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

Abstract

BackgroundIn 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.MethodsIn 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.ResultsInter-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.ConclusionsAccording 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.

Osteochondral Injury After Acute Patellar Dislocation in Children and Adolescents

“…MRI has been shown to have diagnostic value in delineating articular and soft tissue injury, with sensitivities and positive predictive values near 90%. 29 MRI in our study confirmed osteochondral injury in almost half of our patients (44%) despite plain radiograph interpretation as negative for fracture. MRI is strongly recommended after APD for accurate diagnosis and guiding treatment.…”

Non-terminal animal model of post-traumatic osteoarthritis induced by acute joint injury

“…Although MRI was not used in our study, both standing and recumbent magnets can be used for longitudinal examination of this region in the horse and should be considered for future studies. However, we were able to use arthroscopic imaging which is often used as the gold standard for identification and staging of articular cartilage disease 47, 48 since it allows better assessment of the cartilage surface and synovial membrane than MRI, including characterization of the location and severity of lesions 49, 50 . The large size of the animals used in this study was advantageous for arthroscopic and histological data collection, as well as for synovial fluid collection (average 4.3 mL/MCP joint/sample).…”

MRI of the Knee: What Do We Miss?

“…19). The high number of false-negative findings is predominantly secondary to suboptimal spatial resolution and the resulting difficulty in identifying lowgrade, partial-thickness lesions [58,59]. The in-plane spatial resolution needed to detect superficial degenerating cartilage is 0.3 9 0.3 mm [60].…”