Arthroscopy vs. MRI for a detailed assessment of cartilage disease in osteoarthritis: diagnostic value of MRI in clinical practice

Lars V von Engelhardt, Matthias Lahner, André Klussmann, Bertil Bouillon, Andreas Dàvid, Patrick Haage, Thomas K Lichtinger, Lars V von Engelhardt, Matthias Lahner, André Klussmann, Bertil Bouillon, Andreas Dàvid, Patrick Haage, Thomas K Lichtinger

Abstract

Background: In patients with osteoarthritis, a detailed assessment of degenerative cartilage disease is important to recommend adequate treatment. Using a representative sample of patients, this study investigated whether MRI is reliable for a detailed cartilage assessment in patients with osteoarthritis of the knee.

Methods: In a cross sectional-study as a part of a retrospective case-control study, 36 patients (mean age 53.1 years) with clinically relevant osteoarthritis received standardized MRI (sag. T1-TSE, cor. STIR-TSE, trans. fat-suppressed PD-TSE, sag. fat-suppressed PD-TSE, Siemens Magnetom Avanto syngo MR B 15) on a 1.5 Tesla unit. Within a maximum of three months later, arthroscopic grading of the articular surfaces was performed. MRI grading by two blinded observers was compared to arthroscopic findings. Diagnostic values as well as intra- and inter-observer values were assessed.

Results: Inter-observer agreement between readers 1 and 2 was good (kappa = 0.65) within all compartments. Intra-observer agreement comparing MRI grading to arthroscopic grading showed moderate to good values for readers 1 and 2 (kappa = 0.50 and 0.62, respectively), the poorest being within the patellofemoral joint (kappa = 0.32 and 0.52). Sensitivities were relatively low at all grades, particularly for grade 3 cartilage lesions. A tendency to underestimate cartilage disorders on MR images was not noticed.

Conclusions: According to our results, the use of MRI for precise grading of the cartilage in osteoarthritis is limited. Even if the practical benefit of MRI in pretreatment diagnostics is unequivocal, a diagnostic arthroscopy is of outstanding value when a grading of the cartilage is crucial for a definitive decision regarding therapeutic options in patients with osteoarthritis.

Figures

Figure 1
Figure 1
Coronal PD-weighted TSE MRI of a 68-year-old woman. Tibial medial MRI shows a full-thickness defect of the cartilage with denudation of the bone (black arrow). This finding is defined as a grade 4 disorder. Signal heterogeneities within the cartilage at the lateral tibia were documented as a grade 1 cartilage disease (white arrow).
Figure 2
Figure 2
Sagittal PD-weighted TSE MRI of a 41-year-old male. A defect of more than 50% of the cartilage thickness at the medial femoral condyle is visible (white arrow). This finding is defined as grade 3 disease. A grade 2 disorder as a superficial fibrillation or erosion composing less than 50% of the cartilage was noticed at the tibial medial plateau (black arrow).

