A Preliminary Study of Quantitative MRI Cartilage Loss Fraction and Its Association With Future Arthroplasty Using the Osteoarthritis Initiative Database

TL;DR

This study explores a new MRI-based measure of cartilage loss in osteoarthritis and finds it strongly predicts future knee replacement surgery.

Contribution

Introduces cartilage loss fraction as a novel MRI biomarker for predicting future arthroplasty in osteoarthritis.

Findings

Cartilage loss fractions were significantly higher in participants with K-L grade >1.

High AUC values (up to 0.933) indicate strong predictive power for future arthroplasty.

Results outperformed or matched existing OA grading methods in predicting surgery.

Abstract

Background and objective

Osteoarthritis (OA) is the most common arthritis in the world. Despite the high disease burden, there is no therapy to prevent, halt, or reverse OA, and many clinical trials relied on radiographic biomarkers for therapy response. It is important to identify patients with early OA who will eventually need arthroplasty, the end-stage treatment for osteoarthritis. This pilot study evaluates a novel MRI biomarker, cartilage loss fraction, for association with future arthroplasty and evaluates its feasibility of use and effect size estimates.

Materials and methods

Publicly available knee MRIs from the Osteoarthritis Initiative were used. A total of 38 participants with Kellgren-Lawrence (K-L) grade >1 and 38 participants with K-L grade ≤ 1 at enrollment were matched in age, sex, race, and BMI, and assessed for the degree of full-thickness cartilage loss, or cartilage loss fraction. Univariate conditional logistic regression analysis was performed for differences in cartilage loss fractions between groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the association of MRI biomarkers and knee arthroplasty during the eight-year follow-up.

Results

The medial femoral condyle, medial tibial plateau, total, and two-year progression cartilage loss fractions were significantly higher in participants with K-L grade >1 (p < 0.01 for all) and showed high area under the curve (AUC) values on ROC analysis (812, 0.827, 0.917, and 0.933, respectively). These results were comparable or more strongly associated with other OA grading schemes.

Conclusion

MRI biomarker cartilage loss fractions are significantly higher in subjects with K-L grade >1 and show a strong association with arthroplasty. After further validation, cartilage loss fracture may be used to predict future arthroplasty.

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