Osteoarthritis is an extremely common cause of morbidity, affecting an estimated 30.8 million adults in the united states, and is cited as the 5th most common cause of disability and the most prevalent form of musculoskeletal pathology worldwide, contributing to tremendous human and economic burden. MR imaging can provide valuable information regarding a variety of characteristics relevant to the natural history of osteoarthritis, including risk factors, diagnosis and severity of disease, and complications of both disease and treatment, thereby facilitating clinical decision making.
Osteoarthritis: Present
Target Audience: Radiologists, clinicians, technologists, and scientists.
Objectives
- Describe the disease(s) and summarize the current standard imaging techniques;
- Identify the current unmet imaging needs of several musculoskeletal diseases; and
- Discuss potential solutions based on novel/advanced imaging techniques.
Purpose
-Review current techniques for imaging of osteoarthritis and related issues, focusing on current clinical practice.
-Identify imaging factors important for clinical decision making
Methods/Results/Discussion
Osteoarthritis is an extremely common cause of morbidity, affecting an estimated 30.8 million adults in the united states, and is cited as the 5th most common cause of disability and the most prevalent form of musculoskeletal pathology worldwide, contributing to tremendous human and economic burden 1. MR imaging can provide valuable information regarding a variety of characteristics relevant to the natural history of osteoarthritis, including risk factors, diagnosis and severity of disease, and complications of both disease and treatment, thereby facilitating clinical decision making.
A variety of risk factors have been identified as potentially predisposing an individual to the development of osteoarthritis. Two categories of factors in which MRI is particularly useful in this regard are joint morphology and joint injury. Abnormal joint morphology has been recognized as a risk factor for osteoarthritis in numerous joints, for example, femoroacetabular impingement in the hip, patellofemoral dysplasia in the knee, and pes planovalgus in the hindfoot. Additionally, individuals suffering traumatic injuries such as anterior cruciate ligament and meniscal tears, shoulder and patellofemoral dislocation, and ankle sprains are also at increased risk for osteoarthritis. The degree and extent of such findings are well characterized on MR imaging. Diagnosis of osteoarthritis as the cause of a given individual’s joint pain can be challenging, and MR imaging can be useful in assessing the presence and degree of severity of arthrosis, and well as evaluating for concomitant pathology as an alternate and/or contributing source of pain. MR imaging is also valuable for treatment planning in patients with known osteoarthritis, providing an accurate assessment of the degree and extent of disease. Following treatment, MR imaging is capable of evaluating complications and/or re-injury in individuals with persistent or recurrent pain 1-3.
Clinical MR imaging sequences for evaluation of musculoskeletal tissues should be optimized to provide high spatial resolution and appropriate tissue contrast within a clinically feasible scan time. This typically includes some type of fluid sensitive fat suppressed sequence (e.g. inversion recovery, Dixon, T2 fat sat), and well as morphologic sequences, often proton density weighted fast spin echo images, tailored for depiction of musculoskeletal tissues and pathology, and in particular, for depiction of chondral morphology and stratification. More advanced imaging techniques can be added to routine clinical imaging protocols in order to assess for specific types of pathology. For example, parametric cartilage mapping sequences may be added for sensitive assessment of early chondral matrix depletion, while desired evaluation of osseous morphology may warrant the addition of sequencing for depiction of cortical bone, such as zero echo time imaging 2-4. The presence of metallic instrumentation may require acquisition parameter modifications as well as advanced metal imaging sequences such as MAVRIC (multiacquisition variable resonance image combination) 5. Ultimately, imaging protocols should be tailored for each individual, in terms of both clinical and surgical history, and suspected pathology.
Conclusions
Magnetic resonance imaging is capable of providing valuable information regarding all stages in the natural history of osteoarthritis, including risk factors, disease severity and extent, and treatment follow up and complications. Routine clinical imaging algorithms should be optimized for evaluation of musculoskeletal tissues, with parameter modifications as necessary. Advanced imaging sequences may be added as warranted in order to augment evaluation of specific aspects of joint morphology and suspected pathology.
References
1. Arthritis By the Numbers. 2018. https://www.arthritis.org/Documents/Sections/About-Arthritis/arthritis-facts-stats-figures.pdf. Accessed 3/14/19.
2. Crema MD, Watts GJ, Guermazi A, Kim YJ, Kijowski R, Roemer FW. A narrative overview of the current status of MRI of the hip and its relevance for osteoarthritis research - what we know, what has changed and where are we going? Osteoarthritis Cartilage. 2017;25(1):1-13.
3. Nieminen MT, Casula V, Nevalainen MT, Saarakkala S. Osteoarthritis year in review 2018: imaging. Osteoarthritis Cartilage. 2019;27(3):401-411.
4. Argentieri EC, Burge AJ, Potter HG. Magnetic Resonance Imaging of Articular Cartilage within the Knee. The journal of knee surgery. 2018;31(2):155-165.
5. Koch KM, Hargreaves BA, Pauly KB, Chen W, Gold GE, King KF. Magnetic resonance imaging near metal implants. Journal of magnetic resonance imaging : JMRI. 2010;32(4):773-787.