References

    1. Arden N, Nevitt MC. Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol. 2006;11:3–25. doi: 10.1016/j.berh.2005.09.007.
    1. Bruyère O, Burlet N, Delmas PD, Rizzoli R, Cooper C, Reginster JY. Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system. BMC Musculoskeletal Disorders. 2008;11:165. doi: 10.1186/1471-2474-9-165.
    1. Gidwani S, Fairbank A. The orthopaedic approach to managing osteoarthritis of the knee. BMJ. 2004;11:1220–1224. doi: 10.1136/bmj.329.7476.1220.
    1. Gross AE. Cartilage resurfacing: filling defects. J Arthroplasty. 2003;11:14–17. doi: 10.1054/arth.2003.50084.
    1. Hunziker EB. Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects. Osteoarthritis Cartilage. 2002;11:432–463. doi: 10.1053/joca.2002.0801.
    1. Disler DG, McCauley TR, Kelman CG, Fuchs MD, Ratner LM, Wirth CR, Hospodar PP. Fat-suppressed three-dimensional spoiled gradient-echo MR imaging of hyaline cartilage defects in the knee: comparison with standard MR imaging and arthroscopy. Am J Roentgenol. 1996;11:127–132.
    1. Halbrecht JL, Jackson DW. Office arthroscopy: a diagnostic alternative. Arthroscopy. 1992;11:320–326.
    1. Mathieu L, Bouchard A, Marchaland JP, Potet J, Fraboulet B, Danguy-des-Deserts M, Versier G. Knee MR-arthrography in assessment of meniscal and chondral lesions. Orthop Traumatol Surg Res. 2009;11:40–47. doi: 10.1016/j.otsr.2008.09.005.
    1. Nikolaou VS, Chronopoulos E, Savvidou C, Plessas S, Giannoudis P, Efstathopoulos E, Papachristou G. MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Trauma Manag Outcomes. 2008;11:4. doi: 10.1186/1752-2897-2-4.
    1. Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast spin-echo imaging. J Bone Joint Surg Am. 1998;11:1276–1284.
    1. Recht MP, Kramer J, Marcelis S, Pathria MN, Trudell D, Haghighi P, Sartoris DJ, Resnick D. Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology. 1993;11:473–478.
    1. Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology. 1996;11:209–212.
    1. Sonin AH, Pensy RA, Mulligan ME, Hatem S. Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression. Am J Roentgenol. 2002;11:1159–1166.
    1. Wong S, Steinbach L, Zhao J, Stehling C, Ma CB, Link TM. Comparative study of imaging at 3.0 T versus 1.5 T of the knee. Skeletal Radiol. 2009;11:761–769. doi: 10.1007/s00256-009-0683-0.
    1. Yoshioka H, Stevens K, Hargreaves BA, Steines D, Genovese M, Dillingham MF, Winalski CS, Lang P. Magnetic resonance imaging of articular cartilage of the knee: comparison between fat-suppressed three-dimensional SPGR imaging, fat-suppressed FSE imaging, and fat-suppressed three-dimensional DEFT imaging, and correlation with arthroscopy. J Magn Reson Imaging. 2004;11:857–864. doi: 10.1002/jmri.20193.
    1. Bachmann GF, Basad E, Rauber K, Damian MS, Rau WS. Degenerative joint disease on MRI and physical activity: a clinical study of the knee joint in 320 patients. Eur Radiol. 1999;11:145–152. doi: 10.1007/s003300050646.
    1. Blackburn WD Jr, Bernreuter WK, Rominger M, Loose LL. Arthroscopic evaluation of knee articular cartilage: a comparison with plain radiographs and magnetic resonance imaging. J Rheumatol. 1994;11:675–679.
    1. Broderick LS, Turner DA, Renfrew DL, Schnitzer TJ, Huff JP, Harris C. Severity of articular cartilage abnormality in patients with osteoarthritis: evaluation with fast spin-echo MR vs arthroscopy. Am J Roentgenol. 1994;11:99–103.
    1. Drapé JL, Pessis E, Auleley GR, Chevrot A, Dougados M, Ayral X. Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees. Radiology. 1998;11:49–55.
    1. Kawahara Y, Uetani M, Nakahara N, Doiguchi Y, Nishiguchi M, Futagawa S, Kinoshita Y, Hayashi K. Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee. Correlation of MR and arthroscopic findings. Acta Radiol. 1998;11:120–125.
    1. McNicholas MJ, Brooksbank AJ, Walker CM. Observer agreement analysis of MRI grading of knee osteoarthritis. R Coll Surg Edinb. 1999;11:31–33.
    1. von Engelhardt LV, Schmitz A, Burian B, Pennekamp PH, Schild HH, Kraft CN, von Falkenhausen M. 3-Tesla MRI vs. arthroscopy for diagnostics of degenerative knee cartilage diseases: preliminary clinical results. Orthopade. 2008;11:916–922.
    1. Kellgren JH, Lawrence JS. Atlas of standard radiographs: the epidemiology of chronic rheumatism. Vol. 11. Oxford: Blackwell; 1963.
    1. Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;11:752–757.
