. Radiology. 2016; 283(3):769-778. DOI: 10.1148/radiol.2016160155. View

Cigdem O, Deniz C . Artificial intelligence in knee osteoarthritis: A comprehensive review for 2022. Osteoarthr Imaging. 2024; 3(3). PMC: 11213283. DOI: 10.1016/j.ostima.2023.100161. View

Liebl H, Joseph G, Nevitt M, Singh N, Heilmeier U, Subburaj K . Early T2 changes predict onset of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Ann Rheum Dis. 2014; 74(7):1353-9. PMC: 4160419. DOI: 10.1136/annrheumdis-2013-204157. View

Ballegaard C, Riis R, Bliddal H, Christensen R, Henriksen M, Bartels E . Knee pain and inflammation in the infrapatellar fat pad estimated by conventional and dynamic contrast-enhanced magnetic resonance imaging in obese patients with osteoarthritis: a cross-sectional study. Osteoarthritis Cartilage. 2014; 22(7):933-40. DOI: 10.1016/j.joca.2014.04.018. View

10.

Ruhdorfer A, Haniel F, Petersohn T, Dorrenberg J, Wirth W, Dannhauer T . Between-group differences in infra-patellar fat pad size and signal in symptomatic and radiographic progression of knee osteoarthritis vs non-progressive controls and healthy knees - data from the FNIH Biomarkers Consortium Study and the.... Osteoarthritis Cartilage. 2017; 25(7):1114-1121. PMC: 5466837. DOI: 10.1016/j.joca.2017.02.789. View

11.

Hyhlik-Durr A, Faber S, Burgkart R, Stammberger T, Maag K, Englmeier K . Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence. Eur Radiol. 2000; 10(2):297-303. DOI: 10.1007/s003300050047. View

12.

Hudelmaier M, Wirth W, Wehr B, Kraus V, Wyman B, Le Graverand M . Femorotibial cartilage morphology: reproducibility of different metrics and femoral regions, and sensitivity to change in disease. Cells Tissues Organs. 2010; 192(5):340-50. DOI: 10.1159/000318178. View

13.

Dardzinski B, Schneider E . Radiofrequency (RF) coil impacts the value and reproducibility of cartilage spin-spin (T2) relaxation time measurements. Osteoarthritis Cartilage. 2013; 21(5):710-20. PMC: 3624070. DOI: 10.1016/j.joca.2013.01.006. View

14.

Heilmeier U, Mamoto K, Amano K, Eck B, Tanaka M, Bullen J . Infrapatellar fat pad abnormalities are associated with a higher inflammatory synovial fluid cytokine profile in young adults following ACL tear. Osteoarthritis Cartilage. 2019; 28(1):82-91. PMC: 6935420. DOI: 10.1016/j.joca.2019.09.001. View

15.

Steidle-Kloc E, Dannhauer T, Wirth W, Eckstein F . Responsiveness of Infrapatellar Fat Pad Volume Change to Body Weight Loss or Gain: Data from the Osteoarthritis Initiative. Cells Tissues Organs. 2018; 205(1):53-62. DOI: 10.1159/000485833. View

16.

Steidle-Kloc E, Wirth W, Ruhdorfer A, Dannhauer T, Eckstein F . Intra- and inter-observer reliability of quantitative analysis of the infra-patellar fat pad and comparison between fat- and non-fat-suppressed imaging--Data from the osteoarthritis initiative. Ann Anat. 2015; 204:29-35. PMC: 4764434. DOI: 10.1016/j.aanat.2015.10.004. View

17.

Mosher T, Smith H, Collins C, Liu Y, Hancy J, Dardzinski B . Change in knee cartilage T2 at MR imaging after running: a feasibility study. Radiology. 2004; 234(1):245-9. DOI: 10.1148/radiol.2341040041. View

18.

Schneider E, Nevitt M, McCulloch C, Cicuttini F, Duryea J, Eckstein F . Equivalence and precision of knee cartilage morphometry between different segmentation teams, cartilage regions, and MR acquisitions. Osteoarthritis Cartilage. 2012; 20(8):869-79. PMC: 3391588. DOI: 10.1016/j.joca.2012.04.005. View

19.

Mosher T, Dardzinski B . Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol. 2005; 8(4):355-68. DOI: 10.1055/s-2004-861764. View

20.

Sitoci K, Hudelmaier M, Eckstein F . Nocturnal changes in knee cartilage thickness in young healthy adults. Cells Tissues Organs. 2012; 196(2):189-94. DOI: 10.1159/000333456. View