Advances in osteoarthritis imaging

Abstract

Purpose of reviewImaging plays a pivotal role for diagnosis, follow-up and stratification of osteoarthritis patients in clinical trials and research. We aim to present an overview of currently available and emerging imaging techniques for osteoarthritis assessment and provide insight into relevant benefits and pitfalls of the different modalities. Recent findingsAlthough radiography is considered sufficient for a structural diagnosis of osteoarthritis and is commonly used to define eligibility of patients for participation in clinical trials, it has inherent limitations based on the projectional nature of the technique and inherent challenges regarding reproducibility in longitudinal assessment. MRI has changed our understanding of the disease from wear and tear of cartilage to a whole organ disorder. MRI assessment of structural changes of osteoarthritis includes semi-quantitative, quantitative and compositional evaluation. Ultrasound is helpful in evaluating the degree of synovitis and has value in the assessment particularly of the patella-femoral joint. Recent development of computed tomography technology including weight-bearing systems has led to broader application of this technology in a research context. Summary Advances in MRI technology have resulted in a significant improvement in understanding osteoarthritis as a multitissue disease Keywords cartilage, compositional MRI, osteoarthritis, radiography, ultrasound && ]. Application of advanced imaging methods in large epidemiologic studies such as the Osteoarthritis Initiative (OAI, https://nda.nih.gov/oai/) and the Multicenter Osteoarthritis Study (MOST, https://most.ucsf.edu/) have added to our understanding of the natural course of

Epidemiology of osteoarthritis: literature update 2022–2023

“…Radiographs remain the standard imaging modality to assess OA progression, either through the use of the KL grading system or through loss in the semiquantitative joint space width (JSW) [21]. JSW loss is the recommended study endpoint for Phase III clinical trials investigating the efficacy of potential disease modifying OA drugs (DMOAD), despite recognized limitations including lack of direct assessment of cartilage damage, challenges around reproducibility, and poor sensitivity to detect change over time [21]. Magnetic resonance imaging (MRI), on the other hand, is not typically recommended in clinical settings, but its ability to visualize the entire joint of interest and its high sensitivity to longitudinal changes makes it an appealing option for OA research [21,22].…”

“…Imaging allows for the identification and quantification of structural changes in joints with OA [20]. Radiographs remain the standard imaging modality to assess OA progression, either through the use of the KL grading system or through loss in the semi-quantitative joint space width (JSW) [21]. JSW loss is the recommended study endpoint for Phase III clinical trials investigating the efficacy of potential disease modifying OA drugs (DMOAD), despite recognized limitations including lack of direct assessment of cartilage damage, challenges around reproducibility, and poor sensitivity to detect change over time [21].…”

Protease-Activatable Porphyrin Molecular Beacon for Osteoarthritis Management

“…However, radiography is limited to the visualization of bony structural changes and thus cannot adequately capture all joint tissue implicated in OA. Consequently, patient symptoms can often present in the absence of any OA radiographic findings, leading to later stage diagnoses. , Magnetic resonance imaging (MRI) techniques have made visualization of earlier soft tissue structural damage feasible, but are more costly, less readily available and, like radiography, still rely on the presence of appreciable changes in tissue morphology for diagnosis. , Thus, clinically available imaging options cannot capture the early molecular pathophysiological stages of OA that precede such structural damage. As there are currently no disease-modifying treatments for OA, diagnostic techniques that can detect early stage OA are particularly important for secondary disease prevention, slowing disease progression, and improving patient outcomes …”

“…Consequently, patient symptoms can often present in the absence of any OA radiographic findings, leading to later stage diagnoses. 4 , 5 Magnetic resonance imaging (MRI) techniques have made visualization of earlier soft tissue structural damage feasible, but are more costly, less readily available and, like radiography, still rely on the presence of appreciable changes in tissue morphology for diagnosis. 5 , 6 Thus, clinically available imaging options cannot capture the early molecular pathophysiological stages of OA that precede such structural damage.…”

Biomarkers of Cartilage Composition

“…The MRI musculoskeletal (MSK) biomarker committee is committed to the goal of optimizing MRIderived metrics in research and patient care of MSK diseases. 4 Although the focus is on clinical trials, the results of the committee's work could also be regarded as guidance on how to apply cartilage imaging biomarkers in clinical practice. QIBA profiles are based on published data whenever available or on expert consensus opinion when such data do not exist.…”