Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features
Peter R. Kornaat Margreet Kloppenburg Ruby Sharma Stella A. Botha-Scheepers Marie-Pierre Hellio Le Graverand L. Napoleon J. E. M. Coene Johan L. Bloem Iain Watt
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M.-P. H. Le Graverand Pfizer Groton
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Groton
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CT
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USA
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L. N. J. E. M. Coene Department of Orthopaedic Surgery, Haga Hospital
, The Hague,
Netherlands
It has been suggested that bone marrow edema-like (BME) lesions in the knee are associated with progression of osteoarthritis (OA). The purpose of our study in patients with OA was to evaluate prospectively changes of BME lesions over 2 years and their relationship with clinical features. Magnetic resonance (MR) images of the knee were obtained from 182 patients (20% male; aged 4376 years; mean age 59 years) who had been diagnosed with familial symptomatic OA at multiple joint sites. MR images were made at baseline and at 2 years follow-up. BME lesions in 2 years were associated with clinical
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features assessed by Western Ontario
and McMaster Universities
Osteoarthritis (WOMAC) scores. A total of
327 BME lesions were recorded. Total
size of BME lesions changed in 90
patients (66%). Size of individual
lesions changed in 147 foci (45%):
new lesions appeared in 69 (21%),
existing lesions disappeared in 32
(10%), increased in size in 26 (8%)
and decreased in size in 20 (6%)
lesions. Increase or decrease of BME
lesions, over a 2-year time period, was
not associated with severity of
WOMAC scores. BME lesions
fluctuated in the majority of patients with
OA over a 2-year time period. These
changes were not associated with
severity of WOMAC scores at the
study end point.
OA [2, 3]. However, other studies reported no association
between BME lesions and clinical symptoms [46].
Further, the role of BME as a marker for progression of
OA is open to discussion. In a study by Felson et al. [7],
BME was associated with progression of OA as assessed
by joint space narrowing on conventional radiographs. On
the other hand, in a study by Phan et al. [5], changes in
BME did not significantly change with progression of
disease assessed by Western Ontario and McMaster
Universities Osteoarthritis (WOMAC) scores.
Since these contradictory results regarding the
association between BME and clinical features have been
reported, the purpose of our study was to evaluate changes
in BME lesions over a 2-year period, and associate them
with clinical features.
Patients and methods
The present prospective study is part of the ongoing GARP
(Genetics, Osteoarthritis and Progression) study [8]. The
primary goal of the GARP study is the identification of
genetic susceptibility determinants to OA and disease
progression in middle-aged sibling pairs with OA at
multiple joint sites. MR image sets of the knee were
obtained in 182 patients at study entry and after 2 years [6].
Only one knee, the most symptomatic, was imaged per
patient. In the present, study 39% (71/182) of the patients
had symptomatic knee OA in their imaged knee, defined as
pain or stiffness on most days in the month prior to study
entry, and osteophytes on radiographs. As the purpose of
the MR study was to assess progression of OA, no images
were made of a knee that already had a maximum Kellgren
and Lawrence score of grade 4 [9].
Clinical assessment
Clinical data were assessed by WOMAC to assess pain,
stiffness and functional impairment of the imaged knee at
the 2-year time point, not at baseline [10].
Knees were imaged using a transmit-receive four-channel
knee coil in a 1.5-T superconducting magnet (Philips
Medical Systems, Best, the Netherlands). Each
examination consisted of: coronal proton density and T2-weighted
dual spin echo (SE) images (with repetition time (TR) of
2,200 ms; echo time (TE) of 20/80 ms; number of
excitations per data line (NEX) 2; 5 mm slice thickness;
0.5 mm intersection gap; 160 mm field of view (FOV);
256 205 acquisition matrix, 18 slices); sagittal proton
density and T2-weighted dual SE images (TR 2,200 ms;
TE 20/80 ms; NEX 2; 4 mm slice thickness; 0.4 mm
intersection gap; 160 mm (FOV); 256 205 acquisition
matrix, 20 slices); sagittal 3D T1-weighted spoiled gradient
echo (GE) frequency selective fat suppressed images (TR
46 ms; TE 2.5 ms; NEX 1; flip angle 40; 3.0 mm slice
thickness; slice overlap 1.5 mm; no gap; 180 mm (FOV);
256 acquisition matrix, 80 slices); and axial proton density
and T2-weighted turbo spin echo (TSE) fat suppressed
images (TR 2,500 ms; TE 7.1/40 ms; NEX 2; 2 mm slice
thickness; no gap; 180 mm (FOV); 256 acquisition matrix,
62 slices). Total acquisition time (including the initial
survey sequence) was 30 min.
MR interpretation
All MR images were analyzed in known chronological
order by means of consensus between three experienced
readers, using a comprehensive score form [11]. During the
assessment, the readers were blinded to radiographic
results, patient symptoms and patient age. In cases of
disagreement between the readers the more conservative,
less severe score was recorded. BME or cysic lesions was
ass (...truncated)