    1. Klußmann A, Gebhardt H, Liebers F, von Engelhardt LV, Dávid A, Bouillon B, Rieger MA. Individual and occupational risk factors for knee osteoarthritis - Study protocol of a case control study. BMC Musculoskelet Disord. 2008;11:26. doi: 10.1186/1471-2474-9-26.
    1. Suh JS, Lee SH, Jeong EK, Kim DJ. Magnetic resonance imaging of articular cartilage. Eur Radiol. 2001;11:2015–2025. doi: 10.1007/s003300100911.
    1. Uhl M, Allmann KH, Ihling C, Hauer MP, Conca W, Langer M. Cartilage destruction in small joints by rheumatoid arthritis: assessment of fat-suppressed three-dimensional gradient-echo MR pulse sequences in vitro. Skeletal Radiol. 1998;11:677–682. doi: 10.1007/s002560050458.
    1. Brittberg M. Evaluation of Cartilage Injuries and Cartilage Repair. Osteologie. 2000;11:17–25.
    1. Kundel HL, Polansky M. Measurement of observer agreement. Radiology. 2003;11:303–308. doi: 10.1148/radiol.2282011860.
    1. Landis JR, Koch GC. The measurement of observer agreement for categorical data. Biometrics. 1977;11:159–174. doi: 10.2307/2529310.
    1. Guckel C, Jundt G, Schnabel K, Gachter A. Spin-echo and 3D gradient-echo imaging of the knee joint: a clinical and histopathological comparison. Eur J Radiol. 1995;11:25–33. doi: 10.1016/0720-048X(95)00681-F.
    1. Murphy BJ. Evaluation of grades 3 and 4 chondromalacia of the knee using T2*-weighted 3D gradient-echo articular cartilage imaging. Skeletal Radiol. 2001;11:305–311. doi: 10.1007/s002560100330.
    1. Bachmann G, Heinrichs C, Jürgensen I, Rominger M, Scheiter A, Rau WS. Comparison of different MRT techniques in the diagnosis of degenerative cartilage diseases. In vitro study of 50 joint specimens of the knee at T1.5. Rofo. 1997;11:429–436.
    1. Hodler J, Resnick D. Current status of imaging of articular cartilage. Skeletal Radiol. 1996;11:703–709. doi: 10.1007/s002560050165.
    1. Erickson SJ, Prost RW, Timins ME. The "magic angle" effect: background physics and clinical relevance. Radiology. 1993;11:23–25.
    1. Waldschmidt JG, Rilling RJ, Kajdacsy-Balla AA, Boynton MD, Erickson SJ. In vitro and in vivo MR imaging of hyaline cartilage: zonal anatomy, imaging pitfalls, and pathologic conditions. Radiographics. 1997;11:1387–1402.
    1. van Kampen A, de Waal Malefijt MC, Jerosch J, Castro WH, Busch M, Pape M. Interobserver variance in diagnostic arthroscopy of the knee. Knee Surg Sports Traumatol Arthrosc. 1998;11:16–20. doi: 10.1007/s001670050066.
    1. Brismar BH, Wredmark T, Movin T, Leandersson J, Svensson O. Observer reliability in the arthroscopic classification of osteoarthritis of the knee. J Bone Joint Surg Br. 2002;11:42–47. doi: 10.1302/0301-620X.84B1.11660.
    1. Marx RG, Connor J, Lyman S, Amendola A, Andrish JT, Kaeding C, McCarty EC, Parker RD, Wright RW, Spindler KP. Multirater agreement of arthroscopic grading of knee articular cartilage. Am J Sports Med. 2005;11:1654–1657. doi: 10.1177/0363546505275129.
    1. Acebes C, Roman-Blas JA, Delgado-Baeza E, Palacios I, Herrero-Beaumont G. Correlation between arthroscopic and histopathological grading systems of articular cartilage lesions in knee osteoarthritis. Osteoarthritis Cartilage. 2009;11:205–212. doi: 10.1016/j.joca.2008.06.010.
    1. Putz R. Anatomy and biomechanics of the knee joint. Radiologe. 1995;11:77–86.
    1. Baumgaertner MR, Cannon WD Jr, Vittori JM, Schmidt ES, Maurer RC. Arthroscopic debridement of the arthritic knee. Clin Orthop Relat Res. 1990;11:197–202.
    1. Edelson R, Burks RT, Bloebaum RD. Short- term effects of knee washout for osteoarthritis. Am J Sports Med. 1995;11:345–349. doi: 10.1177/036354659502300317.
    1. Wai EK, Kreder HJ, Williams JI. Arthroscopic débridement of the knee for osteoarthritis in patients fifty years of age or older: utilization and outcomes in the Province of Ontario. J Bone Joint Surg Am. 2002;11:17–22.
    1. Boegård T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the patellofemoral joint. Ann Rheum Dis. 1998;11:395–400. doi: 10.1136/ard.57.7.395.
    1. Boegård T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis. 1998;11:401–407. doi: 10.1136/ard.57.7.401.
    1. Kornaat PR, Bloem JL, Ceulemans RY, Riyazi N, Rosendaal FR, Nelissen RG, Carter WO, Hellio Le Graverand MP, Kloppenburg M. Osteoarthritis of the knee: association between clinical features and MR imaging findings. Radiology. 2006;11:811–817. doi: 10.1148/radiol.2393050253.
    1. Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, Majumdar S. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003;11:373–381. doi: 10.1148/radiol.2262012190.

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