OARSI Clinical Trials Recommendations: Hip imaging in clinical trials in osteoarthritis

Abstract

Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/ techniques (including guidance on positioning for radiography, sequence/protocol recommendations/ hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/ control procedures; measurement methods; measurement performance (reliability, responsiveness, and validity); recommendations for trials; and research recommendations.

T1ρ and T2 relaxation times are associated with progression of hip osteoarthritis

“…The findings of our study indicate a similar relationship exists in the hip. Therefore, our study extends previous work done in the knee and supports T 1ρ and T 2 relaxation time measurements as biomarkers of cartilage degeneration in the hip, a joint with markedly different structure, physiology, and MR technical challenges 4,17,31 . Additionally, our study is the first to identify regional increases in T 1ρ and T 2 relaxation time measurements that are associated with hip OA progression; we have accomplished this using both a traditional, semi-automated ROI-based approach as well a novel, fully automated voxel-based approach.…”

“…Reviewers were blinded to clinical and radiographic findings for all subjects, and discrepancies between the two reviewers were resolved by a consensus review with a senior radiologist (TML). First, the SHOMRI scoring system was used to evaluate the presence of articular cartilage lesions using the three FSE MRI series 4,7 . This semi-quantitative scoring system has been shown to have high intra-rater and inter-rater reliability (ICC > 0.91) and demonstrated strong agreement with radiographic grading and clinical parameters 7 .…”

“…Criteria for radiographic diagnosis include osteophytes and joint space narrowing, features that are indicative of relatively advanced disease. Radiography lacks the soft tissue discrimination necessary to identify hip OA at the earliest stages and shows low sensitivity to changes 4 . Therefore, the identification and validation of imaging biomarkers related to early and subtle changes of hip OA are essential to improving clinical assessment and intervention strategies for this disease.…”

MRI-based hip cartilage measures in osteoarthritic and non-osteoarthritic individuals: a systematic review

“…However, guidelines for an approach to assessment of the hip joint using MRI for clinical trials are now available for reference. 51 It would seem that multiaxial, high field strength (3T), high resolution (≤1.5 mm thick slices), fat-suppression techniques could be best suited for this purpose.…”

3D double-echo steady-state sequence assessment of hip joint cartilage and labrum at 3 Tesla: comparative analysis of magnetic resonance imaging and intraoperative data

“…Compared with other MRI sequences, which are commonly used in the assessment of hip cartilage and acetabular labrum [11][12][13], the double-echo steady-state (DESS) MR sequence with water excitation offers high-resolution, three-dimensional (3D) imaging and multiplanar reformatting. In addition, its strong fluid signal creates an arthrogram-like effect within the joint [14] that may increase the diagnostic capabilities by increasing the conspicuity of labrum and hip joint cartilage alterations [3] particularly if conventional noncontrast MRI is performed.…”