The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis

Abstract

Objective Osteoarthritis (OA) is currently diagnosed using clinical and radiographic findings. In recent years MRI use in osteoarthritis has increasingly been studied. This study was conducted to determine the diagnostic utility of MRI in OA through a meta-analysis of published studies. Methods A systematic literature search was undertaken to include studies that used MRI to evaluate or detect osteoarthritis. MRI was compared to various reference standards: histology, arthroscopy, radiography, CT, clinical evaluation, and direct visual inspection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under the curve were calculated. Random effects models were used to pool results. Results Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of 1220 patients (1071 with OA and 149 without). Overall sensitivity from pooling data of all the included studies was 61% (95% confidence interval [CI] 53 to 68), specificity was 82% (95% CI 77 to 87), PPV was 85% (95% CI 80 to 88), and NPV was 57% (95% CI 43 to 70). The ROC showed an area under the curve of 0.804. There was significant heterogeneity in the above parameters (I2 >83%). With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined. Conclusion MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. The sensitivity of MRI is below the current clinical diagnostic standards. At this time standard clinical algorithm for OA diagnosis, aided by radiographs appears to be the most effective method for diagnosing OA.

Signature of circulating microRNAs in osteoarthritis

“…In addition, MRI may not be sensitive enough to detect very early, clinically silent periods of OA. 32 Thus, stable biochemical markers that are easily assessed in the peripheral blood or urine might be ideal measures to diagnose initial stages of OA, predict and assess disease progression, and monitor effects of diseasemodifying treatments. So far, a large array of biochemical markers, most of them reflecting bone and cartilage metabolism, have been studied, but few of them have shown substantial improvement in predicting OA, 23 and none has so far entered clinical routine.…”

Osteoarthritis as a Cause of Locomotive Syndrome: Its Influence on Functional Mobility and Activities of Daily Living

“…Biomarkers, in addition to the use of imaging technologies such as magnetic resonance imaging (MRI), are now being used to detect and monitor cartilage and bone turnover and synovial metabolism for the critical assessment of the pathophysiological processes that lead to joint failure and pain in OA patients [45][46][47]. We previously showed that there are interrelationships between the presence or absence of knee pain and the changes in skeletal tissue and synovitis biomarkers in early-stage knee OA [38].…”

Osteoarthritis year 2012 in review: imaging

“…Menashe and co-authors performed an extensive literature search intended to determine and evaluate the factors affecting the diagnostic performance of MRI in the setting of OA 47 . Twenty studies out of 1,338 screened abstracts were included in the analysis, with the focus on diagnostic performance using different reference standards including arthroscopy, histology and radiography.…”