Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features

European Radiology, Dec 2007

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 43–76 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 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.

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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 0 M.-P. H. Le Graverand Pfizer Groton 0 Groton 0 CT 0 USA 0 0 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 - 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)


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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. Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features, European Radiology, 2007, pp. 3073-3078, Volume 17, Issue 12, DOI: 10.1007/s00330-007-0711-1